Paraquat fulminant poisoning: Case report

Abstract

Paraquat is one of the most widely used non-selective herbicides in the world, however, it is prohibited in many countries due to its high toxicity and mortality rate. Herein, we present a case of fulminant PQ poisoning in a 21 years-old woman with a six weeks pregnancy, and a history of sexual abuse and rape; computed tomography showed disseminated micronodular alveolar infiltrates and septal thickening. It rapidly progressed to severe acute respiratory distress syndrome, requiring endotracheal intubation; however, paraquat is known to generate reactive oxygen species that cause cell damage through lipid peroxidation, mitochondrial activation, and apoptosis following oxygen exposure. Therefore, in these cases, the line between the risk and benefit of oxygen therapy is very thin. Despite receiving timely treatment, the serious hemodynamic and respiratory deterioration evolved into multiple organ failure and later the death of the patient. Paraquat poisoning severe intoxication has a dim prognosis, although early diagnosis results in therapeutic challenge due to severe respiratory compromise. We also present a brief review of the literature, as well as a discussion of the treatment for paraquat fulminant poisoning.