SURVIVAL IN A CASE OF MASSIVE PARAQUAT INGESTION

Serious exposure to the herbicide paraquat usually results in death, e ither due to gastrointestinal caustic lesions, shock, and acute respir atory distress syndrome or related to the progressive development of p ulmonary fibrosis associated with refractory hypoxemia. We report a ca se of suicidal paraquat ingestion in a 59-year-old man. Most of the in dicators of poor prognosis were encountered in this patient. Treatment consisted of early digestive decontamination and hemodialysis, follow ed by antioxidant therapy, including the administration of deferoxamin e (100 mg/kg in 24 h) and a continuous infusion of acetylcysteine (300 mg/kg/d during 3 weeks). The patient only developed a nonoliguric acu te renal failure, a mild alteration of liver tests, and an impairment of CO transfer factor without any respiratory complaint. Renal and hep atic disturbances completely resolved within 1 month, whereas CO trans fer factor remained altered 14 months later. This observation suggests that early administration of an antioxidant therapy, including defero xamine and acetylcysteine could be usefully associated with measures t hat prevent digestive absorption or enhance elimination to limit syste mic toxicity in potentially fatal paraquat poisoning.