COMPARISION OF CLINICAL OUTCOME OF PARAQUAT POISONING IN PATIENTS

TREATED WITH & WITHOUT

METHYLPREDNISOLONE HARIKRISHNA ANNAM

POST GRADUATEKAKATIYA MEDICAL COLLEGE

INTRODUCTION Paraquat (1,1 dimethyl-4,4’-bipyridylium

dichloride) is a herbicide with a good occupational safety record, but has high mortality after intentional ingestion which is refractory to treatment.

Little recent published data are available regarding the clinical manifestations , treatment and outcome in patients who have consumed paraquat.

MATERIALS & METHODS Retrospective and prospective case record

review of 46 cases of paraquat poisoning admitted in MGMH, Warangal during the period may 2012– may 2015.

All the cases had gastric lavage with charcoal and haemodialysis , ventilator support was instituted accordingly in the patients as needed.

Out of 46 patients 20 were treated with methylprednisolone.

RESULTS

Among the 46 patients there were 22 males and 24 females.

Mean age was 32±(14.02)years.

MALE48%FEMALE

52%

SEX RATIO

MALE FEMALE

RESULTS

Among the 26 patients who were not treated with methylprednisolone there were 10 males and 16 females.

MALE FEMALE0

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4

6

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12

14

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10

13

0

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Chart Title

Alive Dead LAMA

RESULTS

Among the 20 patients who were treated with methylprednisolone there were 12 males and 8 females.

MALE FEMALE0

1

2

3

4

5

6

7

8

2

3

8

3

2 2

Alive Dead LAMA

COMPLICATIONS Among the 46

patients, 33 patients(71.7%) had Acute Kidney Injury (AKI), 28 patients (60.8%) had respiratory failure and 17 patients (36.9%) developed hepatitis.

33

28

17

COMPLICATIONS

AKI RESPIRATORY FAILUREHEPATITIS

COMPARISION OF COMPLICATIONS IN BOTH

GROUPS In the intervention group, 13(65%) had AKI,10(50%) had respiratory failure, 11(55%) developed hepatitis.

In patients who were not treated with methylprednisolone, 20(76.9%) had AKI,18(69.2%) had respiratory failure,6(23%) developed hepatitis.

MP given No MP0

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25

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AKI HepatitisRespiratory failure

COMPARISION OF COMPLICATIONS IN OUTCOME GROUPS Of the 6 patients who

have survived, all have developed hepatitis and 50% have developed AKI.

Of the patients who left against medical advice 66% have developed AKI & hepatitis.

Among the 34 patients who died,28(82.3%) had respiratory failure, 26(76%) had AKI & 7(20.4%) had developed hepatitis.

ALIVE DEAD LAMA0

5

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30

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26

46 7

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28

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AKI HEPATITISRESPIRATORY FAILURE

RESULTS Mean amount of poison consumed in

patients who have survived was 45ml. Mean amount of poison consumed in

patients who were deceased was 130ml. Mean time interval between poison

consumption and hospital admission in patients who survived was 3 hours.

Mean time interval between poison consumption and hospital admission in patients who deceased was 8 hours.

CONCLUSIONS Out of 46 patients , total 34 patients have

died (73.9%), 6 have survived(13.04%) and 6 have left against medical advice (13.04%).

Among the patients treated with methylprednisolone 11 (55%) have died, 5(25%) have survived and 4 (20%) have left against medical advice.

Among non intervention group, 23(88.4%) have died, 1(3%) survived and 2 (7%) have left against medical advice.

CONCLUSIONS Mortality was high in patients who have `consumed greater than 50 ml of paraquat.

Apart from the renal, hepatic and pulmonary involvement most of the patients had developedoral ulcers, gastritis and 10 patients hadseizures.

CONCLUSIONS Prognosis depends upon the amount of

poison consumed , time interval between consumption and hospital administration and initiation of methylprednisolone.

Patients who developed respiratory failure have died invariably.

Hepatitis was noted more in patients who were treated with methylprednisolone.

CONCLUSIONS AKI was the most common complication.

Any patient presenting with unexplained AKI, paraquat poisoning could be considered in the differential diagnosis.

Methylprednisolone has minimized mortality to

considerable extent i.e., from 88% to 55% (p< 0.025).

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