Tzu Chi Medical Journal
Volume 21, Issue 2 , Pages 156-160, June 2009

A Clinical Study of Prognosis and Glucocorticoid Pulse Treatment in Patients with Acute Paraquat Intoxication

  • Jen-Pi Tsai

      Affiliations

    • Division of Nephrology, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan
    • ,
  • Ru-Ping Lee

      Affiliations

    • Department of Nursing, Tzu Chi University, Hualien, Taiwan
    • ,
  • Chih-Hsien Wang

      Affiliations

    • Division of Nephrology, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
    • ,
  • Te-Chao Fang

      Affiliations

    • Division of Nephrology, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
    • School of Medicine, Tzu Chi University, Hualien, Taiwan
    • ,
  • Bang-Gee Hsu

      Affiliations

    • Division of Nephrology, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
    • School of Medicine, Tzu Chi University, Hualien, Taiwan
    • Corresponding Author InformationCorresponding author. Department of Nephrology, Buddhist Tzu Chi General Hospital, 707, Section 3, Chung-Yang Road, Hualien, Taiwan

Received 20 June 2008; received in revised form 25 August 2008; accepted 27 October 2008.

Article Outline

Abstract 

Objective

Paraquat is a highly toxic herbicide that binds strongly to tissue and causes high mortality rates due to pesticide intoxication in Taiwan. In this study, we evaluated the usefulness of methylprednisolone pulse therapy and calculation of the severity index of paraquat poisoning (SIPP) to predict the prognosis in patients with oral paraquat intoxication

Materials and Methods

Thirty-two patients with paraquat poisoning from January 2003 to April 2005 were enrolled into this study at a medical center in eastern Taiwan. All 32 patients had history of oral intake of paraquat and urine paraquat was positive at the emergency department. Time of oral intake of paraquat and serum paraquat levels were assayed at the emergency department for calculating SIPP (hour × mg/L) level. Sixteen patients with oral paraquat poisoning were treated with intravenous methylprednisolone 1 g/day and charcoal hemoperfusion for 3 days (MP group), and 16 patients with oral paraquat poisoning were treated with charcoal hemoperfusion only for 3 days (control group).

Results

The mortality rate of the patients with oral paraquat poisoning was high (87.5%). There were no statistically significant differences in death (p = 1.000), age (p = 0.706), sex (p = 0.069), serum blood urea nitrogen (p= 0.104), creatinine (p= 0.174), aspartate aminotransferase (p= 0.083), alanine aminotransferase (p = 0.365), plasma level of paraquat (p = 0.880) and SIPP level (p = 0.734) between the MP group and control group. Young age (p = 0.030), lower initial plasma paraquat level (p = 0.002), lower serum creatinine (p = 0.009), female sex (p = 0.033), lower elapsed time from ingestion of paraquat to arrival at hospital (p = 0.035) and SIPP level less than 10 (p < 0.001) were associated with survival in patients with oral paraquat poisoning. Multivariate forward stepwise linear regression analysis of deaths showed that SIPP > 10 (hour × mg/L) (p < 0.001) was an independent predictor of death in patients with oral paraquat poisoning and explained 77.1% of the variance (R2 = 0.771).

Conclusion

Treatment with methylprednisolone pulse therapy did not show better results in patients with acute oral paraquat poisoning. SIPP was an independent predictor of death in patients with oral paraquat poisoning.

Keywords:  Methylprednisolone pulse therapy , Paraquat , Prognosis , Severity index of paraquat poisoning

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PII: S1016-3190(09)60029-X

doi:10.1016/S1016-3190(09)60029-X

Tzu Chi Medical Journal
Volume 21, Issue 2 , Pages 156-160, June 2009

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