Paraquat poisoning, what we should know
A review article
Keywords:
paraquat, paraquat poisoning, edavarone, perfenidoneAbstract
Paraquat (PQ) a brown syrupy liquid also known as methyl viologen is a commonly used herbicide in India. A highly toxic compound to humans, although, a large majority of fatalities from PQ poisoning are suicides. Accidental exposure is causing immense harm to farmers and agriculture workers, which is not documented. Accidental or deliberate ingestion has an extremely high case-fatality rate, and clinical features are due to generating reactive oxygen species which cause cellular damage ultimately leading to multiorgan failure. At present there is no antidote to PQ poisoning, various treatment modalities from immunosuppressants to antioxidants are used with no clear clinical efficacy. Elimination methods such as haemodialysis and haemoperfusion when done early have shown to be useful in few studies. Recently drug-like Edaravone and Perfenidone are being used but with no survival benefit. Neither proper information nor training on the use of PQ and personal protective equipment are provided by agriculture offices to farmers leading to accidental exposure. Hence paraquat use has been restricted in many parts of the world and an appeal for a ban in India is underway as a need for preventive measures.
Downloads
References
Dileep kumar A D. Conditions Of Paraquat Use In India [ e-book]. India: PAN Asia Pacific 2015 [2015 april]. Available from: https://www.iuf.org/wp-content/uploads/attachments/Joint%20paraquat%20study%20India_0.pdf
Raghu, Kondle et al. “Paraquat poisoning: A case report and review of literature.” Journal of family & community medicine vol. 20,3 (2013): 198-200. doi:10.4103/2230-8229.122023
3.B Somu, S Halkur Shankar, U Baitha, A Biswas, Paraquat poisoning, QJM: An International Journal of Medicine, Volume 113, Issue 10, October 2020, Page 752, https://doi.org/10.1093/qjmed/hcaa009
Sukumar, Cynthia A et al. “Paraquat: The Poison Potion.” Indian journal of critical care medicine : peer-reviewed, official publication of Indian Society of Critical Care Medicine vol. 23,Suppl 4 (2019): S263-S266. doi:10.5005/jp-journals-10071-23306
Hoet PH, Nemery B. Polyamines in the lung: polyamine uptake and polyamine-linked pathological or toxicological conditions. Am J Physiol Lung Cell Mol Physiol. 2000;278(3):L417–L433. doi: 10.1152/ajplung.2000.278.3.L417.
Delirrad M, Majidi M, Boushehri B. Clinical features and prognosis of paraquat poisoning: a review of 41 cases. Int J Clin Exp Med. 2015;8(5):8122-8128. Published 2015 May 15.
Gawarammana IB, Buckley NA. Medical management of paraquat ingestion. Br J Clin Pharmacol. 2011;72:745–757.
Bismuth C, Garnier R, Dally S, Fournier PE, Scherrmann JM.Prognosis and treatment of paraquat poisoning: a review of 28 cases. J Toxicol Clin Toxicol 1982; 19:461–74.
L.L. Smith, Mechanism of Paraquat Toxicity in Lung and its Relevance to Treatment ; Human Toxicology, 1987, 6 (1), : 31-36
10.T J Meredith et al, Treatment of paraquat poisoning in man: methods to prevent absorption, Hum Toxicol. 1987 Jan;6(1):49-55.
Ravichandran R, Amalnath D, Shaha KK, Srinivas BH. Paraquat Poisoning: A Retrospective Study of 55 Patients From a Tertiary Care Center in Southern India. Indian J Crit Care Med. 2020;24(3):155-159. doi:10.5005/jp-journals-10071-23369
Sabzghabaee A M et al. Fatality in paraquat poisoning. Singapore Med J 2010; 51(6) : 496
Lee HL, Lin HJ, Yeh ST, Chi CH, Guo HR. Presentations of patients of poisoning and predictors of poisoning-related fatality: findings from a hospital-based prospective study. BMC Public Health 2008; 8:7.
Jyothsna P, Vinapamula KS. Urine sodium dithionite test: A useful clinical test for paraquat poisoning. J Clin Sci Res [serial online] 2020 [cited 2022 Apr 1];9:184-5. Available from: https://www.jcsr.co.in/text.asp?2020/9/3/184/298948
Eddleston M, Juszczak E, Buckley NA, Senarathna L, Mohamed F, Dissanayake W, Hittarage A, Azher S, Jeganathan K, Jayamanne S, Sheriff MR, Warrell DA. Multiple-dose activated charcoal in acute self-poisoning: a randomised controlled trial. Lancet. 2008;371:579–87.
