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 Keracunan ini amat serius dan selalunya

menyebabkan maur.
 Ia menyebabkan iritasi pada kulit, membran
mukosa serta menyebabkan rasa terbakar di dalam
mulut dan gaster.
 Ia juga boleh menyebabkan pengulseran setempat.
 Kesan utama termasuklah edema pulmonari
akibat alveolitis, kegagalan ginjal, nekrosis hepar
dan seterusnya fibrosis paru-paru yang progresif
serta kegagalan pernafasan.
DEFINISI
 N,N'-dimethyl-4,4'-bipyridinium dichloride
 Paraquat (dipyridylium) is a highly toxic weed &
grass killer ~ Herbicide
 Poisoning : swallowing or breathing in Paraquat
 Cause lung damage & inflammation mucosa
lining of GIT
Diagnosis of paraquat poisoning
1. History of paraquat ingestion – from
patients or other observers
2. Evidence of paraquat ingestion (suicide
note, empty container, residue,odour or
colour).
3. Clinical signs, especially with intractable
vomiting, or inflammation or ulceration of
mucous membranes (which occurs several
hours following ingestion)
CIRI-CIRI KLINIKAL
 IRRITASI KULIT DAN MEMBRAN MUKOSA
 PERUBAHAN PADA BENTUK MORPHOLOGI KUKU
 EPISTAXIS
 KECEDERAAN COMEAL
 LAKRIMASI
 ULSER BIBIR
 TANDA KEBAKARAN DAN ULSERASI PADA LIDAH
SERTA FARINKS
 ULCERASI OESOPHAGEAL
 PERFORASI OESOPHAGEAL
 OEDEMA PULMONARI
 KEGAGALAN JANTUNG
 KEGAGALAN GINJAL
 KEGAGALAN HEPAR
 KONVULSI
 MAUT
 PAIN AND SWELLING OF THE MOUTH AND
THROAT
 NAUSEA, VOMITING, ABDOMINAL PAIN, AND
DIARRHEA
 DIFFICULTY BREATHING
 SEIZURES
 SHOCK
 SHORTNESS OF BREATH
CIRI-CIRI KLINIKAL
 Effects within several days to several weeks:
 Liver failure
 Kidney failure
 Heart failure
 Lung scarring
CIRI-CIRI KLINIKAL
Mild or subacute poisoning:
<20 – 30 mg paraquat ion/kg body weight.
- Asymptomatic or vomiting and diarrhoea.
- Renal and hepatic lesions are minimal or absent.
- An initial decrease of the pulmonary diffusion capacity
may be present.
- Complete recovery would be expected.
CIRI-CIRI KLINIKAL
Moderate to severe acute poisoning:
>20 – 30 but <40 – 50 mg paraquat ion/kg body weight.
- immediate: vomiting.
- hours: diarrhoea, abdominal pain, mouth and throat
ulceration.
- one to four days: renal failure, hepatic impairment,
hypotension and tachycardia.
- one to two weeks: cough, haemoptysis, pleural effusion,
pulmonary
Survival is possible, but in the majority of cases death occurs
within 2 – 3 weeks from pulmonary failure.
CIRI-CIRI KLINIKAL
Fulminant: >40 – 55 mg/kg mg paraquat ion/kg body
weight.
- immediate: vomiting
- hours to days: diarrhoea, abdominal pain, renal
and hepatic failure, gastrointestinal ulceration,
pancreatitis, toxic myocarditis, refractory
hypotension, coma, convulsions.

Death from cardiogenic shock and multi-organ


failure occurs within 1-4 days
EFFECTS OF PARAQUAT
 Local effects – skin irritation, blistering and
ulceration.
 Inhalation effects – epistaxis & sore throat
 Ingestion effects – nausea & vomiting, diarrhoea,
painful ulceration on tongue, lip, fauces, renal failure,
dyspnoea, pulmonary fibrosis.
 Eye – severe inflamation of the cornea and
conjunctiva, cornea and conjunctival ulceration.
Investigation
 Plasma - Arterial blood gases
 Daily BUSE
 Chem-20
 Chest x-ray (Day 1,7,10)
 Creatinine
 Lung function test (LFT) & Serum ALT (Day 1 & 5)
 Urine and gastric aspiration for Paraquat
detection
 Urine toxicology screen
 Facilities available send for plasma paraquat level
Management
Early management
- Ensure Airway, Breathing and Circulation are intact
- i.v. fluids
- analgesics – aggressive analgesia (e.g. opiates)
- mouth care for ulceration and inflammation.
- kept NBM if suspicion of oropharyngeal or
oesophageal injury.
- avoid supplemental oxygen unless significant
hypoxia exists (oxygen enhances paraquat toxicity).

If the patient is not vomiting then administer either:


- activated charcoal - 100g for adults or 2 g/kg body
weight in children or
Management
 Quickly take off clothing that has liquid paraquat
 wash any liquid paraquat from skin with large
amounts of soap and water
 eyes burning or vision is blurred, rinse eyes with plain
water for 10 to 15 minutes
Management
 NOTE: The use of gastric lavage without
administration of an adsorbent has not shown any
clinical benefit
 Rehydrate the patient to optimise renal clearance of
paraquat ~ fluid overload and electrolyte imbalance.
 NOTE: Forced diuresis is not recommended.
RAWATAN
 Cetuskan muntah dgn merangsang farink, diikuti oleh
lavaj gaster (menggunakan larutan 15% ‘fuller’s earth’
iaitu 150 g/1).
 Selepas lavaj, 1 liter larutan 15% ‘fuller’s earth’
hendaklah ditinggalkan di dlm perut sebagai bahan
penyerap.
 Berikan magnesium sulfat secara oral sebagai bahan
pelawas.
 Masukkan tiub nasogaster dan ulang langkah-langkah
2 dan 3 setiap 2-4 jam selama 24-48 jam.
 Singkirkan Paraquat yg telah diserap, dgn dibantu oleh
diuresis paksaan (jika tiada, kegagalan ginjal),
hemodialisis atau hemoperfusi arang.
 Periksa profil ginjal dan hati secara teratur. Periksa gas
darah dan x-ray dada jika perlu
 Dos steroid yg tinggi utk mengurangkan kejadian
fibrosis paru2.
 Pemberian oksigen adalah kontraindikasi.
Subsequent management
- Analgesia as necessary
- Intravenous fluid
- Antibiotics for supervening infection
- Supporting renal function with haemodialysis or
haemofiltration may be required
- Care of the mouth and throat ulcer
- O2 if PaO2 < 60 mmHg
Complications
 Death may occur up to 30 days after ingestion
 Acute respiratory distress syndrome
 Holes in the esophagus
 Inflammation of the area between the lungs
(mediastinitis)
 Scarring of the lungs (pulmonary fibrosis)