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      Acute kidney injury in patients with paraquat intoxication; a case report and review of the literature

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          Abstract

          Paraquat and diquat are classified as bipyridyl compounds not only leads to acute organ damage, but also to a variety of complications. Patients with severe paraquat-induced poisoning may succumb to multiple organ failure involving the circulatory and respiratory systems. Deliberate self-poisoning with paraquat continues to be a major public health concern in many developing countries. At present there is no specific antidote to paraquat poisoning, hence the need to more focus on prevention and in cases of poisoning aggressive decontamination to prevent further absorption. This article presented a 12-year-old male with acute kidney injury following the ingestion of paraquat in suicidal attempt and serves to explore the complications associated with paraquat poisoning and current recommended treatment

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          Paraquat poisonings: mechanisms of lung toxicity, clinical features, and treatment.

          R J Dinis-Oliveira, J Duarte, A. Sánchez-Navarro … (2008)
          Paraquat dichloride (methyl viologen; PQ) is an effective and widely used herbicide that has a proven safety record when appropriately applied to eliminate weeds. However, over the last decades, there have been numerous fatalities, mainly caused by accidental or voluntary ingestion. PQ poisoning is an extremely frustrating condition to manage clinically, due to the elevated morbidity and mortality observed so far and due to the lack of effective treatments to be used in humans. PQ mainly accumulates in the lung (pulmonary concentrations can be 6 to 10 times higher than those in the plasma), where it is retained even when blood levels start to decrease. The pulmonary effects can be explained by the participation of the polyamine transport system abundantly expressed in the membrane of alveolar cells type I, II, and Clara cells. Further downstream at the toxicodynamic level, the main molecular mechanism of PQ toxicity is based on redox cycling and intracellular oxidative stress generation. With this review we aimed to collect and describe the most pertinent and significant findings published in established scientific publications since the discovery of PQ, focusing on the most recent developments related to PQ lung toxicity and their relevance to the treatment of human poisonings. Considerable space is also dedicated to techniques for prognosis prediction, since these could allow development of rigorous clinical protocols that may produce comparable data for the evaluation of proposed therapies.
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            Role of antioxidants in paraquat toxicity.

            Z Suntres (2002)
            Paraquat, a quarternary nitrogen herbicide, is a highly toxic compound for humans and animals and many cases of acute poisoning and death have been reported over the past few decades. The mechanisms of paraquat toxicity involve: the generation of the superoxide anion, which can lead to the formation of more toxic reactive oxygen species, such as hydrogen peroxide and hydroxyl radical; and the oxidation of the cellular NADPH, the major source of reducing equivalents for the intracellular reduction of paraquat, which results in the disruption of important NADPH-requiring biochemical processes. The major cause of death in paraquat poisoning is respiratory failure due to an oxidative insult to the alveolar epithelium with subsequent obliterating fibrosis. Management of paraquat poisoning has remained mostly supportive and has been directed towards the modification of the toxicokinetics of the poison. Currently, there are no true pharmacological antagonists for paraquat and there are no chelating agents capable of binding the poison in the blood or other tissues. Recognizing the fact that paraquat induces its toxic effects via oxidative stress-mediated mechanisms, innovations in the management of paraquat poisoning are directed towards the use of antioxidants. In this review, the status of antioxidants in ameliorating or treating the toxic effects produced by paraquat is presented.
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              Improved survival in severe paraquat poisoning with repeated pulse therapy of cyclophosphamide and steroids.

              Ja-Liang Lin, Dan-Tzu Lin-Tan, Kuan-Hsing Chen … (2011)
              To clarify the efficacy of repeated methylprednisolone (MP) and cyclophosphamide (CP) pulse therapy and daily dexamethasone (DEX) therapy in patients with severe paraquat (PQ) poisoning. A total of 111 patients with severe PQ poisoning and dark-blue color in urine tests within 24 h of intoxication were included prospectively. The control group consisted of 52 patients who were admitted between 1998 and 2001 and who received high doses of CP (2 mg/kg per day) and DEX (5 mg every 6 h) for 14 days. The study group consisted of 59 patients who were admitted from 2002 to 2007 and who received initial MP (1 g) for 3 days and CP (15 mg/kg per day) for 2 days, followed by DEX (5 mg every 6 h) until a PaO(2) of >80 mmHg had been achieved, or treated with repeated 1 g MP for 3 days and 1 g CP for 1 day if the PaO(2) was <60 mmHg. There were no differences between the two groups with regard to baseline data and plasma PQ levels. The study group patients had a lower mortality rate (39/59, 66%) than the control group patients (48/52, 92%; P=0.003, log-rank test). Multivariate Cox regression analysis revealed that the repeated pulse therapy was correlated with decreased hazard ratios (HR) for all-cause mortality (HR=0.50, 95% CI 0.31-0.80; P=0.004) and death from lung fibrosis-related hypoxemia (HR=0.10, 95% CI 0.04-0.25; P<0.001) in severely PQ-intoxicated patients. Repeated pulses of CP and MP, rather than high doses of CP and DEX, may result in a lower mortality rate in patients with severe PQ poisoning. © Copyright jointly held by Springer and ESICM 2011
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                Author and article information

                Journal
                Journal ID (nlm-ta): J Renal Inj Prev
                Journal ID (iso-abbrev): J Renal Inj Prev
                Journal ID (publisher-id): J Renal Inj Prev
                Journal ID (publisher-id): JRIP
                Title: Journal of Renal Injury Prevention
                Publisher: Nickan Research Institute
                ISSN (Electronic): 2345-2781
                Publication date Collection: 2016
                Publication date (Electronic): 03 August 2016
                Volume: 5
                Issue: 4
                Pages: 203-206
                Affiliations
                1Division of Nephrology, Department of Pediatrics, Guilan University of Medical Sciences, Rasht, Iran
                2Resident of Pediatrics , Guilan University of Medical Sciences, Rasht, Iran
                Author notes
                [* ] Corresponding author: Afshin Safaei Asl, afshin_safaei2@ 123456yahoo.com
                Article
                DOI: 10.15171/jrip.2016.43
                PMC ID: 5039990
                PubMed ID: 27689124
                SO-VID: 5d42d7a0-1f65-4f06-a98e-13f4512da475
                Copyright © Copyright © 2016 The Author(s); Published by Nickan Research Institute
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 30 April 2016
                Date accepted : 09 July 2016
                Page count
                Figures: 3, Tables: 1, References: 16, Pages: 4
                Categories
                Subject: Case Report

                Keywords: paraquat,poisoning,suicide,acute kidney injury
                Data availability:
                Keywords: paraquat, poisoning, suicide, acute kidney injury

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