Rao, Raghavendra et al. “Golden Hours in Severe Paraquat Poisoning-The Role of Early Haemoperfusion Therapy.” Journal of clinical and diagnostic research : JCDR vol. 11,2 (2017): OC06-OC08. doi:10.7860/JCDR/2017/24764.9166
Hampson EC, Pond SM. Failure of hemoperfusion and hemodialysis to prevent death in paraquat poisoning - a retrospective review of 42 patients. Med Toxicol Adv Drug Exp. 1988;3(1):64–71
Dinis-Oliveira RJ, Duarte JA, Sánchez-Navarro A, Remião F, Bastos ML, Carvalho F. Paraquat poisonings: mechanisms of lung toxicity, clinical features, and treatment. Crit Rev Toxicol. 2008;38(1):13–71. doi: 10.1080/10408440701669959. DOI:
Hong SY, Yang JO, Lee EY, Kim SH. Effect of haemoperfusion on plasma paraquat concentration in vitro and in vivo. ToxicolInd Health. 2003;19(1):17–23
Khazraei, S., Marashi, S.M. & Sanaei-Zadeh, H. Ventilator settings and outcome of respiratory failure in paraquat-induced pulmonary injury. Sci Rep 9, 16541 (2019). https://doi.org/10.1038/s41598-019-52939-3
Kang SA, Jang YJ, Park H. In vivo dual effects of vitamin C on paraquat-induced lung damage: dependence on released metals from the damaged tissue. Free Radic Res. 1998;28:93–107
Narendra S. S et al. "Paraquat Poisoning: A Case Series in South India", International Journal of Science and Research (IJSR), https://www.ijsr.net/get_abstract.php?paper_id=SUB15247, Volume 4 Issue 1, January 2015, 561 – 564
Li LR, Sydenham E, Chaudhary B, Naser KA, Jeganathan K, Munasinghe A, et al. Glucocorticoid with cyclophosphamide for paraquat-induced lung fibrosis. Cochrane Database Syst Rev. 2014:8. doi: 10.1002/14651858.CD008084.pub4:CD008084.
24.Gawarammana IB, Buckley NA, Mohamed F, Naser KA, Jeganathan K, Munasinghe A, et al. A randomised controlled trial of high-dose immunosuppression in paraquat poisoning. Clin Toxicol. 2012;50(4):278.
Yi R, Zhizhou Y, Zhaorui S et al. Retrospective study of clinical features and prognosis of edaravone in the treatment of paraquat poisoning. Medicine. 2019;98(19):e15441. doi: 10.1097/MD.0000000000015441. DOI:
Ren W et al. Inhibitory effect of pirfenidone on pulmonary fibrosis in patients with acute paraquat poisoning. Am J Transl Res. 2021; 13(11):13192-13199.
Banjot Kaur. There’s no antidote to paraquat herbicide, ban it: Odisha docs to govt.DownToEarth.2019.9.17:Available at https://www.downtoearth.org.in/news/agriculture/there-s-no-antidote-to-paraquat-herbicide-ban-it-odisha-docs-to-govt-66779
Berry C, La Vecchia C, Nicotera P. Paraquat and Parkinson's disease. Cell Death Differ. 2010 Jul;17(7):1115-25. doi: 10.1038/cdd.2009.217. Epub 2010 Jan 22. PMID: 20094060.
Published
How to Cite
Issue
Section
Copyright (c) 2022 International journal of health sciences
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Articles published in the International Journal of Health Sciences (IJHS) are available under Creative Commons Attribution Non-Commercial No Derivatives Licence (CC BY-NC-ND 4.0). Authors retain copyright in their work and grant IJHS right of first publication under CC BY-NC-ND 4.0. Users have the right to read, download, copy, distribute, print, search, or link to the full texts of articles in this journal, and to use them for any other lawful purpose.
Articles published in IJHS can be copied, communicated and shared in their published form for non-commercial purposes provided full attribution is given to the author and the journal. Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgment of its initial publication in this journal.
This copyright notice applies to articles published in IJHS volumes 4 onwards. Please read about the copyright notices for previous volumes under Journal History.
