Evaluation of exhaled nitric oxide in acute paraquat poisoning: a pilot study.
BACKGROUND
Fractional exhaled nitric oxide (FENO) is nitric oxide (NO) in the lower airway measured by oral exhalation. FENO can be a useful non-invasive marker for asthma. Paraquat-mediated lung injury can be reflective of an ROS-induced lung injury. We aimed to verify if FENO is a clinical parameter of ROS formation and responsiveness to medical therapies in acute paraquat intoxication.


METHODS
We recruited 12 patients admitted with acute paraquat poisoning. A portable and noninvasive device called NIOX MINO™ (Aerocrine AB, Solna, Sweden) was used to measure FENO. Measurements were made at the time of hospital admission and at 24, 48, 72, 96, and 120 h after paraquat ingestion.


RESULTS
Six out of the total 12 recruited patients had general conditions (e.g. oral pain) that made it difficult for them to exhale with adequate force. Mean plasma paraquat level was 1.4 ± 2.5 g/mL. We found no direct correlation between the paraquat levels (both ingestion amount and plasma concentration) and FENO (initial, maximal, and minimal values). All the measured FENO values were no greater than 20 ppb for the 2 patients who died. FENO did not vary more than 20% from the baseline. Compared to the above findings, FENO measurements were found to be greater than 20 ppb for the patients who survived. FENO tends to reach its peak value at between 50 h and 80 h.


CONCLUSIONS
FENO did not predict mortality, and there was no increase of FENO in patients with severe paraquat intoxication.
Department of Emergency Medicine, Ajou University School of Medicine, Suwon, Korea.
Sang-cheon
SC
Choi
Daegu Research Center for Medical Device and Green Energy, Korea Institute of Machinery and Materials, Daegu, Korea.
Sungho
S
Oh
Department of Emergency Medicine, Ajou University School of Medicine, Suwon, Korea.
Young-gi
YG
Min
Daegu Research Center for Medical Device and Green Energy, Korea Institute of Machinery and Materials, Daegu, Korea.
Ju Young
JY
Cha
Department of Internal Medicine, Soonchunhyang University Cheonan Hospital, Cheonan, Korea.
Hyo-Wook
HW
Gil
Department of Internal Medicine, Soonchunhyang University Cheonan Hospital, Cheonan, Korea.
Sae-yong
SY
Hong
D055371:Acute Lung Injury; D015415:Biomarkers / Q000378:metabolism*; D001944:Breath Tests; D045853:Exhalation / Q000502:physiology; D005260:Female; D006801:Humans; D008297:Male; D009569:Nitric Oxide / Q000378:metabolism*; D010269:Paraquat / Q000097:blood / Q000506:poisoning*; D010865:Pilot Projects; D011654:Pulmonary Edema / Q000175:diagnosis* / Q000378:metabolism*; D056910:Republic of Korea; D013997:Time Factors
D015415:Biomarkers; D009569:Nitric Oxide; D010269:Paraquat