1
|
Saadat S, Beigoli S, Khazdair MR, Amin F, Boskabady MH. Experimental and Clinical Studies on the Effects of Natural Products on Noxious Agents-Induced Lung Disorders, a Review. Front Nutr 2022; 9:867914. [PMID: 35662950 PMCID: PMC9158561 DOI: 10.3389/fnut.2022.867914] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 03/16/2022] [Indexed: 12/27/2022] Open
Abstract
The harmful effects of various noxious agents (NA) are well-known and there are reports regarding the induction of various lung disorders due to exposure to these agents both in animal and human studies. In addition, various studies have shown the effects of natural products (NP) on NA-induced lung disorders. The effects of various NP, including medicinal plants and their derivatives, on lung injury induced by NA, were reviewed in this study. The improving effects of various NP including medicinal plants, such as Aloe vera, Anemarrhena asphodeloides, Avena sativa, Crocus sativus, Curcuma longa, Dioscorea batatas, Glycyrrhiza glabra, Gentiana veitchiorum, Gentiopicroside, Houttuynia cordata, Hibiscus sabdariffa, Hochu-ekki-to, Hippophae rhamnoides, Juglans regia, Melanocarpa fruit juice, Mikania glomerata, Mikania laevigata, Moringa oleifera, Myrtus communis L., Lamiaceae, Myrtle, Mosla scabra leaves, Nectandra leucantha, Nigella sativa, Origanum vulgare L, Pulicaria petiolaris, Paulownia tomentosa, Pomegranate seed oil, Raphanus sativus L. var niger, Rosa canina, Schizonepeta tenuifolia, Thymus vulgaris, Taraxacum mongolicum, Tribulus Terrestris, Telfairia occidentalis, Taraxacum officinale, TADIOS, Xuebijing, Viola yedoensis, Zataria multiflora, Zingiber officinale, Yin-Chiao-San, and their derivatives, on lung injury induced by NA were shown by their effects on lung inflammatory cells and mediators, oxidative stress markers, immune responses, and pathological changes in the experimental studies. Some clinical studies also showed the therapeutic effects of NP on respiratory symptoms, pulmonary function tests (PFT), and inflammatory markers. Therefore, the results of this study showed the possible therapeutic effects of various NP on NA-induced lung disorders by the amelioration of various features of lung injury. However, further clinical studies are needed to support the therapeutic effects of NP on NA-induced lung disorders for clinical practice purposes.
Collapse
Affiliation(s)
- Saeideh Saadat
- Applied Biomedical Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
- Department of Physiology, School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Sima Beigoli
- Applied Biomedical Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohammad Reza Khazdair
- Cardiovascular Diseases Research Center, Birjand University of Medical Sciences, Birjand, Iran
| | - Fatemeh Amin
- Physiology-Pharmacology Research Center, Research Institute of Basic Medical Sciences, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
- Department of Physiology and Pharmacology, School of Medicine, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Mohammad Hossein Boskabady
- Applied Biomedical Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
- Department of Physiology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
- *Correspondence: Mohammad Hossein Boskabady ;
| |
Collapse
|
2
|
Eddleston M, Nagami H, Lin CY, Davis ML, Chang SS. Pesticide use, agricultural outputs, and pesticide poisoning deaths in Japan. Clin Toxicol (Phila) 2022; 60:933-941. [PMID: 35475715 DOI: 10.1080/15563650.2022.2064868] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Although pesticide poisonings occur worldwide, most high-income countries have not been severely affected. Japan is a key exception, with pesticide suicides becoming a major public health concern in the 1980s. We here report the epidemiology of lethal pesticide poisoning in Japan in relation to its pesticide regulation and agricultural output. METHODS We obtained data on pesticide registration and sales from the Japan Plant Protection Association's annual Pesticide Handbook, National Food and Agricultural Materials Inspection Center, and Food and Agriculture Organization of the United Nations. Data on deaths due to pesticide poisoning and population were obtained from Vital Statistics of Japan. We reviewed the registration status and hazard classification of pesticides in Japan and analysed the relationships between the use/sales, pesticides fatalities, and agricultural output. RESULTS Five hundred and twenty-nine pesticide active ingredients are currently registered in Japan, including four WHO hazard class IB organophosphorus and carbamate insecticides. Paraquat was registered in 1962 as a liquid SL20 formulation. In 1986, restrictions were imposed on its sale/use and a 4.3% paraquat ion/4.1% diquat ion combination product registered by ICI. There were 221 pesticide poisoning fatalities in 2019, down from 2648 in 1986, a 92% reduction over 33 years. Self-poisoning was responsible for most pesticide deaths in both 1985 (2013/2476, 81.3%) and 2019 (146/221, 66.1%). Pesticide poisoning made up 8.6% of all suicides in 1985, down to 0.7% in 2019. Unintentional pesticide poisoning deaths also all fell by 83.8%, from 463 to 75. These reductions were associated with reduced sales of both OP/carbamate insecticides and paraquat/diquat but no apparent change in agricultural output across a broad range of crops. CONCLUSIONS Reduced use of highly hazardous pesticides and lowered concentration formulations in Japan were associated with major decreases in all deaths from pesticide poisoning and the proportion of all suicides due to pesticide ingestion.
