title: Correlating the severity of paraquat poisoning with specific hemodynamic and oxygen metabolism variables.
abstract: OBJECTIVE
  To investigate the hemodynamics and oxygen metabolism of patients with varying degrees of severity of paraquat poisoning.
  
  
  METHODS
  Prospective, observational, clinical study.
  
  
  METHODS
  Intensive care unit in a university hospital.
  
  
  METHODS
  Forty-three consecutive patients with paraquat and/or diquat poisoning were classified into three groups by the severity index of paraquat poisoning (SIPP; hr/mg/L).
  
  
  METHODS
  Standard treatments included specific respiratory management, fluid resuscitation, and aggressive circulatory support.
  
  
  RESULTS
  Serum paraquat and diquat levels were measured at arrival, and SIPP was calculated. The cardiac index (CI), left ventricular stroke work index (LVSWI), systemic vascular resistance index (SVRI), oxygen delivery index (DO2I), oxygen consumption index (VO2I), and oxygen extraction ratio (O2ER) were measured at 6, 12, 24, 36, 48, 72, and 96 hrs postadmission. A significant inverse correlation between SIPP and survival time was found in 31 fatal cases (r = .85; p < .001). In the SIPP 10-50 group, CI, DO2I, VO2I, and O2ER were maintained at higher levels than in the SIPP group of <10 (p < .05), whereas SVRI decreased significantly (p < .05). In the SIPP group of >50, CI, LVSWI, SVRI, DO2I, and VO2I decreased, whereas O2ER had a tendency to increase progressively. There was a significant correlation between SVRI and SIPP, O2ER and SIPP, and O2ER and SVRI 24 hrs after admission, respectively (p < .001).
  
  
  CONCLUSIONS
  Paraquat poisoning is characterized by high oxygen consumption with high oxygen extraction, with the degree of derangement based on the severity index. The development of a marked imbalance between increased oxygen demand and decreased oxygen supply because of myocardial depression might be a possible cause of death in circulatory failure.
authors.affiliation: Department of Emergency and Critical Care Medicine, Tokai University School of Medicine, Isehara, Kanagawa, Japan.
authors.forename: I
authors.initials: I
authors.lastname: Yamamoto
authors.forename: T
authors.initials: T
authors.lastname: Saito
authors.forename: N
authors.initials: N
authors.lastname: Harunari
authors.forename: Y
authors.initials: Y
authors.lastname: Sato
authors.forename: H
authors.initials: H
authors.lastname: Kato
authors.forename: Y
authors.initials: Y
authors.lastname: Nakagawa
authors.forename: S
authors.initials: S
authors.lastname: Inokuchi
authors.forename: Y
authors.initials: Y
authors.lastname: Sawada
authors.forename: H
authors.initials: H
authors.lastname: Makuuchi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000378:metabolism*; D010269:Paraquat / Q000506:poisoning*; D011041:Poisoning / Q000378:metabolism / Q000503:physiopathology; D011379:Prognosis; D011446:Prospective Studies; D012720:Severity of Illness Index
chemical_list: D010269:Paraquat; D010100:Oxygen