Diquat is a widely used herbicide that is substituted for paraquat. With paraquat off the market, cases of diquat poisoning have been gradually increasing. The kidney is the most frequently impaired organ in diquat poisoning. Few cases of multiple organ failure caused by diquat have been reported. We herein describe a 30-year-old man who orally ingested about 160 mL of enriched diquat. Despite aggressive treatment, the patient’s condition progressed to multiple organ failure and death. The pulmonary lesions in this patient were different from those previously reported. This patient did not die of renal failure but of severe respiratory failure. He exhibited three different stages of pulmonary disease. The lung lesions in this case were unique. We hope that doctors will pay more attention to the lung lesions in patients with diquat poisoning in future and find new treatment methods to save the lives of such patients.

Background:Vancomycin treatment failure against vancomycin-susceptible gram-positive cocci is not rare in the intensive care unit (ICU). One of the reasons for this is the substandard drug trough concentration. We aimed to examine the hypothesis that the target serum concentration could be reached earlier with a loading dose of vancomycin.Methods:This retrospective cohort study was conducted at our ICU between June 2018 and June 2020 and involved patients who were suspected of having, or confirmed to have, gram-positive cocci infection and treated with vancomycin. One group of the patients was administered a loading dose of vancomycin (loading group) and compared with the group that did not receive a loading dose (control group). The baseline characteristics, vancomycin serum concentrations, and clinical outcomes were collected and analyzed.Results:Fifty-five patients were finally included, of which 29 received a loading dose of vancomycin. The serum concentration of vancomycin before the second dose was significantly higher for the loading group than for the control group (10.3 ± 6.1 mg/L vs. 5.7 ± 4.4 mg/L, P = 0.002). The results for both groups were similar before the fifth dose (12.4 ± 7.3 mg/L vs. 10.3 ± 6.3 mg/L in the loading and the control groups, respectively; P = 0.251). The 28-day mortality was lower for the loading group than for the control group (6.7% vs. 34.6% in the loading and control groups, respectively; P = 0.026). No significant differences were observed in serum creatinine (Cr) concentrations of the two groups.Conclusion:With the loading dose of vancomycin, the target serum concentration of vancomycin may be reached earlier without increasing the risk of acute kidney injury.Trial registration:https://www.chictr.org.cn; ChiCTR2000035369

Background: Studies have shown the failure of vancomycin treatment against vancomycin-sensitive gram-positive bacteria is common, possibly because the drug concentration did not reach the target serum concentration in time. In this study, we conducted a retrospective analysis to determine whether the target serum concentration could be reached earlier with the first loading dose of vancomycin.Methods: A retrospective single-center study was conducted in the Department of Critical Care Medicine, Ruijin Hospital North Affiliated to Shanghai Jiao Tong University School of Medicine between June 2018 and June 2020. The study enrolled patients who were suspected or confirmed with gram-positive bacterial infection and had been treated with vancomycin. According to whether the first loading dose of vancomycin was given, the patients were divided into the loading dose and the control groups. The serum concentration of vancomycin before the second dose and that before the fifth dose were compared to determine whether the target serum concentration was reached earlier with the first loading dose. And renal functions were monitored for a week to analyze whether the loading dose caused any acute kidney injury.Results: 55 patients were finally included in the study. Of these patients, 29 received first-loading dose of vancomycin, while the remaining 26 patients underwent the traditional dose regimen of vancomycin. The concentration of vancomycin before the second dose was 10.3±6.1 mg/L in the loading group, and 5.7±4.4 mg/L in the control group, significantly higher in the former group (P=0.002). The concentration of vancomycin before the fifth dose was 12.4±7.3 mg/L in the loading group, and 10.3±6.3 mg/L in the control group, where there was no inter-group difference (P=0.251). The 28-day motality of loading dose group is significantly lower (6.7% vs 34%, P=0.026) than the control group. There were no significant changes in serum creatinine levels in both groups, and there was no statistical difference in serum creatinine levels between the two groups.Conclusions: With the loading dose of vancomycin, the target serum concentration of vancomycin could be reached earlier without causing acute kidney injuries, also the mortality might be reduced.