Collapse
Affiliation(s)
- Michael Eddleston
- Centre for Pesticide Suicide Prevention, and Pharmacology, Toxicology & Therapeutics, University/BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Hiroshi Nagami
- Institute for Prevention of Pesticide Adverse Effects on Human, Yamatokohriyama, Japan
| | - Chien-Yu Lin
- Institute of Health Behaviors and Community Sciences, and Global Health Program, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Mark L Davis
- Centre for Pesticide Suicide Prevention, and Pharmacology, Toxicology & Therapeutics, University/BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Shu-Sen Chang
- Institute of Health Behaviors and Community Sciences, and Global Health Program, College of Public Health, National Taiwan University, Taipei, Taiwan.,Psychiatric Research Center, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| |
Collapse
|
3
|
Chen CK, Chen YC, Mégarbane B, Yeh YT, Chaou CH, Chang CH, Lin CC. The acute paraquat poisoning mortality (APPM) score to predict the risk of death in paraquat-poisoned patients. Clin Toxicol (Phila) 2021; 60:446-450. [PMID: 34543159 DOI: 10.1080/15563650.2021.1979234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
CONTEXT Mortality prediction in paraquat poisoning is a major issue since most prediction rules are inapplicable if the exact ingestion time cannot be determined and/or the serum paraquat concentration is not readily available, as in most countries. Therefore, we aimed to develop and validate a new prediction rule not requiring these two parameters. METHODS We designed a 10-year observational cohort study including all consecutive paraquat-poisoned patients managed in two Taiwanese hospitals. We built one cohort to define and one cohort to validate this prediction rule. Parameters independently related to mortality determined using a multivariate analysis were used to formulate the Acute Paraquat Poisoning Mortality (APPM) score. RESULTS Overall, 321 paraquat-poisoned patients were included, 156 in the derivation and 165 in the validation cohort. Mortality rates in the derivation and validation cohorts were 73% and 81%, respectively (p = 0.20). The three parameters chosen of 28-day mortality at presentation were urine paraquat level >10 ppm (using a colorimetric sodium dithionite-based test; odds ratio (OR), 12.70; 95% confidence interval (CI), 2.64-61.24), white blood cells >13.0 G/L (OR, 5.50; CI, 1.41-21.48) and blood glucose >140 mg/dL [7.8 mmol/L] (OR, 7.45; CI, 1.70-32.86). In the derivation cohort, the area under the ROC curve (AUC-ROC) of the APPM score did not significantly differ from AUC-ROCs of serum paraquat (0.95, p = 0.25) and the Severity Index of Paraquat Poisoning (0.95, p = 0.33). AUC-ROCs of the APPM score in the derivation and validation cohorts were 0.91 and 0.94, respectively. CONCLUSION We built and validated a reliable score to predict 28-day mortality in paraquat-poisoned patients at presentation, independently from the ingestion time and serum paraquat measurement.
Collapse
Affiliation(s)
- Chun-Kuei Chen
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Medical and Toxicological Critical Care, Lariboisière Hospital, AP-HP, Paris University, Paris, France
| | - Yen-Chia Chen
- Department of Emergency medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Emergency Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Bruno Mégarbane
- Department of Medical and Toxicological Critical Care, Lariboisière Hospital, AP-HP, Paris University, Paris, France
| | - Ying-Tse Yeh
- Department of Emergency Medicine, Taipei Veterans General Hospital, Yuli branch, Taiwan
| | - Chung-Hsien Chaou
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chia-Hsun Chang
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chih-Chuan Lin
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| |
Collapse
|
4
|
Sequential organ failure assessment in predicting mortality after paraquat poisoning: A meta-analysis. PLoS One 2018; 13:e0207725. [PMID: 30444919 PMCID: PMC6239328 DOI: 10.1371/journal.pone.0207725] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2018] [Accepted: 11/05/2018] [Indexed: 12/26/2022] Open
Abstract
Sequential organ failure assessment (SOFA) score is commonly used to determine disease severity and predict prognosis in critically ill patients. However, the prognostic value of SOFA after acute paraquat (PQ) poisoning remains unclear. This meta-analysis aimed to study the capability of SOFA to predict mortality in patients with PQ poisoning. Databases that included PubMed, Embase, Web of Science, ScienceDirect, Embase, and Cochrane Library were searched through May 2018. Six studies involving 946 patients were included in the meta-analysis. Study-specific odds ratios (ORs) and 95% confidence intervals (CIs) were calculated, and then ORs with 95% CIs were pooled for the estimation of the prognostic role of SOFA in patients with PQ poisoning. Results showed that higher SOFA in patients with PQ poisoning was related to severe mortality (OR = 8.14, 95%CI 4.26–15.58, p<0.001). The pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic OR, and area under the curve were 72% (95%CI 0.65–0.79), 75% (95%CI 0.65–0.83), 2.9 (95%CI 2.0–4.1), 0.37 (95%CI 0.28–0.41), 8 (95%CI 4–14), and 0.79 (95%CI 0.76–0.83), respectively. No evidence of publication bias was detected by funnel plot analysis and formal statistical tests. Sensitivity analyses showed no important differences in the estimates of effects. The high SOFA score (8.1-fold) was associated with severe mortality in patients with PQ poisoning.
Collapse
|
5
|
Liu S, Wang Q, Zhou R, Li C, Hu D, Xue W, Wu T, Mohan C, Peng A. Hyperamylasemia as an Early Predictor of Mortality in Patients with Acute Paraquat Poisoning. Med Sci Monit 2016; 22:1342-8. [PMID: 27101346 PMCID: PMC4844273 DOI: 10.12659/msm.897930] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Background Paraquat (PQ) is a non-selective and fast-acting contact herbicide which has been widely used in developing countries. Hyperamylasemia was reported in patients with PQ poisoning. This study investigated the predictive value and clinical characteristics of hyperamylasemia in patients with PQ poisoning. Material/Methods This study included 87 patients with acute PQ poisoning admitted from July 2012 to May 2015. Data were collected from medical records. Receiver operating characteristic (ROC) analysis was conducted to analyze the discriminatory potential of serum amylase with respect to 90-day mortality. Results Of 87 patients, 29 patients had elevated serum amylase. We found that serum amylase was significantly higher among patients with AKI than those with non-AKI (p<0.001), and was an independent predictor of mortality (hazard ratio [HR]=3.644; 95% [CI], 1.684–7.881; p=0.001). The area under the ROC curve for the serum amylase (area under curve [AUC]=0.796; 95% [CI], 0.690–0.903) had a better discriminatory potential than plasma PQ concentration (0.698;0.570–0.825) or urinary PQ concentration (0.647;0.514–0.781) in predicting 90-day mortality. Conclusions Hyperamylasemia is a valuable early predictor of 90-day mortality in PQ poisoning.
