Repeated pulse of methylprednisolone and cyclophosphamide with continuous dexamethasone therapy for patients with severe paraquat poisoning

Lin, Jing; Lin-Tan, Dan-Tzu; Chen, Kuan‐Hsing; Huang, Wen‐Hung

doi:10.1097/01.ccm.0000195013.47004.a8

Cited by 114 publications

(114 citation statements)

References 23 publications

(36 reference statements)

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“…Although the patient was not admitted until post-ingestion day 4, the sodium dithionite urine test result (for paraquat) was still positive at admission. He was submitted to hemodialysis and immunosuppressive therapy with cyclophosphamide, methylprednisolone, and dexamethasone, according to the protocol recommended by Lin et al (3) In addition, he received N-acetylcysteine.…”

Section: Discussionmentioning

confidence: 99%

Intoxicação grave por paraquat: achados clínicos e radiológicos em um sobrevivente

et al. 2010

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A 22-year-old male was admitted to the emergency department with a sore throat, dysphagia, hemoptysis, and retrosternal pain. He had attempted suicide by ingesting 50 mL of a paraquat solution four days prior to admission and had been treated, at another facility, with gastric lavage and administration of activated charcoal. It is of note that he had attempted suicide previously, on more than one occasion.

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Section: Discussionmentioning

confidence: 99%

Intoxicação grave por paraquat: achados clínicos e radiológicos em um sobrevivente

et al. 2010

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“…Immunosuppressive treatments attenuate alveolar inflammation that leads to fibrosis [2][3][4][5]. In moderate-to-severe paraquat poisonings, the early phase of alveolar type I and type II epithelial cell destruction due to NADPH depletion and peroxidation damage is followed by a proliferative phase associating alveolitis, pulmonary edema, and inflammatory cell infiltration [1].…”

Section: Discussionmentioning

confidence: 99%

“…In a subgroup of patients who are yet to be defined, case reports and prospective studies have suggested the possible interest of pulse therapy (i.e., high-dose intermittent intravenous infusions) of immunosuppressive treatments. In these studies, cyclophosphamide (15 mg/kg per day for 2 days) administered simultaneously with glucocorticoids (methylprednisolone 1 g/day for 3 days, followed by dexamethasone 30 mg/day for 14 days) was initiated within 24-48 hours after ingestion [2][3][4][5][6]. Other possibly effective therapies have been suggested, such as oral adsorbents (to decrease paraquat absorption), hemodialysis or hemoperfusion (to enhance paraquat elimination), antioxidant agents (to prevent and scavenge reactive oxygen species or repair induced lesions), and lung transplant [1].…”

Section: Introductionmentioning

confidence: 99%

Delayed immunosuppressive treatment in life-threatening paraquat ingestion: A case report

et al. 2009

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Introduction: Combined glucocorticoids and cyclophosphamide pulse therapy showed promising results in moderate-to-severe paraquat poisonings to reduce life-threatening respiratory complications. Its benefit has been observed when given early in the course of poisoning; however, whether its delayed administration remains beneficial is unknown.Case Report: We describe a 23-year-old male who ingested 70 mL of a commercialized concentrate formulation with 20% weight/volume paraquat in a suicide attempt. Within 24 hours from paraquat ingestion, he presented most of the indicators of poor outcome, including gastritis, early renal dysfunction, dark blue urine colorimetric dithionite test, and marked plasma paraquat concentrations (0.56 g/mL at 13 hours, and 0.41 g/mL at 24 hours after ingestion). The patient received early gastrointestinal decontamination and aggressive supportive treatments. However, due to a rapidly progressive severe pulmonary infection, glucocorticoids and cyclophosphamide were delayed until day 14. Interestingly, our patient survived with mild respiratory sequelae despite poor initial prognosis.Discussion: This observation suggests the potential benefit of immunosuppressive pulse therapy, even if administered 14 days after paraquat ingestion, and highlights the role of paraquat-induced alveolitis in the development of fibrosis.Conclusion: Combined glucocorticoids and cyclophosphamide should be considered in moderate-to-severe paraquat poisonings, even if delayed.

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“…However, PQ poisoning remains a major cause of death among patients with acute poisoning in Asia[1] and its mortality is as high as 80%. [2] PQ is absorbed mainly through the intestinal tract, its plasma level peaked within 4 hours after oral administration. PQ extensively accumulates in the whole body, but is mainly stored in the lung and stomach where it is retained even the blood concentration decreases, finally is excreted by the kidney.…”

Section: Introductionmentioning

confidence: 99%

Therapeutic effects of smecta or smectite powder on rats with paraquat toxication

Jiang¹,

Ma²,

Wang³

et al. 2013

World Journal of Emergency Medicine

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BACKGROUND:The plasma concentration of paraquat is closely related to the prognosis of patients with paraquat toxication, and the most common cause of death from paraquat poisoning is multiple organ failure (MOF). This study aimed to evaluate therapeutic effect of smecta on the plasma concentrations of paraquat and multi-organ injury induced by paraquat intoxication in rats.METHODS:A total of 76 healthy adult SD rats were randomly divided into group A (control group, n=6), group B (poisoned group, n=30) and group C (smecta-treated group, n=30). Rats in groups B and C were treated intragastrically with PQ at 50 mg/kg, and rats in group A was treated intragastrically with saline (1 mL). Rats in group C were given intragastrically smecta at 400 mg/kg 10 minutes after administration of PQ, while rats in other two groups were treated intragastrically with 1 mL saline at the same time. Live rats in groups B and C were sacrificed at 2, 6, 24, 48, 72 hours after administration of PQ for the determination of paraquat plasma concentrations and for HE staining of the lung, stomach and jejunum. The rats were executed at the end of trial by the same way in group A.RESULTS:The plasma concentration of paraquat (ng/mL) ranged from 440.314±49.776 to 4320.6150±413.947. Distinctive pathological changes were seen in the lung, stomach and jejunum in group B. Lung injuries deteriorated gradually, edema, leukocyte infiltration, pneumorrhagia, incrassated septa and lung consolidation were observed. Abruption of mucosa, hyperemic gastric mucosa and leukocyte infiltration were obvious in the stomach. The hemorrhage of jejunum mucosa, the abruption of villus, the gland damage with the addition of inflammatory cell infiltration were found. Compared to group B, the plasma concentration of paraquat reduced (P<0.01) and the pathological changes mentioned above were obviously alleviated in group C (P<0.05, P<0.01).CONCLUSION:Smecta reduced the plasma concentration of paraquat and alleviated pathologic injury of rats with PQ poisoning.

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Repeated pulse of methylprednisolone and cyclophosphamide with continuous dexamethasone therapy for patients with severe paraquat poisoning

Abstract: The novel anti-inflammatory therapy reduces the mortality rate for patients with severe paraquat poisoning.

Cited by 114 publications

References 23 publications

Intoxicação grave por paraquat: achados clínicos e radiológicos em um sobrevivente

Intoxicação grave por paraquat: achados clínicos e radiológicos em um sobrevivente

Delayed immunosuppressive treatment in life-threatening paraquat ingestion: A case report

Therapeutic effects of smecta or smectite powder on rats with paraquat toxication

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