Case series: Diquat poisoning with acute kidney failure, myocardial damage, and rhabdomyolysis

Abstract

Diquat is a herbicide that can have deleterious effects on the kidneys, liver, heart, lungs, and central nervous system on ingestion. Diquat poisoning-associated rhabdomyolysis has rarely been reported. We describe two cases of diquat poisoning with acute renal failure, myocardial damage, and rhabdomyolysis. Case 1: A 17-year-old man experienced anuria after ingesting ~200 mL of diquat 16 h prior. On admission, his creatinine (400 μmol/L), urea (11.7 mmol/L), creatine kinase (2,534 IU/L), and myohemoglobin (4,425 ng/mL) concentrations were elevated. Case 2: An 18-year-old woman who ingested ~200 mL of diquat 5.5 h prior to admission had normal creatinine, urea, and creatine kinase concentrations. Eleven hours after ingestion, she developed anuria with elevated creatinine (169 μmol/L) concentration; her creatine kinase (13,617 IU/L) and myohemoglobin (>3,811 ng/mL) concentrations were remarkably elevated 24 h after ingestion. Both patients also had elevated aminotransferase and myocardial enzyme concentrations. After undergoing hemoperfusion and hemofiltration, blood diquat concentrations in cases 1 and 2 on admission (16/6 h after ingestion), after hemoperfusion (20/11 h after ingestion), and after 8 h of hemofiltration/8 h of hemofiltration and 2 h of hemoperfusion (29/21 h after ingestion) were 4.9/9.1, 3.4/5.4, and 1.5/1.2 μg/mL, respectively. Severe diquat poisoning can cause acute kidney failure and rhabdomyolysis. Rhabdomyolysis may induce myocardial injury, aggravating kidney damage, and also increase transaminase concentration. Hemoperfusion and hemofiltration could be effective treatments for eliminating diquat in the blood.

Exposome and Metabolome Analysis of Sugarcane Workers Reveals Predictors of Kidney Injury

“… 20 , 21 , 67 , 68 , 69 Carbofuran, metolachlor, paraquat, and diquat are 4 of such compounds which are known to cause acute kidney injury and have been previously implicated in CKD. 67 , 69 , 70 , 71 , 72 , 73 , 74 In particular, a recent study found evidence that paraquat might have a participatory role in CKDu from Central America. 75 These pesticides and associated metabolites were found to increase in abundance over the harvest season, across both KFD and non-KFD workers.…”

Case report: Successful outcome of a young patient with rhabdomyolysis and shock caused by diquat poisoning

“…Diquat rapidly distributed throughout the body, and largely damaged tissues and cells, and subsequent systemic inflammatory response, resulting in reduced effective circulating blood volume (19), which probably explained the cause of shock. According to the previous report on diquat poisoning combined with rhabdomyolysis, the shock was the main cause of death due to the damage to myocardial function (8). Especially, the high level of IL6 indicated the development of systemic inflammatory response syndrome (SIRS) (20).…”

“…Diquat poisoning caused acute kidney injury (AKI) as much as 73.3%, which was higher than other types of pesticide poisoning (4)(5)(6). Rhabdomyolysis is rarely reported in diquat poisoning (7,8), but it could largely aggravate kidney injury. Meanwhile, diquat poisoning with shock was extremely fatal (9), and no surviving cases had been reported so far (8,10), indicating the need for more effective treatment options.…”

Evaluation of Lac and NGAL on the Condition and Prognosis of Patients with Diquat Poisoning

“…Oral administration of DQ into the body results in oral mucosal ulcers, nausea, vomiting, skin mucosa and nail damage, coma, hepatic and renal impairment, pulmonary edema, intracranial hemorrhage, or cerebral infarction, but renal injury is the most common. 8 Clinical treatment mainly involves protecting the kidneys, maintaining the kidneys themselves, and enhancing the renal metabolic function to facilitate the clearance of toxins and reduce the occurrence of AKI. However, the success rate of treatment is low.…”