Collapse
Affiliation(s)
- Shuai Liu
- Department of Nephrology & Rheumatology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China (mainland)
| | - Qiang Wang
- Department of Nephrology & Rheumatology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China (mainland)
| | - Rong Zhou
- Department of Nephrology, Shanghai Yangpu Hospital, Tongji University School of Medicine, Shanghai, China (mainland)
| | - Changbin Li
- Department of Nephrology & Rheumatology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China (mainland)
| | - Dayong Hu
- Department of Nephrology & Rheumatology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China (mainland)
| | - Wen Xue
- Department of Nephrology & Rheumatology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China (mainland)
| | - Tianfu Wu
- Department of Nephrology, Shanghai Yangpu Hospital, Tongji University School of Medicine, Shanghai, China (mainland)
| | - Chandra Mohan
- Department of Nephrology & Rheumatology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China (mainland)
| | - Ai Peng
- Department of Nephrology & Rheumatology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China (mainland)
| |
Collapse
|
6
|
Sun IO, Shin SH, Yoon HJ, Lee KY. Predicting the probability of survival in acute paraquat poisoning. Kidney Res Clin Pract 2016; 35:102-6. [PMID: 27366665 PMCID: PMC4919560 DOI: 10.1016/j.krcp.2016.01.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Revised: 01/24/2016] [Accepted: 01/31/2016] [Indexed: 10/24/2022] Open
Abstract
BACKGROUND Paraquat (PQ) concentration-time data have been used to predict prognosis for 3 decades. The aim of this study was to find a more accurate method to predict the probability of survival. METHODS This study included 788 patients with PQ poisoning who were diagnosed using plasma PQ concentration between January 2005 and August 2012. We divided these patients into 2 groups (survivors vs. nonsurvivors), compared their clinical characteristics, and analyzed the predictors of survival. RESULTS The mean age of the included patients was 57 years (range, 14-95 years). When we compared clinical characteristics between survivors (n = 149, 19%) and nonsurvivors (n = 639, 81%), survivors were younger (47 ± 14 years vs. 59 ± 16 years) and had lower plasma PQ concentrations (1.44 ± 8.77 μg/mL vs. 80.33 ± 123.15 μg/mL) than nonsurvivors. On admission, serum creatinine was lower in survivors than in nonsurvivors (0.95 ± 0.91 mg/dL vs. 1.88 ± 1.27 mg/dL). In multivariate logistic regression analysis, age and logarithmically converted serum creatinine [ln(Cr)], [ln(time)], and [ln(PQ)] were assessed as prognostic factors to predict survival in PQ poisoning. The predicted probability of survival using significant prognostic factors was exp (logit)/[1 + exp(logit)], where logit = -1.347 + [0.212 × sex (male = 1, female = 0)] + (0.032 × age) + [1.551 × ln(Cr)] + [0.391 × ln(hours since ingestion)] + [1.076 × ln(plasma PQ μg/mL)]. With this equation, the sensitivity and specificity were 86.5% and 98.7%, respectively. CONCLUSION Age, ln(Cr), ln(time), and ln(PQ) were important prognostic factors in PQ poisoning, and our equation can be helpful to predict the survival in acute PQ poisoning patients.
Collapse
Affiliation(s)
- In O Sun
- Division of Nephrology & Toxicology, Department of Internal Medicine, Presbyterian Medical Center, Jeonju, Korea
| | - Sung Hye Shin
- Department of Biochemistry, Christian Medical Research Center, Jeonju, Korea
| | - Hyun Ju Yoon
- Division of Nephrology & Toxicology, Department of Internal Medicine, Presbyterian Medical Center, Jeonju, Korea
| | - Kwang Young Lee
- Division of Nephrology & Toxicology, Department of Internal Medicine, Presbyterian Medical Center, Jeonju, Korea; Department of Biochemistry, Christian Medical Research Center, Jeonju, Korea
| |
Collapse
|
7
|
Abnormal pancreatic enzymes and their prognostic role after acute paraquat poisoning. Sci Rep 2015; 5:17299. [PMID: 26603772 PMCID: PMC4658566 DOI: 10.1038/srep17299] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Accepted: 10/26/2015] [Indexed: 02/07/2023] Open
Abstract
Ingestion of paraquat causes multi-organ failure. Prognosis is best estimated through
measurement of blood paraquat concentrations but this facility is not available in
most hospitals. We studied the prognostic significance of abnormal pancreatic
enzymes for survival. Patients with acute paraquat poisoning were recruited. An
extensive series of blood tests including serum amylase were serially checked.
Patients were sorted according to their serum amylase activity (normal
[<220 U/L], mildly elevated [220 to 660 U/L],
elevated [>660 U/L]), and survival compared between groups. 177
patients were enrolled to the study, of whom 67 died and 110 survived. 122 (70.62%),
27 (15.25%) and 25 (14.13%) patients were in the normal, mildly elevated and
elevated amylase activity groups, respectively. The case fatality in the elevated
group was 100% compared to 17% in the normal group
(P < 0.001). We found four independent factors for
paraquat death prediction: amylase, PaCO2, leukocyte number, and
neutrophil percentage. Models using pancreatic enzyme activity showed good
prediction power. We have found that abnormal pancreatic enzymes are useful
prognostic marker of death after acute paraquat poisoning. Including serum amylase
activity into a prognostic model provides a good prognostication.
