Paraquat Poisoning (Lethal Herbicide):A Rare Case Report
Abstract
Paraquat, chemically 1, 1’ dimethyl-4-4’-bipyridinium, is a green colored herbicide. It is one of the most lethal herbicide and is hazardous in very small quantities. More than 93% of deaths by paraquat are suicidal in nature. Poisoning by paraquat is commoner in developing countries because of agriculture based economy. The presentation of paraquat poisoning varies from case to case and depends on the amount consumed. As the compound is highly lethal, an early suspicion & management is must to prevent complications. Present case is of paraquat poisoning with full blown early picture of mucosal ulceration, pneumonitis and acute kidney injury which later on complicated in esophageal perforation, pneumothorax and pneumomediastinum.
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Introduction
Paraquat is a green colored, liquid corrosiveand have aromatic odour. It is bipyridal herbicide, chemically 1, 1’ dimethyl-4-4’-bipyridinium, and is a contact poison. At present it is the second highest selling herbicide globally, available in 20% solution and needs dilution before use1 . Most of the adult cases of poisoning are suicidal in nature. It acts by inhibiting reduction of NADP to NADPH during photosynthesis. It leads to production of reactive oxygen species which in turn results in destruction of lipid membranes of organelles.
There is scarcity of case reporting on paraquat in India2 . So this rare case of adult accidental paraquat poisoning with acute and late complications was decided to report.
Conclusion
Paraquat poisoning leads to dreaded life threatening complications and has high mortality. Early presentation of patient within 6-8 hours of ingestion and lesser quantity of ingestion (20mg/kg) has better survival rates. No antidote is available till date. Early diagnosis and rigorous management is essential to save lives. Combination of supportive measures, immune suppression and antioxidant medication is the key to the management of paraquat poisoning.