Spectrum of corrosive esophageal injury after intentional paraquat ingestion.
BACKGROUND
This is an observational study that examines the clinical features, the degrees of esophageal injury, physiological markers, and clinical outcomes after paraquat ingestion and seeks to determine what association, if any, may exist between these findings.


METHODS
The study included 16 of 1410 paraquat subjects who underwent endoscopies at Chang Gung Memorial Hospital between 1980 and 2007.


RESULTS
Corrosive esophageal injuries were classified as grade 1 in 8, 2a in 5, and 2b in 3 patients. No patients had grade 0, 3a, or 3b esophageal injuries. After paraquat ingestion, systemic toxicity occurred, with rapid development of hypoxia, hepatitis, and renal failure in many cases. Hypoxia occurred in 1 (12.5%), 5 (100%), and 3 (100%) patients with grades 1, 2a, and 2b esophageal injury, respectively. There were more hypoxic patients with grades 2a and 2b than those with grade 1 esophageal injury (P < .05). The nadir Pao(2) was lower in patients with grades 2a and 2b than those with grade 1 esophageal injury (P < .05). However, there were no significant differences in terms of acute hepatitis, peak serum alanine aminotransferase, acute renal failure, and peak serum creatinine between the 3 groups (P > .05). Kaplan-Meier analysis did not find any difference in survival between the groups (P > .05).


CONCLUSIONS
Paraquat, a mild caustic agent, produces only grades 1, 2a, and 2b esophageal injury. Our findings showed a potential relationship between the degree of hypoxia, mortality, and degree of esophageal injury, although such a low number of study subjects limits the conclusions that can be made by this study.
Yen
Tzung-Hai
TH
Department of Nephrology and Division of Clinical Toxicology, Chang Gung Memorial Hospital, Taipei 105, Taiwan. m19570@adm.cgmh.org.tw
Lin
Ja-Liang
JL
Lin-Tan
Dan-Tzu
DT
Hsu
Ching-Wei
CW
Weng
Cheng-Hao
CH
Chen
Yu-Hui
YH
D000328:Adult; D002057:Burns, Chemical / Q000209:etiology* / Q000401:mortality / Q000473:pathology*; D015331:Cohort Studies; D004636:Emergency Service, Hospital; D004724:Endoscopy; D004947:Esophagus / Q000293:injuries*; D005260:Female; D006540:Herbicides / Q000506:poisoning*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010269:Paraquat / Q000506:poisoning*; D012189:Retrospective Studies; D055815:Young Adult
D006540:Herbicides; D010269:Paraquat