Collapse
|
8
|
The volume ratio of ground glass opacity in early lung CT predicts mortality in acute paraquat poisoning. PLoS One 2015; 10:e0121691. [PMID: 25830638 PMCID: PMC4382148 DOI: 10.1371/journal.pone.0121691] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2014] [Accepted: 02/14/2015] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Pulmonary injury is the main cause of death in acute paraquat (PQ) poisoning. However, whether quantitative lung computed tomography (CT) can be useful in predicting the outcome of PQ poisoning remains unknown. We aimed to identify early findings of quantitative lung CT as predictors of outcome in acute PQ poisoning. METHODS Lung CT scanning (64-slide) and quantitative CT lesions were prospectively measured for patients after PQ intoxication within 5 days. The study outcome was mortality during 90 days follow-up. Survival curves were derived by the Kaplan-Meier method, and mortality risk factors were analyzed by the forward stepwise Cox regression analysis. RESULTS Of 97 patients, 41 (42.3%) died. Among the eight different types of lung CT findings which appeared in the first 5-day of PQ intoxication, four ones discriminated between survivors and non-survivors including ground glass opacity (GGO), consolidation, pneumomediastinum and "no obvious lesion". With a cutoff value of 10.8%, sensitivity of 85.4% and specificity of 89.3%, GGO volume ratio is better than adopted outcome indicators in predicting mortality, such as estimated amount of PQ ingestion, plasma or urine PQ concentration, acute physiology and chronic health evaluation (APACHE) II and sequential organ failure assessment (SOFA) scores. GGO volume ratios above 10.8% were associated with increased mortality (hazard ratio, 5.82; 95% confidence interval, 4.77-7.09; P < 0.001). CONCLUSIONS The volume ratio of GGO exceeding 10.8% is a novel, reliable and independent predictors of outcome in acute PQ poisoning.
Collapse
|
9
|
Weng CH, Hu CC, Lin JL, Lin-Tan DT, Huang WH, Hsu CW, Yen TH. Sequential organ failure assessment score can predict mortality in patients with paraquat intoxication. PLoS One 2012; 7:e51743. [PMID: 23272154 PMCID: PMC3522704 DOI: 10.1371/journal.pone.0051743] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2012] [Accepted: 11/05/2012] [Indexed: 11/21/2022] Open
Abstract
Introduction Paraquat poisoning is characterized by multi-organ failure and pulmonary fibrosis with respiratory failure, resulting in high mortality and morbidity. The objective of this study was to identify predictors of mortality in cases of paraquat poisoning. Furthermore, we sought to determine the association between these parameters. Methods A total of 187 patients were referred for management of intentional paraquat ingestion between January 2000 and December 2010. Demographic, clinical, and laboratory data were recorded. Sequential organ failure assessment (SOFA) and acute kidney injury network (AKIN) scores were collected, and predictors of mortality were analyzed. Results Overall hospital mortality for the entire population was 54% (101/187). Using a multivariate logistic regression model, it was found that age, time to hospitalization, blood paraquat level, estimated glomerular filtration rate at admission (eGFR first day), and the SOFA48-h score, but not the AKIN48-h score, were significant predictors of mortality. For predicting the in-hospital mortality, SOFA48-h scores displayed a good area under the receiver operating characteristic curve (AUROC) (0.795±0.033, P<0.001). The cumulative survival rate differed significantly between patients with SOFA48-h scores <3 and those ≥3 (P<0.001). A modified SOFA (mSOFA) score was further developed by using the blood paraquat level, and this new score also demonstrated a better AUROC (0.848±0.029, P<0.001) than the original SOFA score. Finally, the cumulative survival rate also differed significantly between patients with mSOFA scores <4 and ≥4 (P<0.001). Conclusion The analytical data demonstrate that SOFA and mSOFA scores, which are based on the extent of organ function or rate of organ failure, help to predict mortality after intentional paraquat poisoning.
Collapse
Affiliation(s)
- Cheng-Hao Weng
- Department of Nephrology, Chang Gung Memorial Hospital, Linkou Medical Center, Taipei, Taiwan
- Chang Gung University, College of Medicine, Taoyuan, Taiwan
| | - Ching-Chih Hu
- Department of Hepatogastroenterology and Liver Research Unit, Chang Gung Memorial Hospital, Keelung, Taiwan
- Chang Gung University, College of Medicine, Taoyuan, Taiwan
| | - Ja-Liang Lin
- Department of Nephrology, Chang Gung Memorial Hospital, Linkou Medical Center, Taipei, Taiwan
- Chang Gung University, College of Medicine, Taoyuan, Taiwan
| | - Dan-Tzu Lin-Tan
- Department of Nephrology, Chang Gung Memorial Hospital, Linkou Medical Center, Taipei, Taiwan
- Chang Gung University, College of Medicine, Taoyuan, Taiwan
| | - Wen-Hung Huang
- Department of Nephrology, Chang Gung Memorial Hospital, Linkou Medical Center, Taipei, Taiwan
- Chang Gung University, College of Medicine, Taoyuan, Taiwan
| | - Ching-Wei Hsu
- Department of Nephrology, Chang Gung Memorial Hospital, Linkou Medical Center, Taipei, Taiwan
- Chang Gung University, College of Medicine, Taoyuan, Taiwan
| | - Tzung-Hai Yen
- Department of Nephrology, Chang Gung Memorial Hospital, Linkou Medical Center, Taipei, Taiwan
- Chang Gung University, College of Medicine, Taoyuan, Taiwan
- * E-mail:
| |
Collapse
|
10
|
Seok S, Kim YH, Gil HW, Song HY, Hong SY. The time between paraquat ingestion and a negative dithionite urine test in an independent risk factor for death and organ failure in acute paraquat intoxication. J Korean Med Sci 2012; 27:993-8. [PMID: 22969243 PMCID: PMC3429840 DOI: 10.3346/jkms.2012.27.9.993] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2011] [Accepted: 06/07/2012] [Indexed: 11/20/2022] Open
Abstract
To identify a prognostic marker that is less sensitive to variations in the elapsed time since paraquat ingestion, we assessed the time between paraquat ingestion and a negative dithionite urine test as a prognostic parameter in patients with acute paraquat intoxication. Forty-one patients with acute paraquat intoxication were enrolled in this study and analyzed to verify significant determinants of mortality and organ dysfunction. The amount of paraquat ingested, paraquat plasma levels, and the time to a negative urine dithionite test were significant independent risk factors predicting mortality. The amount of paraquat ingestion, and the time to a negative urine dithionite test were independent risk factors predicting organ dysfunction. With a cut-off value of 34.5 hr for the time to negative conversion of the urine dithionite test, the sensitivity and specificity for mortality were 71.4% and 75.0%, respectively. The incidence of acute kidney injury and respiratory failure above 34.5 hr were 100% and 85.0%, respectively. In conclusion, the time to a negative urine dithionite test is the reliable marker for predicting mortality and/or essential organ failure in patients with acute paraquat intoxication, who survive 72 hr.
