Serum Paraquat Levels Research Articles

Prediction of mortality and morbidity following paraquat poisoning based on trend of liver and kidney injury

BackgroundParaquat is a non-selective herbicide that causes severe tissue damage in various organs including the liver and kidney. The aim of this study was to determine the trend of the liver and kidney injury in patients with paraquat poisoning.MethodsThis retrospective cross-sectional study was performed at the Khorshid Hospital referral poisoning emergency center. The medical records of all patients with acute paraquat poisoning admitted from March 2017 to October 2020 were reviewed. Demographic factors, liver and kidney function tests and outcomes were recorded. Patients were divided into two groups based on the outcome of mortality (death or survived). The two groups were compared in terms of changes in creatinine and liver enzymes during hospitalization.ResultsA significant difference in mean creatinine levels between the two groups was observed from the third day after admission. The peak median Cr was 3.5 mg/dl for deceased patients in day 6 and 1.47 mg/dl for survived patients on 4th day. Minor elevations of ALT and AST were present in those who died. Logistic regression analysis shows patients who had level of creatinine higher than normal from the 2nd to 6th day post overdose, the risk of mortality was 4.83 to 7.44 times more than patients with normal creatinine level. The mean (SD) area under the curve for outcome prediction was reported to be excellent for creatinine on the 8th day post overdose (85.7 ± 13.2). Creatinine was higher than 2 on the 8th day post ingestion and had a sensitivity 100% and specificity 85.7% for mortality prediction (P value, 0.05).ConclusionsThe risk of mortality secondary to paraquat ingestion was highly associated with a rise in creatinine. Minor elevations of ALT and AST were also present in those who died. The creatinine concentration on different days post overdose can be helpful in predicting the severity of poisoning especially when the serum paraquat levels are not available.

Rapid Simultaneous Determination of Paraquat and Creatinine in Human Serum Using a Piece of Paper.

Paraquat intoxication is characterized by acute kidney injury and multi-organ failure, causing substantial mortality and morbidity. This study aims to develop a 2-in-1 paper-based analytical device to detect the concentrations of paraquat and creatinine in human serum, which can help clinicians diagnose patients with paraquat poisoning in a more rapid and geographically unrestricted manner. The procedure involves fabrication of a paper-based analytical device, i.e., printing of design on a filter paper, heating of wax-printed micro zone plates so as molten wax diffusing into and completely through the paper to the other side, forming hydrophobic boundaries that could act as detection zones for the paraquat colorimetric assay, and finally analysis using ImageJ software. The paper employed a colorimetric sodium dithionite assay to indicate the paraquat level in a buffer or human serum system in less than 10 min. In this study, colorimetric changes into blue color could be observed by the naked eye. By curve fitting models of sodium dithionite in normal human serum, we evaluated the serum paraquat levels for five paraquat patients. In the sodium dithionate assay, the measured serum paraquat concentrations in patients 1–5 were 22.59, 5.99, 26.52, 35.19 and 25.00 ppm, respectively. On the other hand, by curve fitting models of the creatinine assay in normal human serum, the measured serum creatinine concentrations were 16.10, 12.92, 13.82, 13.58 and 12.20 ppm, respectively. We found that the analytical performance of this device can compete with the standard of Clinical Laboratory of Chang Gung Memorial Hospital, with a less complicated sample preparation process and more rapid results. In conclusion, this 2-in-1 paper-based analytical device has the advantage of being simple and cheap, enabling rapid detection of paraquat intoxication as well as assessment of renal prognosis.

Paraquat tongue: rebirth of paraquat intoxication

The World Health Organization (WHO) acknowledges that acute pesticide poisoning account for significant morbidity and mortality worldwide, especially in developing countries. We presented an interesting case of paraquat intoxication.A 39-year-old man was brought to our emergency department (ED) by his family soon after attempting suicide by ingesting unknown substances. Initial vital signs, laboratory data, and chest radiography showed normal. Only green-blue color of finger and redness of tongue were noted. Initial urine paraquat test (qualitative) was also negative at our ED. We still arranged hemoperfusion therapy due to the strong contact history and some physical examination findings. Finally, the serum paraquat level at ED was 0.1 μg/ml. This case highlights that even in cases with negative urine paraquat tests, detailed history taking and physical examination can help the diagnosis of paraquat poisoning. Early recognition and the appropriate treatment are imperative.

