A Study of Clinical Profile of Paraquat Poisoning and Predictors of Short Term Outcome in a Tertiary Care Hospital

Background: Poisoning is a global public health problem. The World Health Organization (WHO) estimates that nearly 250,000 deaths occur globally due to poisoning each year, with pesticides alone causing 150,000 deaths. Most poisoning deaths occur in lower- and middle-income countries (LMIC).The number of deaths occurring from particular poisons or poison classes varies from place to place, and over time, as a result of changes in access, effective and timely medical management, preventative measures, and regulatory policies. Paraquat (1,1′-dimethyl-4,4′-bipyridylium dichloride) is one of the most widely used herbicides. Methodology: The study was conducted in the Department of General Medicine in collaboration with Department of Biochemistry, Radiology, ENT, Chest medicine, of Calcutta National Medical College and Hospital, Kolkata along with sonography unit of department of General medicine and Dialysis unit. 50 patients were recruited after taking written consent from the inpatient as well as outpatient department of Dept. of General Medicine of CNMCH. Results: Mean age of female population was 38.14 ± 12.25 year which was slightly higher than mean age of male population (36.78 ± 11.85 year). Majority of male population belonged to the age group of (31 – 45) year. Predominantly people from farming background took PQ as a suicidal poison and majority of them were from a rural area. Study showed that majority of Paraquat poisoning was suicidal. Only 1 subject is exposed to it accidentally. Overall, suicidal poisoning is much more severe than accidental poisoning due to the consumption of higher doses of poison. Most common sign of paraquat poisoning was oral ulceration (94%) followed by tachypnoea (48%), icterus (32%) and Shock (14%). The present study showed that almost all patient had raised creatinine value during hospital stay. The most common cause of death was multi organ damage followed by Respiratory failure, shock, and renal failure (61%, 30%, 6% and 3% respectively). Conclusion: PQ was used for suicide in rural area mainly from families dependent on cultivation. As a corrosive poison almost all patient with significant intake had local ulceration in mouth and pharynx. Its systemic toxicity can affect all major organs though kidney, lung and livers were commonly effected ones. By using consensus based guidelines we found that one third of the patient survived which was better than the data reported in last decade. Amount of ingestion was one of the main predictors of outcome whereas early hospital admission and early hemodialysis significantly increases the chance of survival.