J Korean Soc Clin Toxicol.  2008 Dec;6(2):130-133.

A Case of Moderate Paraquat Intoxication with Pulse Therapy in the Subacute Stage of Pulmonary Fibrosis

• Hong KH
• Jung JH
• Eo EK

Abstract

In South Korea, attempted suicide by paraquat (PQ) intoxication is fairly common, and is lethal by pulmonary fibrosis and hypoxemia. However, the treatment of PQ poisoning is primarily supportive management. To increase the survival rate associated with PQ intoxication, many treatments have been developed. Here, we treated a case of PQ intoxication with steroid pulse therapy. A 23-year-old man was admitted to the hospital because of PQ intoxication. He drank two mouthfuls of Gramoxon (24% commercial paraquat). His vital signs were stable, but he had a throat infection, and navy blue urine in the sodium dithionite test. Standard treatment, including gastric lavage with activated charcoal was performed, and emergent hemoperfusion with a charcoal filter was initiated 11 h after PQ ingestion. Pharmacotherapy was initiated 18 h after PQ ingestion with the administration of 5 mg dexamethasone. On day 10, chest PA showed pulmonary fibrosis. Therefore, we initiated steroid pulse therapy, with 1 g methylprednisolone in 100 mL of D5W administered over 1 h repeated daily for 3 days, and 1g cyclophosphamide in 100 mL of D5W administered over 1 h daily for 2 days. On day 15, dexamethasone therapy was initiated. On day 30, pulmonary fibrosis was improved. Thus, if pulmonary fibrosis becomes exacerbated after dexamethasone therapy during the subacute stage, pulse therapy with methylprednisolone and cyclophosphamide could be helpful.

Keyword

Paraquat; Pulmonary fibrosis; Steroid; Pulse therapy

MeSH Terms

Anoxia
Charcoal
Cyclophosphamide
Dexamethasone
Dithionite
Eating
Gastric Lavage
Hemoperfusion
Humans
Methylprednisolone
Mouth
Paraquat
Pharynx
Pulmonary Fibrosis
Republic of Korea
Suicide, Attempted
Survival Rate
Thorax
Vital Signs
Young Adult
Charcoal
Cyclophosphamide
Dexamethasone
Dithionite
Methylprednisolone
Paraquat