COMPARISION OF CLINICAL

OUTCOME OF PARAQUAT
POISONING IN PATIENTS
TREATED WITH & WITHOUT
METHYLPREDNISOLONE
HARIKRISHNA ANNAM
POST GRADUATE
KAKATIYA 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.

SEX RATIO

MALE; 48%

FEMALE; 52%

Mean

age was
32(14.02)years.
MALE

FEMALE

RESULTS
Chart Title

Among

the 26 patients 14
who were not treated 12
with
10
8
methylprednisolone
there were 10 males 6
4
and 16 females.

13

10

2
1

2
0

0 MALE

0
Alive

FEMALE
Dead

LAMA

RESULTS
8
8

Among

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

7
6
5
4
3

3
2

2
1
0

MALE

FEMALE

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.

COMPLICATIONS

17
34

28

AKI
HEPATITIS

RESPIRATORY FAILURE

COMPARISION OF
COMPLICATIONS IN BOTH
In the intervention group, GROUPS
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.

25
20

20
15

18
13
11

10

10
6

5
0

MP given

AKI
Respiratory failure

No MP

Hepatitis

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.

28

30

26

25
20
15
10
5
0

7
4

ALIVE 0

AKI
RESPIRATORY FAILURE

DEAD

HEPATITIS

LAMA 0

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 developed

oral ulcers, gastritis and 10 patients had
seizures.

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).

THANK YOU