Observational Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Exp Med. Feb 20, 2017; 7(1): 31-39
Published online Feb 20, 2017. doi: 10.5493/wjem.v7.i1.31
Discernment scheme for paraquat poisoning: A five-year experience in Shiraz, Iran
Saeed Kavousi-Gharbi, Reza Jalli, Akbar Rasekhi-Kazerouni, Zahra Habibagahi, Sayed Mahdi Marashi
Saeed Kavousi-Gharbi, Student Research Committee, Shiraz University of Medical Sciences, Shiraz 7134845794, Fars Province, Iran
Reza Jalli, Medical Imaging Research Center, Shiraz University of Medical Sciences, Shiraz 7193711351, Fars Province, Iran
Akbar Rasekhi-Kazerouni, Zahra Habibagahi, Department of Internal Medicine, School of Medicine, Shiraz University of Medical Sciences, Shiraz 7134845794, Fars Province, Iran
Sayed Mahdi Marashi, Trauma Research Center, Emergency Room, Division of Medical Toxicology, Hazrat Ali-Asghar (p) Hospital, Shiraz University of Medical Sciences, Shiraz 7143918796, Fars Province, Iran
Author contributions: Marashi SM contributed to study concept and design; Kavousi-Gharbi S, Jalli R and Marashi SM contributed to analysis and interpretation of data; Rasekhi-Kazerouni A and Marashi SM contributed to drafting of the manuscript; Rasekhi-Kazerouni A, Habibagahi Z and Marashi SM contributed to critical revision of the manuscript for important intellectual content; Kavousi-Gharbi S and Marashi SM contributed to statistical analysis.
Supported by Shiraz University of Medical Sciences. This article has been extracted from the thesis written by the first author of this article, No. 94-01-01-10180 approved on Aug 1, 2016.
Institutional review board statement: The study was reviewed and approved by the Research Office of Hazrat Ali-Asghar (p) Hospital (Shiraz).
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: There are no conflicts of interest to report.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Sayed Mahdi Marashi, Assistant Professor of Forensic Medicine and Clinical Toxicology, Trauma Research Center, Emergency Room, Division of Medical Toxicology, Hazrat Ali-Asghar (p) Hospital, Shiraz University of Medical Sciences, Zand St., Shiraz 7143918796, Fars Province, Iran. marashi@sums.ac.ir
Telephone: +98-92-16919021 Fax: +98-71-32288606
Received: November 25, 2016
Peer-review started: November 28, 2016
First decision: December 15, 2016
Revised: January 5, 2017
Accepted: January 16, 2017
Article in press: January 18, 2017
Published online: February 20, 2017
Processing time: 83 Days and 16.2 Hours
Abstract
AIM

To evaluate various schemes for paraquat poisoning and different variables that influence the outcome of acute paraquat poisoning.

METHODS

In a cross-sectional study, the information about all cases of acute paraquat poisoning who were admitted to teaching hospitals affiliated to Shiraz University of Medical Sciences, in a five year period (September 2010 to September 2015) were evaluated. The variables included: Demographic data, medical assessment, therapeutic options, laboratory findings, and the outcomes. Data were analyzed using SPSS, version 22. Significant difference between groups was tested using t-test for continues outcomes and χ2 test for categorical. The significance level was considered to be P < 0.05.

RESULTS

A total of 104 patients (66.3% male) were evaluated. The mean age of the female patients was 22.81 ± 9.87 years and the male patients’ was 27.21 ± 11.06 years. Ninety seven (93.3%) of all the cases were suicide attempts with mortality rate of 43.2%. Despite the necessity for emergency hemodialysis during the first 6 h of intoxication, none of the patients had dialysis during this time. Immunosuppressive and corticosteroid medications were not administrated in adequate dosage in 31.1% and 60% of the patients, respectively. Ingestion of more than 22.5 cc of paraquat and increase in creatinine level were the most important predictors of mortality.

CONCLUSION

Treatment should start immediately for these patients. Moreover, creating a clinical guideline according to the findings can have an impact on the treatment procedure which seems to be necessary.

Keywords: Mortality; Paraquat; Poisoning; Prognosis; Suicide

Core tip: In developing countries with an agriculture economy poisoning by means of herbicides is very common. Paraquat is a highly toxic compound and consumption of 30 mg/kg is lethal in humans. In this study, we have analyzed multi-center data of patients with paraquat poisoning between September 2010 and September 2015, establishing the largest series of paraquat poisoning in the Middle East. Based on the data, medical knowhow that affects its current management as well as different variables which influence the outcome were evaluated.