A Promising New Therapeutic Strategy to Improve Mortality Outcomes in Patients with Moderate to Severe Paraquat Poisoning

Background: Paraquat ingestion is associated with multi-organ failure and high mortality. The lack of management guidelines and an appropriate antidote is concerning. This report discusses the successful treatment and management of four patients at our tertiary hospital using a novel combination protocol.Methods: We treated four patients with paraquat ingestion who presented to our center with a novel combination protocol, which included administration of intravenous Methylprednisolone, N-acetylcysteine, Cyclophosphamide, oral Vitamin C and Vitamin E, and an antifibrotic agent. We followed up with these patients in the hospital, monitoring their clinical outcome.Results: The ingested volume of paraquat ranged from 10 ml to 50 ml of 24% paraquat. Three patients had paraquat tongue with corrosive injury. We noted a serial rise in creatinine levels in all patients, which returned to baseline on follow-up. Three patients had ground-glass opacifications on a high-resolution Chest computerized tomography scan. At follow-up, we noted normal renal and liver function, with no delayed effects or complications in these patients.Conclusion: A combination therapy with immunosuppression, high-dose antioxidants, and antifibrotics has demonstrated potential in treating paraquat (PQ) poisoning, preventing progressive pulmonary fibrosis, and improving survival. This protocol has shown progress in PQ poisoning management and has laid the groundwork for future research.