Acute renal failure in case of Paraquat poisoning.

Oreopoulos, D. G.; Soyannwo, M. A. O.; Sinniah, Raja; Fenton, S. S.; Bruce, Johanna; Mcgeown, MaryG.

doi:10.1136/bmj.1.5594.749

Cited by 80 publications

(26 citation statements)

References 5 publications

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“…One major feature of the pathological findings was the presence of histological changes in the patient's lungs which corresponded completely with those described in animals (Clark et al, 1966) and in man (Bullivant, 1966 ;Almog and Tal, 1967;Oreopoulos et al, 1968). These included haemorrhages, hyaline membranes, interstitial proliferation of plump fibroblasts in diffuse and whorled patterns, proliferation of bronchiolar and alveolar epithelium, and infiltration by chronic inflammatory cells.…”

Section: Discussionsupporting

confidence: 64%

“…Death following ingestion of one mouthful has been reported (Bullivant, 1966;Oreopoulos et al, 1968). Dr. J. C. R. Greig (personal communication) had under his care an 11-year-old boy in Lewis Hospital, Stornoway, at the same time as we were dealing with our patient.…”

Section: Discussionmentioning

confidence: 83%

“…Fatal poisoning by the weedkiller paraquat (1,1'dimethyl-4,4'-dipyridilium, Gramoxone W) has previously been recorded in adults (Bullivant, 1966;Almog and Tal, 1967;Oreopoulos et al, 1968) and in children (Brit. med.…”

Section: Introductionmentioning

confidence: 99%

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Paraquat Poisoning--Lung Transplantation

Matthew¹,

Logan²,

Woodruff³

et al. 1968

BMJ

166

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Summary: A 15-year-old boy ingested a mouthful of paraquat and developed severe respiratory distress. Treatment included the transplantation of one lung, but subsequently changes developed in the graft which are thought to have been due to paraquat, and the patient died two weeks after the operation.The dangers of keeping poisonous substances in incorrectly labelled bottles has once again been demonstrated, while the pattern of paraquat poisoning, especially the development of proliferative alveolitis and terminal bronchiolitis, is confirmed.Immediate forced diuresis followed by haemodialysis is necessary to remove paraquat, thereby perhaps avoiding initiation of the changes in the lungs. The technical feasibility of human lung transplantation has again been demonstrated. It has also been shown that infection does not necessarily pose an insuperable problem, at any rate if, as in the case described, there was no preoperative pulmonary infection in either recipient or donor.

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Section: Discussionsupporting

confidence: 64%

Section: Discussionmentioning

confidence: 83%

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Paraquat Poisoning--Lung Transplantation

Matthew¹,

Logan²,

Woodruff³

et al. 1968

BMJ

166

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“…

Bruce, 1968). The following is a report on one such case treated by forced diuresis in which the patient recovered.

CASE REPORT

The patient, a man aged 32, was admitted to hospital on 25 November 1967 after ingestion of about 45 g. of Weedol (which contains 5 % paraquat) in an attempt to poison himself.

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confidence: 99%

Paraquat poisoning treated by forced diuresis.

Kerr¹,

Patel²,

Scott³

et al. 1968

BMJ

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Bruce, 1968Examination on admission showed epigastric tenderness and guarding. The liver edge was just palpable below the costal margin. There was no evidence of pre-existing cardiac, pulmonary, or renal disease. Shortly after admission gastric lavage was performed and no solid Weedol particles were visible in the aspirate. Forced diuresis was begun.Next day he complained of anterior chest tightness, frontal headache, and photophobia. Chest auscultation revealed generalized bilateral sibilant rhonchi. The abdominal pain disappeared by the eighth day and tenderness by the tenth day. The liver edge remained palpable throughout. He remained free of oral and pharyngeal ulceration. Clinical examination of the chest showed disappearance of rhonchi by the tenth day and there was no evidence of pulmonary hypertension at any time. The temperature rose on only one occasion to 99°F. (37.2°C.). A five-day course of intramuscular penicillin was started on admission and was followed by a five-day course of prednisolone, begun on the fifth day.Investigations.-Daily chest x-ray films and electrocardiograms performed from time of admission showed no abnormality. The haemoglobin and absolute values were found to be normal. The white cell count was 6,650/cu. mm. on admission and 13,500/cu. mm. on the twelfth day. The E.S.R., blood urea, urine urea, serum electrolytes, serum bicarbonate, standard liver function tests, and arterial blood gas values were all persistently normal. Occult blood was not found in the stools. Creatinine clearance just before discharge was 58 ml./min.Forced diuresis was performed by the method of Linton, Luke, Speirs, and Kennedy (1964) and continued for 24 hours. Throughout the forced diuresis two-hourly aliquots of urine were collected and blood samples were obtained at intervals. The concentrations of paraquat in each of these specimens and in one specimen of gastric aspirate were determined by the method of Daniel and Gag. (1966). The lower limit of sensitivity by this method is 10 pg. of paraquat. This quantitative method is efficient but time-consuming. The urine cell counts were performed by the method of McGeachie and Kennedy (1963).

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“…Although neither case in this report showed any specific neurological signs, the patient in Case 2 became precomatose 4 days before death and autopsy disclosed perivascular hemorrhage in the mid-brain. Survival periods of paraquat poisoning varied from 7 to 20 days (Bullivant 1966;Feenelly et al 1968) and the cause of death is usually respiratory distress except for only one case, in which the patient died of cardiac arrest (Oreopouls et al 1968). Although most cases were fatal (Bullivant 1966;Almog and Tal 1967;Campbell 1968;Feenelly et al 1968;Matthew and Logan 1968), recovered cases without respiratory symptoms were reported (Kerr et al 1968;Mckean 1968;Fisher et al 1971).…”

Section: Discussionmentioning

confidence: 99%