Predictors of Mortality in Paraquat Poisoning: A Two-Year Retrospective Analysis From A Tertiary Care Teaching Hospital in South India

Authors

  • William Wilson
  • Rachana Bhat
  • Bharath Angadi
  • Nymisha Lekha
  • Bhavya Balaji
  • Jayaraj Mymbilly Balakrishnan

DOI:

https://doi.org/10.37506/ijfmt.v15i3.15986

Keywords:

Paraquat, agricultural chemicals, toxicology

Abstract

Backgrounds: Paraquat is a major cause of fatal poisoning in agro-based countries like India. Being, a
veiled offender it is often deluded for its relatively less fatal counterpart i.eorganophhosporous compounds.
It is a highly lethal herbicide, contributing to a majority of the pesticide poisoning related deaths & Disability
Adjusted Life Years (DALY) globally.
Methods: A retrospective record review of the patients presenting with paraquat poisoning to the Emergency
Medicine Department of a tertiary care center in South India,between August 2014 to August 2016 was done.
Demographics, clinical presentation, and laboratory data of patients were analysed to study risk factors
associated with morbidity & mortality.
Results: 91 case were evaluated, of which 65.9% were male and majority (78.1%) belonged to the age group
20-30 years and 31 (34%) being agriculturists. 85 (93.4%) attempts were suicidal in nature. Most common
presenting symptom was vomiting 72 (79.1%), 27% of the patients had hypoxia (pao2<70%) however the
initial mean circulatory assessment were within stable limits (HR- 84/min, BP- 124/78mmhg). Investigations
revealed average serum creatinine of 2.8mg/dL (+ 3.16) and bicarbonate of 17.6 mg/dL (+ 4.47). Treatment
measures included gastric lavage (67%) and haemoperfusion (49.5%) amongst others.47 (51.6%) patients
died with the most common cause of death being Multiorgan dysfunction syndrome -MODS (61.7%) and
Acute Kidney Injury-AKI (29.7%).To determine predictors of mortality, univariate and multivariate analysis
[adjusted odds ratio (95% confidence intervals)] was done which revealed low bicarbonate6.174[1.20-31.59]
and hypokalemia4.79 [1.08-21.19] to be significant risk factors.
Conclusion: Paraquat poisoning has a high disease burden and concerning mortality ratesespecially in
young and middle aged adults.Risk factors for mortality include low bicarbonate, hypokalemia and increased
serum creatinine with AKI and MODS being the most common causes of death.

Author Biographies

William Wilson

Assistant Professor, Department of Emergency Medicine, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India

Rachana Bhat

Assistant Professor, Department of Emergency Medicine, Kasturba Medical College, Manipal, Manipal
Academy of Higher Education, Manipal, Karnataka, India

Bharath Angadi

Assistant Professor, Department of Emergency Medicine, Shri Dharmasthala Medical (SDM) College of Medical Sciences, Dharwad, Karnataka, India

Nymisha Lekha

Medical Intern,Department of Emergency Medicine, Kasturba Medical College, Manipal, Manipal
Academy of Higher Education, Manipal, Karnataka, India

Bhavya Balaji

Medical Intern,Department of Emergency Medicine, Kasturba Medical College, Manipal, Manipal
Academy of Higher Education, Manipal, Karnataka, India

Jayaraj Mymbilly Balakrishnan

Professor& Head, Department of Emergency Medicine, Kasturba Medical College, Manipal, Manipal
Academy of Higher Education, Manipal, Karnataka, India

Published

2021-05-17

How to Cite

Wilson, W. ., Bhat, R., Angadi, B. ., Lekha, N. ., Balaji, B. ., & Balakrishnan, J. M. . (2021). Predictors of Mortality in Paraquat Poisoning: A Two-Year Retrospective Analysis From A Tertiary Care Teaching Hospital in South India. Indian Journal of Forensic Medicine & Toxicology, 15(3), 4435-4443. https://doi.org/10.37506/ijfmt.v15i3.15986