Clinical spectrum and outcome of Patients Admitted with Paraquat Poisoning in a Tertiary Care Teaching Hospital Kangra at Tanda, Himachal Pradesh

Abstract

Background: Paraquat is a herbicide commonly used for controlling weeds in India. It produces various local and systemic manifestations in the early course. It is very notorious to cause multi-organ dysfunction and mortality within 24 hours in large amount of consumption. Lack of specific antidote makes the management of paraquat poisoning challenging. Paraquat is most common insecticide compound used for suicidal consumption in rural part of the HimachalPradesh next to organo-phosphorous compound. Hence, we took up the study to evaluate the clinical features, course, management option, and outcome of the poisoning .

Aim: To study the clinical spectrum and outcome of paraquat poisoning in tertiary care centre. Materials and Methods: It is observational study conducted at Dr. RPGMC Kangra at Tanda College, A Tertiary Rural Care Centre. In this study we included the data of all patients admitted to the hospital with paraquat poisoning for a period of one-year and four months between January 2024  to May 2025.  History was collected from patients and relatives. Clinical features, laboratory parameters were noted regularly and frequently. Patient’s complications were identified initially and treated accordingly. Results: A total of 55 participants were included in the final analysis.  Ninety percent of the patients consumed paraquat with the suicidal intention . The quantity of paraquat ingested was quite varied, ranging from as low as 5ml to as high as 150ml. Out of 55 patients, 43 were males and 12 were females; most of them were in the age group of 18-55 years. Mild poisoning was noted in 10 (18.18%), moderate in 12 (21.815%) and 33 (60%) patients were severe. Most common symptom was nausea and vomiting, signs were oral cavity ulcers followed by tachycardia and tachypnea. The overall mortality was (41) 74.54%, (10) 18.18% were  recovered fully and (4) 7.5% patients referred to higher centre PGIMER Chandigarh for further management. Conclusion: Since there is a lack of antidote, management of paraquat is challenging. Early gastric lavage, aggressive fluids, IV methyl prednisolone , N-Acetyl-Cysteine  and injection cyclophosphamide is beneficial. Acute kidney injury is the major clinical outcome of paraquat poisoning other than lung injury. This may result in multiple organ dysfunction syndrome (MODS) and mortality. Paraquat poisoning  consumption is mainly with suicidal intention. Most of them were young.