Spectrum of toxic hepatitis following intentional paraquat ingestion: analysis of 187 cases

Yang, Chin-Jung; Lin, Jing; Lin-Tan, Dan-Tzu; Weng, Cheng‐Hao; Hsu, Ching‐Wei; Lee, Shen‐Yang; Lee, Shwu-Hua; Chang, Chia‐Ming; Lin, Wey‐Ran; Yen, Tzung‐Hai

doi:10.1111/j.1478-3231.2012.02829.x

Cited by 63 publications

(54 citation statements)

References 35 publications

(58 reference statements)

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“…Limitations of the APACHE II system, including reduced applicability in patients with more severe disease, may contribute to this difference (21). and APACHE II scoring does not include parameters reflecting liver damage, which is a major complication in PQ poisoning (15). Therefore, evaluation of APACHE II score is complex and not advisable for typical hospital inpatients (20).…”

Section: Discussionmentioning

confidence: 99%

“…Selection criteria were as follows: i) Patients were selected according to the diagnostic criteria of acute PQ poisoning in The Diagnosis and Treatment of Acute Poisoning (15), and clinical diagnostic results were available; ii) patients were treated within 24 h after poisoning, and there was evidence of PQ poisoning or circumstantial evidence of PQ poisoning provided by patients or caregivers; iii) patients had not received therapy before admission to the hospital, including blood purification treatment or gastric lavage; and iv) patients had no history of serious heart, liver, kidney and lung diseases. Exclusion criteria were: i) Patients had a history of chronic kidney disease; ii) PQ combined with other drug poisoning; iii) emergency observation was no more than 24 h; iv) patients were admitted 24 h after they took poison; and v) pregnant women, patients that gave up therapy or died due to reasons unrelated to PQ poisoning.…”

Section: Methodsmentioning

confidence: 99%

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Predictive values of urine paraquat concentration, dose of poison, arterial blood lactate and APACHE II score in the prognosis of patients with acute paraquat poisoning

Liu

et al. 2017

Experimental and Therapeutic Medicine

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The present study investigated the predictive values of urine paraquat (PQ) concentration, dose of poison, arterial blood lactate and Acute Physiology and Chronic Health Evaluation (APACHE) II score in the prognosis of patients with acute PQ poisoning. A total of 194 patients with acute PQ poisoning, hospitalized between April 2012 and January 2014 at the First Affiliated Hospital of P.R. China Medical University (Shenyang, China), were selected and divided into survival and mortality groups. Logistic regression analysis, receiver operator characteristic (ROC) curve analysis and Kaplan-Meier curve were applied to evaluate the values of urine paraquat (PQ) concentration, dose of poison, arterial blood lactate and (APACHE) II score for predicting the prognosis of patients with acute PQ poisoning. Initial urine PQ concentration (C0), dose of poison, arterial blood lactate and APACHE II score of patients in the mortality group were significantly higher compared with the survival group (all P<0.05). Logistic regression analysis revealed that C0, dose of poison and arterial blood lactate correlated with mortality risk of acute PQ poisoning (all P<0.05). ROC curve analysis suggested that the areas under the curve (AUC) values of C0, dose of poison, arterial blood lactate and APACHE II score in predicting the mortality of patients within 28 days were 0.921, 0.887, 0.808 and 0.648, respectively. The AUC of C0 for predicting early and delayed mortality were 0.890 and 0.764, respectively. The AUC values of urine paraquat concentration the day after poisoning (Csec) and the rebound rate of urine paraquat concentration in predicting the mortality of patients within 28 days were 0.919 and 0.805, respectively. The 28-day survival rate of patients with C0 ≤32.2 µg/ml (42/71; 59.2%) was significantly higher when compared with patients with C0 >32.2 µg/ml (38/123; 30.9%). These results suggest that the initial urine PQ concentration may be the optimal index for predicting the prognosis of patients with acute PQ poisoning. Additionally, dose of poison, arterial blood lactate, Csec and rebound rate also have referential significance.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Predictive values of urine paraquat concentration, dose of poison, arterial blood lactate and APACHE II score in the prognosis of patients with acute paraquat poisoning

