NITRIC-OXIDE INHALATION FOR PARAQUAT-INDUCED LUNG INJURY

Background: When ingested, concentrated paraquat can cause either rapi d death from multisystem failure and cardiovascular shock or delayed d eath from progressive pulmonary fibrosis. Diquat ingestion does not us ually cause pulmonary fibrosis, but produces early onset acute renal f ailure. Case Report: A 52-year-old male ingested approximately 50 mt o f a solution containing 13% paraquat and 7% diquat (about 6650 mg of p araquat and 3500 mg of diquat), and subsequently developed adult respi ratory distress syndrome and pulmonary fibrosis. Survival prediction e mploying the criteria of Hart et al. for paraquat plasma levels was 30 %, From the probable amount of paraquat ingested, severe toxicity was expected. The clinical course was not consistent with significant diqu at toxicity. Treatment included oral Fuller's earth, forced diuresis, hemofiltration, N-acetylcysteine, methylprednisolone, cyclophosphamide , vitamin E, colchicine, and delayed continuous nitric oxide inhalatio n. The patient recovered and pulmonary function was subsequently norma l. Conclusion: It is unclear which, if any, of the above treatments co ntributed to recovery, but the encouraging outcome suggests a possible benefit of nitric oxide inhalation in paraquat poisoning which deserv es further study.