Prediction of prognosis in acute paraquat poisoning using severity scoring system in emergency department

Objective. The aim of this study was to validate and compare the performance of serum paraquat level, severity index of paraquat poisoning (SIPP), Acute Physiology And Chronic Health Evaluation II (APACHE II), modified Simplified Acute Physiology Score II (MSAPS II), and modified Expanded Simplified Acute Physiology Score II (MSAPS IIe) calculated immediately after arrival on emergency department (ED) for assessing the mortality of acute paraquat poisoning. Methods. A retrospective study design was employed with the main outcome measure being mortality from year 2001 to 2010. MSAPS II and MSAPS IIe were employed in that assessment of the 24-hour urine output were not included. The performance of APACHE II, MSAPS II, MSAPS IIe, serum paraquat level and SIPP for prediction of mortality in acute paraquat poisoning were compared. Results. A total of 102 patients were enrolled in the study. The area under the ROC curve for APACHE II (0.800) was statistically lower than those for MSAPS II, MSAPS IIe, SIPP and serum paraquat (0.879, 0.893, 0.924,and 0.951, respectively). The Hosmer-Lemeshow goodness-of-fit test C statistic revealed that APACHE II, MSAPS II, MSAPS IIe and serum paraquat level showed good calibrations (chi-square 8.477 and p = 0.388, chi-square 4.614 and p = 0.798, chi-squared 5.301 and p = 0.725, chi-squared 1.009 and p = 0.985 respectively), but poor calibration for SIPP (chi-square 21.293 and p = 0.006). Conclusion. Serum paraquat level is still the most reliable prognosis factor in acute paraquat poisoning. But MSAPS II or MSAPS IIe calculated immediately after arrival on ED may be helpful to predict mortality in acute paraquat poisoning especially when hospital has no facility to measure serum paraquat level.

Prediction of Mortality in Patients with Acute Paraquat Intoxication Using Simplified Acute Physiology Score II

Background: The prognosis of paraquat intoxication patients is poor and this makes the prediction of mortality important in administering aggressive treatment and admission. This article investigates the usefulness of simplified acute physiology score II (SAPS II), as a predictor of the mortality in paraquat intoxication. Methods: We retrospectively reviewed 65 patients who were admitted in one hospital between January in 2005 and December in 2010. We calculated their SAPS II, serum paraquat level, and severity index of paraquat poisoning (SIPP) at the time of intensive care unit (ICU) admission. We investigated the relationship between each systems and the mortality. Results: Overall mortality was 73.8%: 48 out of 65 patients died. Non-survived group (n = 48) had a higher SAPS II score (30.44 ± 15.99) than survived group (n = 17 [15.7 ± 6.26], p ＜ 0.001). Serum paraquat level and SIPP were significantly higher in non-survived group than in survived group (p ＜ 0.05, in all comparisons). By using the area under receiver operating characteristic curves (AUC), the SAPS II system yielded equal discriminative power (AUC = 0.82) with serum paraquat level (AUC = 0.896) and SIPP (AUC = 0.865). Hosmer-Lemeshow goodness-of-fit test C indicated SAPS II score validated well in paraquat intoxication group (p = 0.33). Conclusions: Serum paraquat level is the best way for prediction of mortality in patients with acute paraquat intoxication. If checking serum paraquat level is impossible or delayed, SAPS II score can be an alternative tool for evaluating the prognosis in paraquat intoxication.