Collapse
Affiliation(s)
- Sujin Seok
- Department of Internal Medicine, Soonchunhyang University College of Medicine, Cheonan, Korea
| | - Young-hee Kim
- Department of Immunology, Soonchunhyang University College of Medicine, Cheonan, Korea
| | - Hyo-wook Gil
- Department of Internal Medicine, Soonchunhyang University College of Medicine, Cheonan, Korea
| | - Ho-yeon Song
- Department of Immunology, Soonchunhyang University College of Medicine, Cheonan, Korea
| | - Sae-yong Hong
- Department of Internal Medicine, Soonchunhyang University College of Medicine, Cheonan, Korea
| |
Collapse
|
11
|
Lee Y, Lee JH, Seong AJ, Hong CK, Lee HJ, Shin DH, Hwang SY. Arterial lactate as a predictor of mortality in emergency department patients with paraquat intoxication. Clin Toxicol (Phila) 2011; 50:52-6. [DOI: 10.3109/15563650.2011.639716] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
12
|
Huang C, Zhang X. Prognostic significance of arterial blood gas analysis in the early evaluation of Paraquat poisoning patients. Clin Toxicol (Phila) 2011; 49:734-8. [DOI: 10.3109/15563650.2011.607459] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
13
|
Rapid analysis of plasma paraquat using sodium dithionite as a predictor of outcome in acute paraquat poisoning. Am J Med Sci 2009; 338:373-7. [PMID: 19826241 DOI: 10.1097/maj.0b013e3181b4deee] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Paraquat poisoning can be lethal, and aggressive treatments might have little or no effect on severely poisoned patients. Accordingly, a convenient prognostic test is necessary to guide therapy for acute paraquat poisoning. Sodium dithionite reduces paraquat to a blue radical form in alkaline plasma with a paraquat detection sensitivity of 2.0 mg/L, which is a 100% lethal concentration at 10 to 12 hours postingestion. The prognostic utility of this simple reaction was examined prospectively. METHODS Of 233 paraquat-poisoned patients, who were taken to the hospital within 12 hours after ingestion, the plasma samples obtained on arrival were tested using the sodium dithionite reaction. Standard saline containing 2.0 mg/L paraquat was used as the positive control. The test result was interpreted as being positive when the plasma test yielded a blue color darker than that of the positive control. The effects of aggressive treatment, including cyclophosphamide pulse and continuous venovenous hemofiltration, were evaluated retrospectively. RESULTS The discharge survival rate was 41.6% (97 of 233). Ninety-seven of 142 patients with negative or equivocal plasma dithionite test survived. However, all 91 patients with positive plasma dithionite test died of multiorgan failure. Cyclophosphamide and/or continuous venovenous hemofiltration could not improve survival. CONCLUSIONS In this single-center study, a positive plasma dithionite test was associated with 100% mortality, despite aggressive treatment. In contrast, negative or equivocal tests were associated with a 68% survival rate. It is believed that after further verification, this test can be used to guide therapy and predict the outcomes of patients suffering acute paraquat poisoning.
Collapse
|
14
|
Hypokalemia and hypothermia are associated with 30-day mortality in patients with acute paraquat poisoning. Am J Med Sci 2008; 335:451-6. [PMID: 18552575 DOI: 10.1097/maj.0b013e318157cb6d] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Clinical predictors associated with acute paraquat (PQ) poisoning have not been systematically studied. OBJECTIVE To identify independent predictors of death in patients with acute PQ poisoning. METHODS This is a retrospective study executed in the emergency department of a university hospital. One hundred three consecutive patients poisoned with PQ between January 1999 and December 2004 were enrolled. Urine PQ concentration, electrolyte and renal function, detailed history, and Acute Physiology and Chronic Health Evaluation II were extracted from medical records. The outcome measure was 30-day mortality. Multivariate analysis was done by Cox-proportional hazard regression model. Receiver operating characteristics area under the curve was calculated for selected predictors. RESULTS The crude 30-day mortality was 67.9% (70 of 103). Independent predictors of death were acute renal failure (hazard ratio, 3.53; 95% confidence interval, 1.97-6.32), hypokalemia (2.07, 1.21-3.51), hypothermia (2.91, 1.67-5.07), suicide (2.11, 1.04-4.29), and self-reported ingested dose (2.06, 1.38-3.06). The receiver operating characteristics area under the curve of serum potassium concentrations, maximal urine PQ concentrations, and Acute Physiology and Chronic Health Evaluation II scores were 0.75 (95% confidence interval, 0.60-0.81), 0.71 (0.66-0.84), and 0.80 (0.71-0.88), respectively. Under the cutoff value of 3.6 mEq/L, hypokalemia had a sensitivity of 75% and specificity of 54% in predicting mortality. CONCLUSION The identified risk factors may allow better identification of those at greater mortality risk. Future development of a tailored clinical scoring system incorporating the identified risk factors for acute PQ poisoning may be of great help.
