title: [Paraquat poisoning. Case report and overview].
abstract: Paraquat poisoning in Germany is rare. Because plasma levels do not necessarily match the ingested amount of paraquat, repeated measurement of plasma levels is imperative. There is a large potential in the prehospital phase to improve prognosis: further resorption must be terminated by rigorous charcoal administration and early tracheal intubation if necessary. Because paraquat can be resorbed by dermal contact, steps to ensure sufficient protection of emergency medical personnel must be taken.As soon as further resorption has been prevented sufficiently, forced diuresis, renal replacement therapy, and hemoperfusion can be of help, but still remain controversial. To reduce pulmonary fibrosis, inspiratory oxygen concentrations must be adjusted to the minimal amount needed to ensure satisfactory tissue oxygenation. Data supporting the advantageous use of cyclophosphamide combined with methylprednisolone for the treatment of pulmonary fibrosis were recently published. Since the toxic mechanism implies a mismatch of oxidants and anti-oxidants, co-administration of ascorbic acid and N-acetylcysteine are simple treatments with few side effects.
authors.affiliation: II. Medizinische Abteilung/Kardiologie, Asklepios-Klinik St. Georg, Lohmühlenstr. 5, 20099, Hamburg, Germany. t.spangenberg@asklepios.com
authors.forename: T
authors.initials: T
authors.lastname: Spangenberg
authors.forename: H
authors.initials: H
authors.lastname: Grahn
authors.forename: H
authors.initials: H
authors.lastname: van der Schalk
authors.forename: K H
authors.initials: KH
authors.lastname: Kuck
mesh_terms: D000111:Acetylcysteine / Q000008:administration & dosage; D058186:Acute Kidney Injury / Q000139:chemically induced / Q000628:therapy; D055371:Acute Lung Injury; D000328:Adult; D000975:Antioxidants / Q000008:administration & dosage; D001205:Ascorbic Acid / Q000008:administration & dosage; D003131:Combined Modality Therapy / Q000379:methods; D016292:Procedural Sedation; D003299:Cooperative Behavior; D003422:Critical Care / Q000379:methods*; D004305:Dose-Response Relationship, Drug; D004632:Emergency Medical Services / Q000379:methods; D004945:Esophagoscopy; D004947:Esophagus / Q000187:drug effects; D005753:Gastric Mucosa / Q000187:drug effects; D006440:Hemofiltration; D006540:Herbicides / Q000493:pharmacokinetics / Q000506:poisoning*; D006801:Humans; D033183:Interdisciplinary Communication; D007385:Intermittent Positive-Pressure Ventilation; D007413:Intestinal Mucosa / Q000187:drug effects; D008297:Male; D008657:Metabolic Clearance Rate / Q000502:physiology; D010102:Oxygen Inhalation Therapy; D010269:Paraquat / Q000493:pharmacokinetics / Q000506:poisoning*; D011379:Prognosis; D011654:Pulmonary Edema / Q000517:prevention & control; D013406:Suicide, Attempted / Q000517:prevention & control*
chemical_list: D000975:Antioxidants; D006540:Herbicides; D010269:Paraquat; D001205:Ascorbic Acid; D000111:Acetylcysteine