A Clinical Study of Prognosis and Glucocorticoid Pulse Treatment in Patients with Acute Paraquat Intoxication

Objective Paraquat is a highly toxic herbicide that binds strongly to tissue and causes high mortality rates due to pesticide intoxication in Taiwan. In this study, we evaluated the usefulness of methylprednisolone pulse therapy and calculation of the severity index of paraquat poisoning (SIPP) to predict the prognosis in patients with oral paraquat intoxication Materials and Methods Thirty-two patients with paraquat poisoning from January 2003 to April 2005 were enrolled into this study at a medical center in eastern Taiwan. All 32 patients had history of oral intake of paraquat and urine paraquat was positive at the emergency department. Time of oral intake of paraquat and serum paraquat levels were assayed at the emergency department for calculating SIPP (hour × mg/L) level. Sixteen patients with oral paraquat poisoning were treated with intravenous methylprednisolone 1 g/day and charcoal hemoperfusion for 3 days (MP group), and 16 patients with oral paraquat poisoning were treated with charcoal hemoperfusion only for 3 days (control group). Results The mortality rate of the patients with oral paraquat poisoning was high (87.5%). There were no statistically significant differences in death ( p = 1.000), age ( p = 0.706), sex ( p = 0.069), serum blood urea nitrogen ( p= 0.104), creatinine ( p= 0.174), aspartate aminotransferase ( p= 0.083), alanine aminotransferase ( p = 0.365), plasma level of paraquat ( p = 0.880) and SIPP level ( p = 0.734) between the MP group and control group. Young age ( p = 0.030), lower initial plasma paraquat level ( p = 0.002), lower serum creatinine ( p = 0.009), female sex ( p = 0.033), lower elapsed time from ingestion of paraquat to arrival at hospital ( p = 0.035) and SIPP level less than 10 ( p < 0.001) were associated with survival in patients with oral paraquat poisoning. Multivariate forward stepwise linear regression analysis of deaths showed that SIPP > 10 (hour × mg/L) ( p < 0.001) was an independent predictor of death in patients with oral paraquat poisoning and explained 77.1% of the variance ( R 2 = 0.771). Conclusion Treatment with methylprednisolone pulse therapy did not show better results in patients with acute oral paraquat poisoning. SIPP was an independent predictor of death in patients with oral paraquat poisoning.

A long-term follow-up of lung function in survivors of paraquat poisoning.

1. Respiratory failure is a frequent cause of death in moderate to severe paraquat poisoning, and a transient fall in the gas transfer factor may be seen in mild poisoning. 2. The objectives of this study were to detect long-term changes in lung function in survivors of paraquat poisoning. 3. We analyzed 12 survivors retrospectively for age, sex, signs and symptoms, laboratory findings, chest X-ray findings, serum paraquat level, and lung function test. The first and the follow-up lung tests were performed at 3.7+/-1.4 weeks and 3.4+/-1.4 years, respectively. 4. Serum paraquat levels were assayed in all patients and 3/12 were above the Proudfoot's predictive line. Liver dysfunction (GOT > 50) and renal dysfunction (BUN > 30) were noted in 5/12 and 8/12, respectively. D(L)/V(A) was lower than the normal limit in the first study (3.9+/-0.6 L), but increased significantly and returned to the normal range in the follow-up study (4.5+/-0.6 L). %VC was within the normal range in either examination, but significantly decreased in the follow-up. %TLC was within the normal range in the first study (87+/-13%), but significantly decreased below the normal limit in the follow-up (81+/-13%). 5. These results indicate that survivors of paraquat poisoning may be left with a restrictive type of pulmonary dysfunction and suggest that a long-term follow-up of lung function may be necessary for survivors of paraquat poisoning.

A case of paraquat poisoning and subsequent fatality presenting to an emergency department

Paraquat (1,1′-dimethyl-4,4′-dipyridylium) is an herbicide associated with both accidental and intentional ingestion, leading to severe and often fatal toxicity. Prognosis is largely dependent on the amount of paraquat absorbed. Rapid identification of the symptoms of paraquat toxicity (burns or ulceration at the site of ingestion or injection, acute respiratory distress, and renal failure) can facilitate early treatment intervention to limit absorption. We report a case of a 71-year-old man with a suicidal ingestion of paraquat 2 days prior to presentation. Serum paraquat levels, time elapsed since ingestion, and clinical symptoms all indicated poor prognosis. The patient developed severe respiratory distress and progressive renal failure, and died 6 days after admission to the hospital.