Collapse
|
15
|
Dinis-Oliveira RJ, Duarte JA, Sánchez-Navarro A, Remião F, Bastos ML, Carvalho F. Paraquat poisonings: mechanisms of lung toxicity, clinical features, and treatment. Crit Rev Toxicol 2008; 38:13-71. [PMID: 18161502 DOI: 10.1080/10408440701669959] [Citation(s) in RCA: 546] [Impact Index Per Article: 34.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Paraquat dichloride (methyl viologen; PQ) is an effective and widely used herbicide that has a proven safety record when appropriately applied to eliminate weeds. However, over the last decades, there have been numerous fatalities, mainly caused by accidental or voluntary ingestion. PQ poisoning is an extremely frustrating condition to manage clinically, due to the elevated morbidity and mortality observed so far and due to the lack of effective treatments to be used in humans. PQ mainly accumulates in the lung (pulmonary concentrations can be 6 to 10 times higher than those in the plasma), where it is retained even when blood levels start to decrease. The pulmonary effects can be explained by the participation of the polyamine transport system abundantly expressed in the membrane of alveolar cells type I, II, and Clara cells. Further downstream at the toxicodynamic level, the main molecular mechanism of PQ toxicity is based on redox cycling and intracellular oxidative stress generation. With this review we aimed to collect and describe the most pertinent and significant findings published in established scientific publications since the discovery of PQ, focusing on the most recent developments related to PQ lung toxicity and their relevance to the treatment of human poisonings. Considerable space is also dedicated to techniques for prognosis prediction, since these could allow development of rigorous clinical protocols that may produce comparable data for the evaluation of proposed therapies.
Collapse
Affiliation(s)
- R J Dinis-Oliveira
- REQUIMTE, Departamento de Toxicologia, Faculdade de Farmácia, Universidade do Porto, Porto, Portugal.
| | | | | | | | | | | |
Collapse
|
16
|
Huh JW, Jegal Y, Hong SB, Oh YM, Shim TS, Lim CM, Lee SD, Kim WS, Kim DS, Kim WD, Koh Y. Efficacy of deferoxamine on paraquat poisoning. Tuberc Respir Dis (Seoul) 2007. [DOI: 10.4046/trd.2007.62.2.113] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Jin Won Huh
- Department of Internal Medicine Inje University, Korea
| | - Yangjin Jegal
- Department of Internal Medicine University of Ulsan, Korea
| | - Sang-Bum Hong
- Division of Pulmonary and Critical Care Medicine, Asan Medical Center University of Ulsan College of Medicine, Seoul, Korea
| | - Yeon Mok Oh
- Division of Pulmonary and Critical Care Medicine, Asan Medical Center University of Ulsan College of Medicine, Seoul, Korea
| | - Tae Sun Shim
- Division of Pulmonary and Critical Care Medicine, Asan Medical Center University of Ulsan College of Medicine, Seoul, Korea
| | - Chae-Man Lim
- Division of Pulmonary and Critical Care Medicine, Asan Medical Center University of Ulsan College of Medicine, Seoul, Korea
| | - Sang Do Lee
- Division of Pulmonary and Critical Care Medicine, Asan Medical Center University of Ulsan College of Medicine, Seoul, Korea
| | - Woo Sung Kim
- Division of Pulmonary and Critical Care Medicine, Asan Medical Center University of Ulsan College of Medicine, Seoul, Korea
| | - Dong Soon Kim
- Division of Pulmonary and Critical Care Medicine, Asan Medical Center University of Ulsan College of Medicine, Seoul, Korea
| | - Won Dong Kim
- Division of Pulmonary and Critical Care Medicine, Asan Medical Center University of Ulsan College of Medicine, Seoul, Korea
| | - Younsuck Koh
- Division of Pulmonary and Critical Care Medicine, Asan Medical Center University of Ulsan College of Medicine, Seoul, Korea
| |
Collapse
|
17
|
Hantson P, Weynand B, Doyle I, Bernand A, Hermans C. Pneumoproteins as markers of paraquat lung injury: a clinical case. J Forensic Leg Med 2006; 15:48-52. [PMID: 17174135 DOI: 10.1016/j.jcfm.2006.09.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2006] [Accepted: 09/27/2006] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To describe the changes in lung-specific secretory proteins in biological fluids in a fatal case of paraquat ingestion and to present immunostaining data obtained on postmortem lung tissue specimens. METHODS A 20-year-old man committed suicide by ingesting 100ml of a 20% paraquat solution. Surfactant associated proteins A (SP-A), B (SP-B) and Clara cell 16kDa protein (CC16) were determined in the serum and on broncho-alveloar lavage performed 18h after admission. Renal failure progressed rapidly and the patient died from refractory hypoxia. Immunostaining studies using antibodies directed against CC16, SP-A and SP-B were performed on postmortem lung tissue specimens. RESULTS Serum CC16 seemed to increase gradually with the progression of renal impairment. Serum SP-A and SP-B levels increased before any significant changes in pulmonary gas exchanges. The immunostaining study showed that the labeling for SP-A and SP-B was reduced or absent following paraquat toxicity, while Clara cells were relatively preserved. CONCLUSIONS The elevation of serum CC16 with paraquat toxicity is probably mainly related to a reduced renal clearance. The increase of serum SP-A and SP-B could reflect an increased lung to blood leakage, independently of the alteration of the renal function.
