title: Diagnostic and therapeutic approach for acute paraquat intoxication.
abstract: Paraquat (PQ) has known negative human health effects, but continues to be commonly used worldwide as a herbicide. Our clinical data shows that the main prognostic factor is the time required to achieve a negative urine dithionite test. Patient survival is a 100% when the area affected by ground glass opacity is <20% of the total lung volume on high-resolution computed tomography imaging 7 days post-PQ ingestion. The incidence of acute kidney injury is approximately 50%. The average serum creatinine level reaches its peak around 5 days post-ingestion, and usually normalizes within 3 weeks. We obtain two connecting lines from the highest PQ level for the survivors and the lowest PQ level among the non-survivors at a given time. Patients with a PQ level between these two lines are considered treatable. The following treatment modalities are recommended to preserve kidney function: 1) extracorporeal elimination, 2) intravenous antioxidant administration, 3) diuresis with a fluid, and 4) cytotoxic drugs. In conclusion, this review provides a general overview on the diagnostic procedure and treatment modality of acute PQ intoxication, while focusing on our clinical experience.
authors.affiliation: Department of Internal Medicine, Soonchunhyang University Cheonan Hospital, Cheonan, Korea.
authors.forename: Hyo-wook
authors.identifier: 0000-0003-2550-2739
authors.initials: HW
authors.lastname: Gil
authors.affiliation: Department of Internal Medicine, Metropolitan Hospital Center, New York, USA.
authors.forename: Jung-Rak
authors.initials: JR
authors.lastname: Hong
authors.affiliation: Department of Pathology, Soonchunhyang University Cheonan Hospital, Cheonan, Korea.
authors.forename: Si-Hyong
authors.initials: SH
authors.lastname: Jang
authors.affiliation: Department of Internal Medicine, Soonchunhyang University Cheonan Hospital, Cheonan, Korea.
authors.forename: Sae-Yong
authors.identifier: 0000-0003-1119-4456
authors.initials: SY
authors.lastname: Hong
mesh_terms: D058186:Acute Kidney Injury / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy; D000975:Antioxidants / Q000627:therapeutic use; D003404:Creatinine / Q000097:blood; D006464:Hemoperfusion; D006540:Herbicides / Q000506:poisoning*; D006801:Humans; D007502:Iron Chelating Agents / Q000627:therapeutic use; D008171:Lung Diseases / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy; D010269:Paraquat / Q000097:blood / Q000506:poisoning* / Q000652:urine; D014057:Tomography, X-Ray Computed
chemical_list: D000975:Antioxidants; D006540:Herbicides; D007502:Iron Chelating Agents; D003404:Creatinine; D010269:Paraquat
keywords: Antioxidants; Hemoperfusion; Paraquat; Reactive Oxygen Species