title: Hemolytic uremic syndrome associated with paraquat intoxication.
abstract: We report a case of a 66-year-old patient with paraquat intoxication resulting in the requirement for hemoperfusion, hemodialysis, and plasma exchange. His initial serum paraquat level was 0.24 µg/mL (0.0-0.1 µg/mL). Activated charcoal (50 g) was administered orally, and high-dose N-acetylcysteine (150 mg/kg) was administered intravenously. In addition, immediate 4 h hemoperfusion was also performed for three consecutive days after admission. Hemodialysis was started on the 4th day after admission because of uremia. On the 9th day after admission, laboratory findings demonstrated hemolytic uremic syndrome (HUS): microangiopathic hemolytic anemia (MAHA), thrombocytopenia, elevated reticulocyte count, and lactate dehydrogenase (LDH). Plasma exchange was performed three times consecutively. Anemia and thrombocytopenia were improved, and LDH was normalized after plasma exchange. Urine output increased to 2240 mL/day on the 18th day after admission, and hemodialysis was discontinued. He is currently being observed at our follow-up clinic without renal impairment or pulmonary dysfunction for 1.5 years since discharge. We should suspect paraquat-associated HUS when thrombocytopenia and anemia are maintained for a long time after paraquat intoxication.
authors.affiliation: Department of Internal Medicine, School of Medicine Gyeongsang University, Jinju, South Korea.
authors.forename: Ha Nee
authors.initials: HN
authors.lastname: Jang
authors.forename: Eun Jin
authors.initials: EJ
authors.lastname: Bae
authors.forename: Kyungo
authors.initials: K
authors.lastname: Hwang
authors.forename: Yeojin
authors.initials: Y
authors.lastname: Kang
authors.forename: Seongeun
authors.initials: S
authors.lastname: Yun
authors.forename: Hyun Seop
authors.initials: HS
authors.lastname: Cho
authors.forename: Se-Ho
authors.initials: SH
authors.lastname: Chang
authors.forename: Dong Jun
authors.initials: DJ
authors.lastname: Park
mesh_terms: D000368:Aged; D003404:Creatinine / Q000097:blood; D006463:Hemolytic-Uremic Syndrome / Q000139:chemically induced* / Q000503:physiopathology / Q000628:therapy*; D006464:Hemoperfusion; D006540:Herbicides / Q000493:pharmacokinetics / Q000506:poisoning*; D006801:Humans; D008297:Male; D010269:Paraquat / Q000493:pharmacokinetics / Q000506:poisoning*; D010951:Plasma Exchange; D006435:Renal Dialysis; D013406:Suicide, Attempted
chemical_list: D006540:Herbicides; D003404:Creatinine; D010269:Paraquat
keywords: acute kidney injury; hemolytic uremic syndrome; paraquat; plasma exchange