Collapse
Affiliation(s)
- Philippe Hantson
- Cliniques St Luc, Department of Intensive Care, Avenue Hippocrate 10, 1200 Brussels, Belgium.
| | | | | | | | | |
Collapse
|
18
|
Szymanowicz A, Danel V. Bio marqueurs de toxicité dans les principales intoxications graves. ACTA ACUST UNITED AC 2005. [DOI: 10.1016/j.immbio.2005.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
19
|
Eddleston M, Wilks MF, Buckley NA. Prospects for treatment of paraquat-induced lung fibrosis with immunosuppressive drugs and the need for better prediction of outcome: a systematic review. QJM 2003; 96:809-24. [PMID: 14566036 PMCID: PMC1948029 DOI: 10.1093/qjmed/hcg137] [Citation(s) in RCA: 88] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Acute paraquat self-poisoning is a significant problem in parts of Asia, the Pacific and the Caribbean. Ingestion of large amounts of paraquat results in rapid death, but smaller doses often cause a delayed lung fibrosis that is usually fatal. Anti-neutrophil ('immunosuppressive') treatment has been recommended to prevent lung fibrosis, but there is no consensus on efficacy. AIM To review the evidence for the use of immunosuppression in paraquat poisoning, and to identify validated prognostic systems that would allow the use of data from historical control studies and the future identification of patients who might benefit from immunosuppression. DESIGN Systematic review. METHODS We searched PubMed, Embase and Cochrane databases for 'paraquat' together with 'poisoning' or 'overdose'. We cross-checked references and contacted experts, and searched on [www.google.com] and [www.yahoo.com] using 'paraquat', 'cyclophosphamide', 'methylprednisolone' and 'prognosis'. RESULTS We found ten clinical studies of immunosuppression in paraquat poisoning. One was a randomized controlled trial (RCT). Seven used historical controls only; the other two were small (n = 1 and n = 4). Mortality in controls and patients varied markedly between studies. Three of the seven non-RCT controlled studies measured plasma paraquat; analysis using Proudfoot's or Hart's nomograms did not suggest that immunosuppression increased survival in these studies. Of 16 prognostic systems for paraquat poisoning, none has been independently validated in a large cohort. DISCUSSION The authors of the RCT have performed valuable and difficult research, but their results are hypothesis-forming rather than conclusive; elsewhere, the use of historical controls is problematic. In the absence of a validated prognostic marker, a large RCT of immunosuppression using death as the primary outcome is required. This RCT should also prospectively test and validate the available prognostic methods, so that future patients can be selected for this and other therapies on admission.
Collapse
Affiliation(s)
- M Eddleston
- Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, UK.
| | | | | |
Collapse
|
20
|
Abstract
Acute paraquat poisoning is often fatal. Many studies have investigated successful treatment modalities, but no standard treatment yet exists. The purpose of this study was to determine the predictors of survival after acute paraquat poisoning in 602 patients. The paraquat exposure was assessed based on the amount of ingested paraquat and a semiquantitative measure of the urine level of paraquat. Initial clinical parameters including vital signs, hemoglobin, white-blood-cell count, pH, PaCO2, PaO2, blood urea nitrogen, creatinine, aspartate aminotransferase, alanine aminotransferase, total bilirubin, amylase, and glucose were obtained at the time of arrival at the emergency room. Outcomes after acute paraquat poisoning were categorized as survivors and nonsurvivors. Multiple logistic regression analysis was applied to assess the predictors of survival after acute paraquat poisoning. Some patients (55.5%) survived after oral ingestion of paraquat, whereas all those exposed to paraquat percutaneous or inhalational route survived. The amount of paraquat (24.5% concentrate of 1,1'-dimethyl-4,4'-bipyridium dichloride) ingested was 45.6 +/- 74.1 mL (mean +/- SD). In addition to degree of paraquat exposure, survival after acute paraquat poisoning was associated with age, respiratory rate, pH, PaCO2, hemoglobin, white-blood-cell count, blood urea nitrogen, amylase, and the number of failed organs in multiple logistic regression analysis. In conclusion, young age, percutaneous or inhalational route, exposure to less paraquat, and lesser degrees of leukocytosis, acidosis, and renal, hepatic, and pancreatic failures on admission are good prognostic factors of survival after acute paraquat poisoning.
Collapse
Affiliation(s)
- Eun-Young Lee
- Department of Internal Medicine, College of Medicine, Soonchunhyang University, Chonan, Chungnam, Korea
| | | | | | | |
Collapse
|
21
|
Hong SY, Yang DH, Hwang KY. Associations between laboratory parameters and outcome of paraquat poisoning. Toxicol Lett 2000; 118:53-9. [PMID: 11137309 DOI: 10.1016/s0378-4274(00)00264-2] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Paraquat, a non-selective herbicide, is a known fatal substance in humans, and intentional ingestion of paraquat is increasing among Korean suicides. In 1999, 147 subjects admitted to the Institute of Pesticide Poisoning, Soonchunhyang Chunan Hospital, Korea ingested paraquat. Initial routine laboratory tests were conducted and the outcome of paraquat poisoning was categorized as survivor and fatality. Mean amount (S.D.) of ingestion was 54.5 (104.9) ml, and the overall fatality rate was 44.2%. Abnormal liver function (GOT and GPT), renal dysfunction (BUN and creatinine), metabolic acidosis (pH and PaCO(2)), and abnormal urine analysis (RBC, WBC, and protein) had significant odds ratios (ORs) for paraquat fatality (P<0.05). In multiple logistic regression, subjects with liver or renal dysfunction or metabolic acidosis had significant risks of the fatality. Our results determined that initial routine laboratory parameters could be used to predict the outcome of paraquat poisoning and recommended that evaluation of acid-base status and renal and liver function should be conducted and evaluated before intensive therapy.
