Management of Paraquat Poisoning: A Comprehensive Approach
Paraquat poisoning requires immediate and specialized treatment with oxygen restriction to 85-88% saturation, gastrointestinal decontamination, and consideration of hemoperfusion or hemodialysis for severe cases. Early intervention is critical as there is no specific antidote, and mortality rates are extremely high.
Initial Assessment and Protective Measures
- Healthcare provider safety first: Wear appropriate protective equipment including gloves when handling patients with paraquat poisoning to prevent secondary exposure 1
- Recognize paraquat poisoning: Symptoms include caustic burns in upper digestive tract, respiratory distress, and multi-organ failure
- Obtain plasma paraquat concentration if available - this is the most important prognostic indicator 2
Immediate Interventions
Oxygen Management (Critical)
- Target oxygen saturation of 85-88% - this is specifically recommended for paraquat poisoning 1
- Avoid supplemental oxygen unless saturation falls below 85% as oxygen may worsen lung injury through free radical formation 1, 2
- Monitor oxygen saturation continuously
Gastrointestinal Decontamination
- Administer Fuller's earth or activated charcoal immediately if within 1-2 hours of ingestion 2
- Consider gastric lavage only if very recent ingestion (within 1 hour) and airway is protected
Specific Therapeutic Measures
Extracorporeal Elimination
- Hemoperfusion should be initiated as early as possible, ideally within the first few hours after ingestion 2, 3
- Hemodialysis may be considered if hemoperfusion is not available, though it's less effective 2
Antioxidant Therapy
- Consider administration of:
Immunosuppressive Therapy
- Glucocorticoids may help reduce inflammatory response and pulmonary fibrosis 5
- Caution: Pulmonary damage may worsen when glucocorticoid treatment is stopped 5
Supportive Care
- Fluid resuscitation to maintain adequate renal perfusion
- Monitor for and treat renal failure - non-oliguric renal failure is common
- Hepatic support as liver damage is frequently observed
- Respiratory support without excessive oxygen supplementation
Monitoring and Follow-up
- Regular assessment of organ function:
- Renal function tests
- Liver function tests
- Pulmonary function tests including CO transfer factor
- Long-term follow-up is essential as pulmonary fibrosis may develop or worsen weeks after exposure 5
Prognosis
- Mortality is extremely high (up to 95%) with significant ingestions 6
- Poor prognostic indicators include:
- High plasma paraquat concentration
- Presence of caustic burns in upper digestive tract
- Development of renal failure
- Respiratory distress
Special Considerations
- Consult with regional poison center or toxicologist immediately 1
- In the US, call 1-800-222-1222 to reach a poison center 1
- Despite all interventions, survival in cases of significant paraquat ingestion remains poor 2, 6
Early and aggressive treatment focusing on preventing further absorption and enhancing elimination, while carefully managing oxygen therapy, offers the best chance for survival in this often fatal poisoning.