Liu

et al. 2017

Experimental and Therapeutic Medicine

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“…The collected data include laboratory examinations, amount of paraquat ingested, time elapsed between ingestion and hospital arrival, severity index of paraquat poisoning (SIPP; the product of plasma-paraquat level in milligrams per litre and time from paraquat intake to arrival in hours) [20], [21], pulse therapy regimen, and treatment outcome [22]. The inclusion/exclusion criteria and detoxification protocol (including gastric lavage, haemoperfusion and repeated pulse of methylprednisolone and cyclophosphamide with continuous dexamethasone therapy) for paraquat poisoning patients are described elsewhere [22]. In brief, we included patients aged 18 years or older admitted due to paraquat intoxication with detectable paraquat blood or urine level.…”

Section: Methodsmentioning

confidence: 99%

Psychiatric Comorbidity and Its Impact on Mortality in Patients Who Attempted Suicide by Paraquat Poisoning during 2000–2010

et al. 2014

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BackgroundParaquat poisoning is a lethal method of suicide used around the world. Although restricting its accessibility had been widely discussed, the underlying psychopathological mechanism of paraquat self-poisoning and its association with mortality have not yet been explicitly evaluated.MethodsWe included all patients admitted to a tertiary general hospital in Taiwan between 2000 and 2010 following a suicide attempt by paraquat self-administration. Diagnoses were made upon psychiatric consultation based on the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria. The risk of mortality was calculated by logistic regression with various psychiatric or medical covariates.ResultsThe consultation-liaison psychiatry team assessed 157 patients who attempted suicide by paraquat poisoning. Mood disorders (54.0%), including dysthymic (26.7%) and major depressive disorders (24.7%), were the most common psychiatric diagnoses among the self-poisoning patients. Among those who attempted suicide, 87 patients (58.0%) died and dysthymic disorder (OR = 5.58, 95% CI: 1.13–27.69; p<0.05) significantly increased the mortality risk after adjustment for relevant medical variables, including age, gender, severity index of paraquat poisoning (SIPP), and risk for respiratory failure.ConclusionsAwareness of comorbid psychiatric illnesses, especially dysthymic disorder, is vital in the prevention and treatment of suicide by paraquat poisoning.

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“…Paraquat (N,N′-dimethyl-4,4′-bipyridinium dichloride; PQ), an effective herbicide that has favorable environmental characteristics, as well as being cost-effective, was first synthesized in 1882 and has been used as an herbicide since 1955 (1). PQ is an important herbicide used in agriculture; however, thousands of individuals succumb due to PQ intoxication every year in the developing world.…”

Section: Introductionmentioning

confidence: 99%

A case report of acute severe paraquat poisoning and long-term follow-up

Kan

Jian

et al. 2014

Experimental and Therapeutic Medicine

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In the present study, the successful management of severe paraquat (PQ) poisoning with multiple organ dysfunction syndrome is described. A 42-year-old female ingested >100 ml PQ (20% weight/volume) in an attempted suicide. After 22 h the patient was admitted to hospital with serious liver, kidney and lung damage. Comprehensive therapy that maximized poison elimination was administered, along with appropriate glucocorticoids and medication for anticoagulation and protection of the liver and kidney. The patient was successfully treated and recovered after 40 days. However, pulmonary damage was aggravated when the glucocorticoid treatment was stopped after 2 months; the lungs recovered again following systematic therapy. Subsequent to a 8-month follow-up, the patient was able to look after herself in her daily life. To the best of our knowledge, successful treatment following severe PQ poisoning is rare.

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Spectrum of toxic hepatitis following intentional paraquat ingestion: analysis of 187 cases

Abstract: A substantial proportion of paraquat patients suffered from hepatic complication (46.52%), but the spectrum of hepatitis in these patients seemed mild and transient.

Cited by 63 publications

References 35 publications

Predictive values of urine paraquat concentration, dose of poison, arterial blood lactate and APACHE II score in the prognosis of patients with acute paraquat poisoning

Predictive values of urine paraquat concentration, dose of poison, arterial blood lactate and APACHE II score in the prognosis of patients with acute paraquat poisoning

Psychiatric Comorbidity and Its Impact on Mortality in Patients Who Attempted Suicide by Paraquat Poisoning during 2000–2010

A case report of acute severe paraquat poisoning and long-term follow-up

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