Predictors of Mortality in Paraquat Poisoning: A Two-Year Retrospective Analysis From A Tertiary Care Teaching Hospital in South India
Keywords:Paraquat, agricultural chemicals, toxicology
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.
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