Combined methylprednisolone and dexamethasone therapy for paraquat poisoning.
OBJECTIVE
To report a severe case of paraquat poisoning successfully treated with repeated-pulse therapy of methylprednisolone.


METHODS
Case study.


METHODS
University Hospital, Lin-Kou Medical Center, Taipei, Taiwan, Republic of China.


METHODS
A 60-yr-old man with paraquat poisoning with severe acute renal failure (serum creatinine level of 11.8 mg/dL and serum paraquat level of 3.66 microg/mL at 10 hrs after ingestion) and severe hypoxemia (Pao2, 66.6 mm Hg).


METHODS
Repeated 3-day pulse therapy with methylprednisolone, one course of 2-day cyclophosphamide, and a high dose of dexamethasone for 33 days. MEASUREMENTS AND MAIN OUTCOME: Arterial blood gas analysis was obtained regularly. A chest radiography was obtained every week. The arterial blood oxygen concentrations dramatically elevated from 66 mm Hg to 97 mm Hg, and the chest radiographs markedly improved after repeated-pulse therapy with anti-inflammatory agents and cyclophosphamide.


CONCLUSIONS
We successfully treated a severe paraquat poisoned patient with repeated methylprednisolone pulse therapy and prolonged dexamethasone treatment. This case demonstrates that the severe inflammation, not the fibrosis, of the lungs plays a major role in the lethal hypoxemia of patients with paraquat poisoning during the subacute period and confirms our previous hypotheses. Clearly, the use of anti-inflammatory therapy to treat paraquat-poisoned patients needs further evaluation; however, anti-inflammatory therapy may be an effective treatment after failure of standard therapies.
Chen
Guan-Hsing
GH
Poison Center, Chang Gung Memorial Hospital, Lin-Kou Medical Center, Chang Gung Medial College and University, Taipei, Taiwan, Republic of China.
Lin
Ja-Liang
JL
Huang
Yao-Kuang
YK
D000368:Aged; D003907:Dexamethasone / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008775:Methylprednisolone / Q000627:therapeutic use*; D010269:Paraquat / Q000506:poisoning*; D011658:Pulmonary Fibrosis / Q000188:drug therapy* / Q000209:etiology*; D020551:Pulse Therapy, Drug
D005938:Glucocorticoids; D003907:Dexamethasone; D010269:Paraquat; D008775:Methylprednisolone