Massive paraquat poisoning. Successful treatment with n-acetylcysteine andearly haemodialysis.

Case report of a 30-year-old patient, admitted one hour after an intentiona l ingestion of paraquat (60 g). The initial treatment included gastric wash ing, parenteral n-acetylcysteine and forced diuresis, Considering the sever ity of the intoxication, conventional haemodialysis was started four hours after the ingestion. Plasma concentrations of paraquat, in the lethal range at admission, decreased rapidly and significantly after haemodialysis. Thi s case raises the question of the part played by n-acetylcysteine and haemo dialysis respectively in a favourable outcome. As the determination of para quat blood concentrations requires some delay, these data are of no help fo r therapeutic decisions. Therefore, in cases of massive poisoning or uncert ainty of the ingested dose, a technique of blood purification in indicated. Charcoal haemoperfusion is the most efficient, however conventional haemod ialysis, which is more widespread, should be considered if the former is no t available. (C) 1999 Elsevier, Paris.