Fatal paraquat poisoning: a case report and literature review on rapid deterioration and therapeutic challenges.

INTRODUCTION AND

IMPORTANCE

Paraquat (PQ) poisoning is a life-threatening condition with a high-mortality rate. As it lacks a specific antidote, treatment is mainly supportive, focusing on reducing oxidative damage and organ dysfunction. Despite aggressive intervention, the condition can rapidly progress to multiorgan failure. This report presents a fatal case of PQ poisoning, highlighting its clinical course and management challenges.

CASE PRESENTATION: A 45-year-old female ingested 10 mL of 20% PQ, presenting with vomiting, dizziness, and generalized body aches. At presentation, she was alert, with stable vital signs and no significant findings. Immediate treatment, including gastric lavage, activated charcoal, corticosteroids, antioxidants, and monitoring of renal and hepatic function, was initiated. On Day 2, her condition deteriorated with jaundice, respiratory distress, and PQ-induced tongue ulcers. Lab results showed worsening renal and hepatic dysfunction. She received cyclophosphamide, N-acetylcysteine, and heparin-free hemodialysis, but her condition continued to decline, leading to multiorgan failure. She succumbed to her condition on the fourth day.

CLINICAL DISCUSSION: PQ toxicity causes oxidative stress, resulting in rapid progression to multiorgan failure. Early decontamination and supportive care are key, but no curative treatment exists. The rapid progression and limited effectiveness of current therapies make management difficult.

CONCLUSION

PQ poisoning remains a critical medical emergency with a high-mortality rate. Timely recognition, aggressive supportive care, and further research into novel detoxification and therapeutic strategies are essential to improving survival outcomes. Additionally, public health measures, including stricter regulations and increased awareness regarding PQ's toxicity, are crucial in preventing future cases.