Spectrum of toxic hepatitis following intentional paraquat ingestion: analysis of 187 cases.
BACKGROUND
This retrospective observational study examined the clinical features, the degrees of toxic hepatitis, physiological markers and clinical outcomes after intentional paraquat poisoning and sought to determine what association, if any, might exist between these findings.


METHODS
A total of 187 patients were referred for management of intentional paraquat ingestion between 2000 and 2010. Patients were categorized into two groups according to their hepatic complication, i.e. with (N = 87) or without (N = 100) toxic hepatitis. Demographic, clinical and laboratory data were obtained for analysis. Mortality rates were also analysed.


RESULTS
It was found that patients with toxic hepatitis were younger (39.7 ± 13.7 vs 44.2 ± 16.6 year old, P = 0.046), and suffered from greater incidences of acute respiratory failure (63.2 vs 48.0%, P = 0.037) and acute renal failure (75.9 vs 56.0%, P = 0.004) than patients without hepatitis. The hospitalization period was longer in patients with hepatitis than without hepatitis (16.2 ± 14.6 vs 11.2 ± 12.1 days, P = 0.012), even though there was no difference in mortality rate between both groups (56.3 vs 53.0%, P = 0.649). Notably, the symptoms of toxic hepatitis developed within 6.7 ± 6.3 days of exposure to paraquat with aspartate aminotransferase (AST) 138 ± 156 U/L, alanine aminotransferase (ALT) 127 ± 114 U/L and total bilirubin 2.7 ± 2.6 mg/dL. The hepatitis peaked at 9.5 ± 8.8 days with AST 125 ± 139 U/L, ALT 183 ± 181 U/L and total bilirubin 3.2 ± 3.6 mg/dL. Nevertheless, the symptoms resolved within 17.3 ± 9.8 days of paraquat exposure, and none of the patients died of hepatic complication.


CONCLUSIONS
A substantial proportion of paraquat patients suffered from hepatic complication (46.52%), but the spectrum of hepatitis in these patients seemed mild and transient.
Department of Nephrology and Division of Clinical Toxicology, Chang Gung Memorial Hospital, Taipei, Taiwan.
Chin-Jung
CJ
Yang
Ja-Liang
JL
Lin
Dan-Tzu
DT
Lin-Tan
Cheng-Hao
CH
Weng
Ching-Wei
CW
Hsu
Shen-Yang
SY
Lee
Shwu-Hua
SH
Lee
Chia-Ming
CM
Chang
Wey-Ran
WR
Lin
Tzung-Hai
TH
Yen
D000328:Adult; D000367:Age Factors; D000931:Antidotes / Q000008:administration & dosage; D002606:Charcoal / Q000008:administration & dosage; D056486:Chemical and Drug Induced Liver Injury / Q000209:etiology / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D005260:Female; D006464:Hemoperfusion; D006540:Herbicides / Q000506:poisoning*; D006801:Humans; D007902:Length of Stay; D008111:Liver Function Tests; D008297:Male; D010269:Paraquat / Q000506:poisoning*; D051437:Renal Insufficiency / Q000188:drug therapy / Q000209:etiology / Q000401:mortality; D012131:Respiratory Insufficiency / Q000175:diagnosis / Q000209:etiology / Q000401:mortality; D012189:Retrospective Studies; D012720:Severity of Illness Index; D015996:Survival Rate; D013624:Taiwan / Q000453:epidemiology; D062606:Tertiary Care Centers
D000931:Antidotes; D006540:Herbicides; D002606:Charcoal; D010269:Paraquat