Gramoxone is a commercial formulation of a herbicide containing the di-metho sulphate salt of paraquat (1,1'-dimethyl-4, 4'-dipyridilium).Bullivant (1966) reported that up to July 1964 one case of paraquat poisoning had occurred in a child in Ireland. He described two additional cases in men in 1966. The first was that of a 28-year-old man who drank half a glass of 20 % paraquat solution; a day later gastrointestinal symptoms appeared, followed by signs of hepatorenal damage. He died of severe respiratory failure. The second case was that of a man aged 23 who drank a mouthful of paraquat and vomited immediately. In this case also signs of mild hepatorenal damage appeared, and he too died of respiratory failure.The purpose of this paper is to present an additional case of paraquat poisoning, this time by subcutaneous injection. Suicide in such an unusual way has not to our knowledge been described in medical literature. CASE REPORTThe patient was a 30-year-old Yemeni-born farmer, divorced, who emigrated to Israel 21 years ago. He was known from the records of a mental hospital to suffer from paranoid schizophrenia.On 2 August 1966, by means of a syringe that was used for immunizing chickens, he injected himself with approximately 1 ml. of a 20% solution of Gramoxone. He was admitted to hospital a few hours later after vomiting and passing loose bloody stools. He was found to be in good general condition. His pupils were equal and reacted to light. His pulse was 76 and blood pressure 130/80. No other abnormal physical findings were observed. Two days after admission a right facial paresis occurred, abdominal reflexes were reduced on the right side, and Oppenheim's sign was present on the left side. On the fifth day after admission these findings were no longer elicited. Laboratory findings were not abnormal except that urinary sediment contained some erythrocytes and leucocytes. Blood urea varied from 69 to 140 mg./100 ml. and urinary output from 1,000 to 2,000 ml. a day. An E.C.G. was within normal limits.For two days after admission he felt well, but on the third day he complained of anorexia and chest pain, and his temperature rose to 39' C. He had no dyspnoea at this time. X-ray examination during this phase showed a slight infiltrative shadow of the right lung base. After five days he again improved, his pain disappeared, and his temperature returned to normal. In spite of this his radiological changes persisted. On the eighth day in hospital jaundice appeared.He was tender in the right hypochondrium and the liver was felt 6 cm. below the costal margin. Total serum bilirubin values were raised to 4.6 mg./100 ml., of which direct bilirubin was 3 mg./ 100 ml., and the serum S.G.O.T. rose to 250 units. Serum ammonia was 375 ,ug./100 ml. and leucine aminopeptidase was 364 units. All these findings disappeared by the 11th day. The patient felt well for the next three days, but on the 14th day he developed dyspnoea and tachycardia, both of which increased in severity. X-ray examination of the chest showed bilatera...
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