Diagnostic and Therapeutic Approach for Acute Paraquat Intoxication

Gil, Hyo‐Wook; Hong, Jungrak; Jang, Si‐Hyong; Hong, Sae‐Yong

doi:10.3346/jkms.2014.29.11.1441

Cited by 86 publications

(112 citation statements)

References 55 publications

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“…Paraquat has been used in Korea for the past three decades, with an estimated 2000 toxic ingestions annually and an associated 60–70% mortality 1. As there are still no effective therapies to treat paraquat poisoning,2 various measures have been instituted in the effort to reduce the mortality rate thereof. The INTEON formulation, which contains a natural alginate that immediately gels in the gastric pH environment, was developed to reduce the gastrointestinal absorption of paraquat 3.…”

Section: Introductionmentioning

confidence: 99%

Effects of Paraquat Ban on Herbicide Poisoning-Related Mortality

You

Cho

et al. 2017

Yonsei Med J

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PurposeIn Korea, registration of paraquat-containing herbicides was canceled in November 2011, and sales thereof were completely banned in November 2012. We evaluated the effect of the paraquat ban on the epidemiology and mortality of herbicide-induced poisoning.Materials and MethodsThis retrospective study analyzed patients treated for herbicide poisoning at 17 emergency departments in South Korea between January 2010 and December 2014. The overall and paraquat mortality rates were compared pre- and post-ban. Factors associated with herbicide mortality were evaluated using logistic analysis. To determine if there were any changes in the mortality rates before and after the paraquat sales ban and the time point of any such significant changes in mortality, R software, version 3.0.3 (package, bcp) was used to perform a Bayesian change point analysis.ResultsWe enrolled 2257 patients treated for herbicide poisoning (paraquat=46.8%). The overall and paraquat poisoning mortality rates were 40.6% and 73.0%, respectively. The decreased paraquat poisoning mortality rate (before, 75% vs. after, 67%, p=0.014) might be associated with increased intentionality. The multivariable logistic analysis revealed the paraquat ban as an independent predictor that decreased herbicide poisoning mortality (p=0.035). There were two major change points in herbicide mortality rates, approximately 3 months after the initial paraquat ban and 1 year after complete sales ban.ConclusionThis study suggests that the paraquat ban decreased intentional herbicide ingestion and contributed to lowering herbicide poisoning-associated mortality. The change point analysis suggests a certain timeframe was required for the manifestation of regulatory measures outcomes.

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Section: Introductionmentioning

confidence: 99%

Effects of Paraquat Ban on Herbicide Poisoning-Related Mortality

You

Cho

et al. 2017

Yonsei Med J

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“…Over the last several decades, paraquat (PQ) has become a broadly used herbicide. However, PQ is highly toxic to humans and animals that come into direct contact with it, and in recent years, the incidence of PQ poisoning by suicide or accident has exhibited an increasing trend in Asia, especially in China [1,2]. The fatality rate of oral PQ poisoning is as high as 60-87.5%, and most of the survivors have pulmonary fibrosis, which has a poor prognosis [3,4].…”

Section: Introductionmentioning

confidence: 99%

HIF‐1α regulates EMT via the Snail and β‐catenin pathways in paraquat poisoning‐induced early pulmonary fibrosis

Zhu

Tan

Xie

et al. 2016

J Cellular Molecular Medi

104

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Paraquat (PQ) poisoning‐induced pulmonary fibrosis is one of the primary causes of death in patients with PQ poisoning. Hypoxia‐inducible factor‐1α (HIF‐1α) and epithelial‐mesenchymal transition (EMT) are involved in the progression of pulmonary fibrosis. Snail and β‐catenin are two other factors involved in promoting EMT. However, the relationship among HIF‐1α, Snail and β‐catenin in PQ poisoning‐induced pulmonary fibrosis is not clear. Our research aimed to determine whether the regulation of HIF‐1α in EMT occurs via the Snail and β‐catenin pathways in PQ poisoning‐induced pulmonary fibrosis. Sixty‐six Sprague–Dawley rats were randomly and evenly divided into a control group and a PQ group. The PQ group was treated with an intragastric infusion of a 20% PQ solution (50 mg/kg) for 2, 6, 12, 24, 48 and 72 hrs. A549 and RLE‐6TN cell lines were transfected with HIF‐1α siRNA for 48 hrs before being exposed to PQ. Western blotting, real‐time quantitative PCR, immunofluorescence, immunohistochemistry and other assays were used in our research. In vivo, the protein levels of HIF‐1α and α‐SMA were increased at 2 hrs and the level of ZO‐1 (Zonula Occluden‐1) was reduced at 12 hrs. In vitro, the transient transfection of HIF‐1α siRNA resulted in a decrease in the degree of EMT. The expression levels of Snail and β‐catenin were significantly reduced when HIF‐α was silenced. These data demonstrate that EMT may be involved in PQ poisoning‐induced pulmonary fibrosis and regulated by HIF‐1α via the Snail and β‐catenin pathways. Hypoxia‐inducible factor‐1α may be a therapeutic target for the treatment of PQ poisoning‐induced pulmonary fibrosis.

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“…The mortality rate of paraquat intoxication is incomparably higher among all categories of pesticides [24] .…”

Section: Discussionmentioning

confidence: 99%

Concurrent Hemoperfusion and Hemodialysis in Patients with Acute Pesticide Intoxication

et al. 2016

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Background: Water soluble and insoluble chemicals in the pesticide formulation may be eliminated more effectively in time if hemodialysis (HD) and hemoperfusion (HP) are performed concurrently. Aim: This study is aimed at evaluating the efficacy of concurrent HP and HD in patients with acute pesticide intoxication. Methods: Between January 2011 and December 2012, we used HP and HD consecutively (HP-HD group, 347 cases), and then during the next 2 years (January 2013 to December 2014), we used concurrent HP and HD (HPD group, 383 cases). We compared the clinical outcomes between the 2 groups. Results: The mortality was higher in the HP-HD group than in the HPD group: (48.1 vs. 20.9%) for the overall mortality and (81.8 vs. 57.9%) for the paraquat (bipyridylium) mortality (p < 0.001). In multiple logistic analyses, age (p = 0.013), ingested volume (p < 0.001), and HP-HD (p = 0.014) were significant risk factors for mortality in the paraquat ingested group. Conclusion: Concurrent HP and HD would be an effective and safe treatment for patients with acute pesticide intoxication, in particular, paraquat intoxication.

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Diagnostic and Therapeutic Approach for Acute Paraquat Intoxication

Cited by 86 publications

References 55 publications

Effects of Paraquat Ban on Herbicide Poisoning-Related Mortality

Effects of Paraquat Ban on Herbicide Poisoning-Related Mortality

HIF‐1α regulates EMT via the Snail and β‐catenin pathways in paraquat poisoning‐induced early pulmonary fibrosis

Concurrent Hemoperfusion and Hemodialysis in Patients with Acute Pesticide Intoxication

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