Clinical characteristics of paraquat poisoning in 22 Chinese children

Abstract

Objective: To retrospectively analyze the clinical characteristics and experience of Chinese children with paraquat poisoning.

Methods: Twenty-two children with paraquat poisoning who presented to the hospital from October 2007 through September 2012 were enrolled into this study. The clinical indices of these cases were collected and analyzed.

Results: All the children were poisoned due to oral ingestion of paraquat. Different degrees of damage were found in multiple systems in their bodies. All of them were administered pulse therapy using methylprednisolone (20 mg/kg/d × 3d) and Gamma globulin (total 2 g/kg divided into 3 d to 5 d) in the early stage. Prednisone was then given orally for 4 wk to 8 wk. The total mortality rate of the patients was 63.6 % (14 of 22 patients died). Statistical differences (P < 0.05) were found between the surviving and dead patients, with regard to age, plasma paraquat levels, the highest levels of alanine aminotransferase, aspartate aminotransferase, γ-glutamyl transferase, total bilirubin, direct bilirubin, indirect bilirubin, blood urea nitrogen, creatinine and pH value, the lowest levels of PaO2, PaCO2 and SaO2. Plasma paraquat level was positively related to pH value, but was negatively related to PaO2, PaCO2 and SaO2 levels. None of the patients died from hepatic and renal complications. Pulmonary fibrosis was the most severe complication and the primary cause of death.

Conclusions: Paraquat poisoning is difficult to cure. In this study, pulmonary fibrosis was the primary cause of death. Treatment by administering large doses of glucocorticoids and Gamma globulin proved to be effective in the early stage. However, the treatment may not reverse the development of pulmonary fibrosis. The long-term prognosis of paraquat poisoning was not optimistic. The plasma paraquat level could be a significant factor in predicting the prognosis.