Effects of Fuller's Earth and activated charcoal on oral absorption of paraquat in rabbits.

1. Thirty male rabbits of local strain (weighing 1.5-2 kg) were divided into five groups. Four groups were treated with an oral dose of paraquat, which was followed by either Fuller's Earth or activated charcoal 0.5 or 2.0 h later. The remaining group acted as the control group and was treated only with an oral dose of paraquat. The dose of paraquat was 20.0 mg/kg given in a concentration of 20.0 mg/mL. 2. Both adsorbents were administered in 15 mL normal saline as a 30% slurry. Blood was sampled from the ear vein 0.5, 1, 2, 4, 8 and 24h after the administration of paraquat. 3. Paraquat concentration was determined spectophotometrically at 600 nm by comparing against a standard curve of paraquat obtained by the addition of standard paraquat into normal rabbit serum and extracting interfering substances with ether. 4. The results of the present study show that either adsorbent can bring down the serum paraquat level. There was no significant difference found in the effectiveness of either adsorbent. 5. It is concluded that the administration of an adsorbent as early as possible will help in the reduction of paraquat absorption from the gastrointestinal tract. 6. Activated charcoal is still effective in lowering serum paraquat concentration when given more than 1 h after ingestion of paraquat.

Clinical studies on paraquat poisoning; prognosis and severity index of paraquat poisoning using the urine levels

The prognosis of paraquat poisoning has been assessed from serum paraquat levels using e.g. produfoot survival curve. The prognosis of paraquat poisoning has not been investigated from urinary paraquat levels. The purpose of this study is to clarify whether the prognosis of paraquat poisoning can be determined by urinary paraquat levels or not. Urinary severity index of paraquat poisoning (U-SIPP) was employed. U-SIPP is calculated as hours between ingestion of paraquat and start of intensive treatment multiplied by the paraquat level in the urine at the same time. Urinary excretion of paraquat is correlated with renal function. The prognosis of paraquat poisoning using U-SIPP was further discussed, based on creatinine clearance (Ccr) and the relation between serum and urine paraquat levels. The following results were obtained. 1) When creatinine clearance was greater than 20 ml/min, patients who died of circulatory failure were with U-SIPP level over 1250, patients who died of respiratory failure were with U-SIPP level between 1250 and 250, and survivors were with U-SIPP below 250. 2) Survival duration was closely correlative with U-SIPP in cases with Ccr greater than 20 ml/min (r = 0.8123, p less than 0.025). 3) When Ccr was greater than 20 ml/min, urinary paraquat levels were correlated very well with the serum levels at admission, even during direct hemoperfusion (DHP) treatment. 4) When diuretic agents such as furosemide was effective, the assessment of the prognosis of paraquat poisoning using urinary paraquat levels seemed to be possible. Urinary paraquat level was approximately measured by an applied qualitative analysis method with using a dilution method.

Paraquat poisoning: An analytical toxicologic study of three cases

Paraquat concentrations were measured in tissue, serum, urine and hemodialysate obtained from 3 patients who died 16.5 h, 22 days and 23 days after ingestion. In the patient who died 16.5 h post-ingestion, tissue paraquat levels were high. Kidney and liver had paraquat concentrations of 14 μg/g and 13.2 μg/g respectively, whereas lung tissue had a paraquat level of 3.8 μg/g. Low concentrations of paraquat were detectable in the tissues of the patients who died 22 and 23 days post-ingestion. Early in the poisoning, serum paraquat levels were high and large quantities of paraquat could be removed by both hemodialysis and forced diuresis. During an 8-h period, 713 mg of paraquat were removed by hemodialysis and 340 mg by forced diuresis. After the day of ingestion, little paraquat could be removed by hemodialysis or by forced diuresis; however, at all stages of the poisoning studied, hemodialysis was more effective than forced diuresis removing paraquat from the blood.