Repeated pulse of methylprednisolone and cyclophosphamide with continuous dexamethasone therapy for patients with severe paraquat poisoning.
OBJECTIVE
Paraquat is widely used in the world, and all treatments for paraquat poisoning have been unsuccessful. Many patients have died of paraquat poisoning in developing countries. A novel anti-inflammation method was developed to treat severe paraquat-poisoned patients with >50% to <90% predictive mortality: initial pulse therapy with methylprednisolone (1 g/day for 3 days) and cyclophosphamide (15 mg/kg/day for 2 days), followed by dexamethasone 20 mg/day until Pao2 was >11.5 kPa (80 mm Hg) and repeated pulse therapy with methylprednisolone (1 g/day for 3 days) and cyclophosphamide (15 mg/kg/day for 1 day), which was repeated if Pao2 was <8.64 kPa (60 mm Hg).


METHODS
Randomized controlled trial.


METHODS
Academic medical center in Taiwan.


METHODS
Twenty-three paraquat-poisoned patients with >50% and <90% predictive mortality assessed by plasma paraquat levels were prospectively and randomly assigned to the control and study groups at a proportion of 1:2.


METHODS
The control group received conventional therapy and the study group received the novel repeated pulse treatment with long-term steroid therapy.


RESULTS
We measured patient mortality during the study period. There was not a different distribution of basal variables between the two study groups. The mortality rate (85.7%, six of seven) of the control group was higher than that of the study group (31.3%, five of 16; p = .0272).


CONCLUSIONS
The novel anti-inflammatory therapy reduces the mortality rate for patients with severe paraquat poisoning.
Lin
Ja-Liang
JL
Division of Clinical Toxicology and Nephrology, Department of Medicine, Chang Gung Memorial Hospital, Lin-Kou Medical Center, Chang Gung University, School of Medicine, Taipei, Taiwan, ROC. jllin99@hotmail.com
Lin-Tan
Dan-Tzu
DT
Chen
Kuan-Hsing
KH
Huang
Wen-Hung
WH
D000328:Adult; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D003520:Cyclophosphamide / Q000008:administration & dosage / Q000627:therapeutic use*; D003907:Dexamethasone / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D006540:Herbicides / Q000097:blood / Q000506:poisoning*; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage / Q000627:therapeutic use*; D009026:Mortality; D010269:Paraquat / Q000097:blood / Q000506:poisoning*; D011237:Predictive Value of Tests; D020551:Pulse Therapy, Drug / Q000379:methods*; D012720:Severity of Illness Index; D013624:Taiwan
D000893:Anti-Inflammatory Agents; D006540:Herbicides; D007166:Immunosuppressive Agents; D003907:Dexamethasone; D003520:Cyclophosphamide; D010269:Paraquat; D008775:Methylprednisolone