Abstract
With increasing numbers of patients surviving acute intoxication phase, long-term complication after paraquat intoxication is a topic worth exploring, such as osteonecrosis (ON) of femoral head. We reviewed 86 paraquat-intoxicated survivors between 2000 and 2012 in Chang Gung Memorial Hospital, a 3700-bed tertiary hospital in Taiwan. With all the patients underwent same detoxification protocol in the acute stage, 17.4% of paraquat poisoning survivors developed ON of femoral head requiring surgery during follow up. Most of ON episodes occurred within 2 to 4 years after paraquat intoxication and then plateau after 6 years. ON patients exhibited higher SOFA scores than non-ON patients (2.80 ± 2.14 vs. 1.76 ± 1.52, p = 0.028). Furthermore, AKIN scores are also higher in the ON patients than non-ON patients (0.87 ± 1.13 vs. 0.38 ± 0.74, p = 0.040). Multivariate logistic regression showed higher AKIN score and higher partial pressure of carbon dioxide in the blood 48 hours after admission significantly predicted ON of femoral head after paraquat intoxication (p = 0.002 and p = 0.006 respectively). Larger studies with longer follow-up durations are warranted to confirm our finding.
Highlights
Under investigation, bone vasculature compromise causing marrow infarction with subsequent structure collapse is common to most proposed etiologies
We investigated the predictors of ON of femoral head after paraquat intoxication
Bilateral ON of femoral heads are noted in 5 patients
Summary
Under investigation, bone vasculature compromise causing marrow infarction with subsequent structure collapse is common to most proposed etiologies. Both direct damage to osteocytes (e.g., by toxin production) and indirect damage (e.g., due to disorders of fat metabolism or hypoxia) may lead to ON8–11. As most of the long-term complications of paraquat have been ignored, research about ON of femoral head after paraquat intoxication is very rare. There are only two previous studies reported ON of femoral head after paraquat intoxication, but both are case reports[18,19]. There is no retrospective study for paraquat intoxication related ON of femoral head till this date. We investigated the predictors of ON of femoral head after paraquat intoxication
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