title: Acute paraquat poisoning: report of a survival case following intake of a potential lethal dose.
abstract: When properly used, paraquat (PQ) is a widely used bipyridil herbicide with a good safety record. Most cases of PQ poisoning result from intentional ingestion, with death resulting from hypoxemia secondary to lung fibrosis in moderate to severe poisonings. With high ingestion volumes (>50 mL of a 20% wt/vol formulation), death results from multiple organ failure and cardiovascular collapse within 1 week after intoxication. The present report describes a successful clinical case regarding the intoxication of a 15-year-old girl by a presumed lethal dose of PQ. The adolescent ingested approximately 50 mL of a commercialized concentrate (20% wt/vol of dichloride salt) formulation of PQ. High serum and urinary levels of PQ confirmed the bad prognosis. However, the therapeutic protocol followed in the present clinical case led to a positive outcome. Besides the measures for decreasing PQ absorption and increasing its elimination, other protective procedures were applied in aiming to reduce the production of reactive oxygen species (ROS), to scavenge ROS, to repair ROS-induced lesions, and to reduce inflammation. The status-of-the-art concerning the biochemical and toxicological aspects of PQ poisoning and the pharmacologic basis of the respective treatment is also presented.
authors.affiliation: REQUIMTE, Department of Toxicology, Faculty of Pharmacy, University of Porto, Rua Aníbal Cunha, 164, 4099-030 Porto, Portugal. ricardinis@ff.up.pt
authors.forename: Ricardo J
authors.initials: RJ
authors.lastname: Dinis-Oliveira
authors.forename: António
authors.initials: A
authors.lastname: Sarmento
authors.forename: Paulo
authors.initials: P
authors.lastname: Reis
authors.forename: Augusta
authors.initials: A
authors.lastname: Amaro
authors.forename: Fernando
authors.initials: F
authors.lastname: Remião
authors.forename: Maria L
authors.initials: ML
authors.lastname: Bastos
authors.forename: Felix
authors.initials: F
authors.lastname: Carvalho
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D005260:Female; D006801:Humans; D010269:Paraquat / Q000008:administration & dosage / Q000506:poisoning*; D017741:Survivors
chemical_list: D010269:Paraquat