Paraquat Poisoning

Sivagami*

ANS, Nursing Department, Kauvery Hospital Salem, Tamil Nadu

*Correspondence

Abstract

Paraquat poisoning is a life-threatening condition with high mortality due to multi- organ toxicity especially pulmonary fibrosis. Early diagnosis and aggressive management are crucial. This case report highlights clinical presentation, management, and outcome of patient with paraquat ingestion.

Key words: Paraquat poisoning; Pulmonary fibrosis; Herbicide

Introduction

Paraquat is highly toxic herbicide widely used in agriculture. Even small quantities can lead to severe toxicity and death. Poisoning may occur accidentally or intentionally and primarily affects the lungs, kidneys and liver.

History

55 yrs old gentleman, History of chronic smoker / chronic alcoholic, known case of HTN on medications. Patients alleged history of consumption of paraquat around 50 ml under influence of alcohol.

Symptoms

Vomiting
Difficulty swallowing

Relevant clinical findings

Vitals

BP	140/90mmHg
PR	108 beats/min
RR	18 breaths/min
SPO2	99 % in room air

Systemic Examination

CVS	S1S2(+)
RS	B/L AE (+)
P/A	Soft
CNS	NFND

Investigation

Date	27.10.25	30.10.25	01.11.2025	04.11.25	08.11.25	10.11.25	13.11.25
WBC	7110	12150	6860	8100	18040	12820	8720
HB	17.8	15.3	15.3	14.6	14.2	13.6	12.5
Platelet	1.72	0.82	0.91	1.43	2.66	2.76	2.08
Urea	13	89	145	154	88	71	46
Creatinine	1.20	3.33	5.05	5.06	3.10	2.84	2.38
Bilirubin	0.6	1.3	1.0	1.4	1.0	0.6	0.6

X ray chest

CT chest

Patchy subpleural consolidation in medial segment of right middle lobe lung.
Few subpleural ground glass opacities in left lingula and postero basal segments of bilateral lower lobe lungs.
Bilateral minimal pleural effusion.
Multiple hypodense lesions in both lobes of liver – Likely cysts
Bilateral renal calculi. No hydronephrosis.

Diagnosis: Paraquat Poisoning

Hospital Management

Patient was evaluated on arrival in ER urine dithionite test positive, increased renal parameters and liver parameters and shifted to ICU.
Planned for hemoperfusion and 3 sessions of hemoperfusion were done. Patients started on pulse steroid (Inj. Methylprednisolone 500 mg on Day 1,2 and Day 3) and treated with IV NAC infusion, after pulse steroid 1 doses of Inj. Endoxan (Cyclophosphamide) 500 mg was given on 31.10.25. 2nd dose of Endoxan was given on 12.11.25.
Hepato and renal protective drug, Cardiologist opinion was obtained in view of AF with controlled ventricular rate and advised anticoagulant and antiarrhythmic drugs.

Nursing Managements

ABC & Vitals monitoring
Early decontamination (Charcoal)
Early decontamination (Charcoal)
Strict I/O labs monitoring
Watch lungs & Kidneys
Give prescribed drugs

Outcome: Patient condition improved

Discharge

Discharged with stable vitals.
Advised follow-up for lung function monitoring

Discussion-Medical Aspects

Paraquat toxicity causes oxidative stress leading to cellular damage, especially in lung tissue resulting in fibrosis. Early decontamination and immunosuppressive therapy may improve outcomes, but prognosis remains poor in moderate to severe poisoning.

Discussion -Nursing Aspects

Continuous monitoring of vitals and oxygen saturation
Oral care for mucosal ulcers
Strict fluid balance monitoring
Psychological support (especially in suicidal cases)
Patient and family education
Infection prevention

Conclusion

Paraquat poisoning is a medical emergency with high mortality. Early intervention, multidisciplinary care, and nursing management play a crucial role in improving patient outcomes. Now patient on regular follow up.

Patient was symptomatically improved and hence discharged with following advice.

Discharge advice

Drug name	Dose	Frequency
Tab. Mucomix	600mg	BD
Tab. Pantocid	40mg	BD(b/f)
Tab. Cardarone	100mg	BD
Tab. Prolomet -xl	25mg	1/2-0-1/2
Tab. Wysolone	40mg	OD
Tab. Shelcal	500mg	BD
Tab. Nodosis	500mg	TDS
Tab. Dabigatran	75mg	OD
Tab. Pirfenidone	400mg	TDS

Paraquat Poisoning

Paraquat Poisoning

Sivagami*

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