Paraquat poisoning: Acute lung injury - a missed diagnosis

Paraquat is a herbicide of great toxicological importance because it is associated with high mortality rates, mainly due to respiratory failure. We report the case of a 28-year-old man admitted to the casualty department at Ngwelezana Hospital, Empangeni, KwaZulu-Natal, South Africa, with a history...

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Published inSouth African medical journal Vol. 107; no. 5; pp. 399 - 401
Main Authors Ntshalintshali, Sipho D, Manzini, Thandekile C
Format Journal Article
LanguageEnglish
Published South Africa South African Medical Association 01.05.2017
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Abstract Paraquat is a herbicide of great toxicological importance because it is associated with high mortality rates, mainly due to respiratory failure. We report the case of a 28-year-old man admitted to the casualty department at Ngwelezana Hospital, Empangeni, KwaZulu-Natal, South Africa, with a history of vomiting and abdominal pain after ingestion of ~100 mL of an unknown substance, later identified as paraquat, together with an unknown amount of alcohol, in a suicide attempt. He developed respiratory distress associated with lung parenchymal infiltrates that required ventilatory support and later a spontaneous pneumothorax, and died in the intensive care unit. We discuss the importance of a high index of suspicion of paraquat poisoning in rural areas, where paraquat is readily available as a herbicide on farms, in patients with a similar presentation. We further stress the importance of identifying the classic radiological progression after paraquat poisoning, to help avoid a delay in diagnosis if the culprit substance is not known (as happened in our case). Lastly, we look at the importance of avoiding oxygen supplementation, and early administration of immunosuppressive therapy, to improve outcome.
AbstractList Paraquat is a herbicide of great toxicological importance because it is associated with high mortality rates, mainly due to respiratory failure. We report the case of a 28-year-old man admitted to the casualty department at Ngwelezana Hospital, Empangeni, KwaZulu-Natal, South Africa, with a history of vomiting and abdominal pain after ingestion of ~100 mL of an unknown substance, later identified as paraquat, together with an unknown amount of alcohol, in a suicide attempt. He developed respiratory distress associated with lung parenchymal infiltrates that required ventilatory support and later a spontaneous pneumothorax, and died in the intensive care unit. We discuss the importance of a high index of suspicion of paraquat poisoning in rural areas, where paraquat is readily available as a herbicide on farms, in patients with a similar presentation. We further stress the importance of identifying the classic radiological progression after paraquat poisoning, to help avoid a delay in diagnosis if the culprit substance is not known (as happened in our case). Lastly, we look at the importance of avoiding oxygen supplementation, and early administration of immunosuppressive therapy, to improve outcome.
Author Manzini, Thandekile C
Ntshalintshali, Sipho D
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SubjectTerms Acute Lung Injury - chemically induced
Acute Lung Injury - diagnostic imaging
Adult
Diagnostic Errors
Disease Progression
Eating
Fatal Outcome
Herbicides - poisoning
Humans
Intensive Care Units
Lung injury
Male
Paraquat - poisoning
Paraquat toxicity
Pneumothorax - chemically induced
Pneumothorax - diagnostic imaging
Radiography, Thoracic
Radiological progression
Respiratory Distress Syndrome, Adult - chemically induced
Respiratory Distress Syndrome, Adult - diagnosis
South Africa
Suicide
Title Paraquat poisoning: Acute lung injury - a missed diagnosis
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