Clinical Profile, Organ Dysfunction Patterns, and Outcomes in Paraquat Poisoning: A Retrospective Analysis

Background: Paraquat is a highly toxic herbicide associated with high mortality following acute ingestion, particularly in rural agricultural regions of India where it remains readily available. Objective: To characterize the clinical profile and organ dysfunction patterns of acute paraquat poisoning and to describe their relationship with in-hospital mortality outcomes in a rural tertiary care setting. Methods: This retrospective observational study included adults admitted with acute oral paraquat ingestion at a tertiary care hospital in South India between August 2020 and August 2025. Demographic data, clinical features, organ involvement, treatment modalities, and outcomes were analyzed. Results: Twenty-seven patients were included (mean age, 33.4 ± 15.1 years; 20 males (74.1%)). All ingestions were intentional (27/27, 100%). Multiorgan involvement was common, with respiratory failure in 25 patients (92.6%), acute kidney injury in 21 (77.8%), circulatory failure in 20 (74.1%), and hepatic dysfunction in nine (33.3%). Overall in-hospital mortality was 20/27 (74.1%). Mortality increased progressively with the cumulative number of dysfunctional organ systems: no deaths occurred among patients with isolated single-organ dysfunction (0/4, 0%), mortality was three of six (50%) in those with two-organ involvement, and all patients with dysfunction of three or more organ systems did not survive in this cohort (17/17, 100%). Age, gender, and time to hospital presentation were not significantly associated with survival. Conclusion: Acute paraquat poisoning is associated with severe multisystem toxicity and high mortality. Mortality increased markedly with increasing organ dysfunction burden, with uniformly fatal outcomes once three or more organ systems were involved. Early hemoperfusion, although unavailable at our center, has been associated with improved survival in prior studies. These findings underscore the need for improved institutional preparedness and consideration of strengthened regulatory measures in regions where paraquat remains widely accessible.