Collapse
Affiliation(s)
- S Y Hong
- Department of Internal Medicine, School of Medicine, Soonchunhyang University, Chunan, South Korea
| | | | | |
Collapse
|
22
|
Suzuki K, Takasu N, Okabe T, Ishimatsu S, Ueda A, Tanaka S, Fukuda A, Arita S, Kohama A. Effect of aggressive haemoperfusion on the clinical course of patients with paraquat poisoning. Hum Exp Toxicol 1993; 12:323-7. [PMID: 8104011 DOI: 10.1177/096032719301200411] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The effect of aggressive haemoperfusion; i.e. haemoperfusion of 10 h or more during the first 24 h after ingestion, on the clinical course of paraquat poisoning was studied. Among 40 patients admitted within 15 h after ingestion of paraquat with an SIPP of less than 100 (h x micrograms ml-1), 21 received aggressive haemoperfusion and 19 received conventional haemoperfusion; i.e. haemoperfusion of less than 10 h during the same period. Survival rates of patients with severity between an SIPP of 100 and Proudfoot's curve in the two groups were compared by the log-rank test. Aggressive haemoperfusion did not improve the outcome but did improve the survival rates; that is, the number of patients surviving at particular points in time (P < 0.05). The length of haemoperfusion for the aggressive haemoperfusion group was longer than that for the conventional group on the first day (P < 0.001), but the difference was insignificant during the following two days. Neither the time from ingestion to haemoperfusion, urine volume from the first to third day, nor initial plasma-paraquat concentrations and SIPP were significant between groups. These findings imply that aggressive haemoperfusion reduces the severity of paraquat poisoning and elongates survival time. We, therefore, propose that the efficacy of more aggressive haemoperfusion, such as the 'continuous haemoperfusion' proposed by Okonek et al., should be further studied.
Collapse
Affiliation(s)
- K Suzuki
- Department of Emergency and Critical Care Medicine, Kawasaki Medical School, Kurashiki, Japan
| | | | | | | | | | | | | | | | | |
Collapse
|
23
|
Ikebuchi J, Proudfoot AT, Matsubara K, Hampson EC, Tomita M, Suzuki K, Fuke C, Ijiri I, Tsunerari T, Yuasa I. Toxicological index of paraquat: a new strategy for assessment of severity of paraquat poisoning in 128 patients. Forensic Sci Int 1993; 59:85-7. [PMID: 8330811 DOI: 10.1016/0379-0738(93)90147-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
A new assessment of the severity of paraquat poisoning in 128 patients has been developed. It involves toxicological index of paraquat and discriminant function score. This system not only allows a more accurate assessment of severity of the poisoning, but also provides a more reliable prediction of the outcome in an early stage for the purpose of forensic and clinical toxicology.
Collapse
Affiliation(s)
- J Ikebuchi
- Department of Legal Medicine, Tottori University School of Medicine, Yonago, Japan
| | | | | | | | | | | | | | | | | | | |
Collapse
|
24
|
Suzuki K, Takasu N, Arita S, Ueda A, Okabe T, Ishimatsu S, Tanaka S, Kohama A. Evaluation of severity indexes of patients with paraquat poisoning. Hum Exp Toxicol 1991; 10:21-3. [PMID: 1673620 DOI: 10.1177/096032719101000104] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
1. Three indexes for evaluating the severity of paraquat poisoning based on plasma-paraquat concentration are presently in use; the curves of Proudfood et al. and Scherrmann et al. and the SIPP. Their effectiveness in determining the prognosis of patients with paraquat poisoning was evaluated. 2. To determine which index was more accurate, contigency tables of the three indexes were obtained and compared; Proudfoot's curve vs the SIPP Scherrmann's curve vs the SIPP. Proudfoot's curve and the SIPP were applied to patients admitted within 24 h after intoxication. Scherrmann's curve and the SIPP were applied to patients admitted more than 24 h after intoxication. The proportions of patients with true positive and true negative results to total patients were compared by a ratio test. 3. Proudfoot's curve was found to be more accurate than the SIPP for predicting the prognosis of patients admitted within 24 h (P less than 0.05). No significant difference, however, was noted between Scherrmann's curve and the SIPP in determining the prognosis of patients admitted after more than 24 h. 4. In conclusion, Proudfoot's curve proved a better index for predicting the outcome of patients who were admitted within 24 h. However, for the prognosis of patients admitted more than 24 h after the ingestion of paraquat, further study is required.
Collapse
Affiliation(s)
- K Suzuki
- Department of Emergency and Critical Care Medicine, Kawasaki Medical School, Kurashiki, Japan
| | | | | | | | | | | | | | | |
Collapse
|
25
|
Yamaguchi H, Sato S, Watanabe S, Naito H. Pre-embarkment prognostication for acute paraquat poisoning. Hum Exp Toxicol 1990; 9:381-4. [PMID: 2271229 DOI: 10.1177/096032719000900604] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
1. In order to assess which laboratory parameters could be related to the prognosis of patients with acute paraquat poisoning, we reviewed the medical records of 160 patients who had ingested paraquat in an attempt at suicide. 2. Serum creatinine and potassium concentrations, arterial blood bicarbonate and base excess levels, arterial blood pH, volume of paraquat ingested and the strength of the urinary paraquat qualitative test (sodium dithionate colour reaction) on admission in the surviving patients were significantly different from those of the patients who died within 48 h of ingestion. 3. The relationship of the quantity Eq1 defined as: Eq1 = ([K+] x [HCO3-])/([Cre] x 0.088) (mEq l-1) against the interval of time after ingestion to admission (T) had a significant correlation with prognosis (P less than 0.01). Patients with Eq1 greater than (1500 - 399 X LogT) had a 90% survival rate, Eq1: (930 - 399 X LogT) less than Eq1 less than or equal to (1500 - 399 X LogT) 38% and Eq1 less than or equal to (930 - 399 X LogT) 3%, P less than 0.01.
Collapse
Affiliation(s)
- H Yamaguchi
- Department of Anesthesiology, University of Tsukuba, Japan
| | | | | | | |
Collapse
|