title: Repeated pulse of methylprednisolone and cyclophosphamide with continuous dexamethasone therapy for patients with severe paraquat poisoning.
abstract: 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.
authors.affiliation: 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
authors.forename: Ja-Liang
authors.initials: JL
authors.lastname: Lin
authors.forename: Dan-Tzu
authors.initials: DT
authors.lastname: Lin-Tan
authors.forename: Kuan-Hsing
authors.initials: KH
authors.lastname: Chen
authors.forename: Wen-Hung
authors.initials: WH
authors.lastname: Huang
mesh_terms: 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
chemical_list: D000893:Anti-Inflammatory Agents; D006540:Herbicides; D007166:Immunosuppressive Agents; D003907:Dexamethasone; D003520:Cyclophosphamide; D010269:Paraquat; D008775:Methylprednisolone