Improved survival in severe paraquat poisoning with repeated pulse therapy of cyclophosphamide and steroids

Lin, Jing; Lin-Tan, Dan-Tzu; Chen, Kuan‐Hsing; Huang, Wen‐Hung; Hsu, Ching‐Wei; Hsu, Hsiang-Hao; Yen, Tzung‐Hai

doi:10.1007/s00134-010-2127-7

Cited by 72 publications

(80 citation statements)

References 26 publications

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“…[34] Current treatment of PQ poisoning focuses on reducing the absorption of PQ from the gastrointestinal tract and increasing its elimination. [32] Even though activated charcoal was used to treat PQ toxication,[14] evidence was not enough to confirm that charcoal can improve the prognosis of patients. Since the therapeutic effect of smecta on rats with PQ toxication has rarely been studied, we tried to explore whether smecta can reduce the PQ plasma concentration and improve the pathological changes of rats after PQ poisoning.…”

Section: Discussionmentioning

confidence: 99%

“…[11–13] Studies[14–16] focus mostly on gastric lavage, blood purification, glucocorticoid and cyclophosphamide, but there are different opinions on these methods. It was reported that to prevent the absorption of PQ by the gastrointestinal tract, patients were administered with activated charcoal in 250 mL magnesium citrate via a nasogastric tube,[14] suggesting that superactive adsorbent is beneficial to reduce blood concentration.…”

Section: Introductionmentioning

confidence: 99%

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Therapeutic effects of smecta or smectite powder on rats with paraquat toxication

Jiang¹,

Ma²,

Wang³

et al. 2013

World Journal of Emergency Medicine

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BACKGROUND:The plasma concentration of paraquat is closely related to the prognosis of patients with paraquat toxication, and the most common cause of death from paraquat poisoning is multiple organ failure (MOF). This study aimed to evaluate therapeutic effect of smecta on the plasma concentrations of paraquat and multi-organ injury induced by paraquat intoxication in rats.METHODS:A total of 76 healthy adult SD rats were randomly divided into group A (control group, n=6), group B (poisoned group, n=30) and group C (smecta-treated group, n=30). Rats in groups B and C were treated intragastrically with PQ at 50 mg/kg, and rats in group A was treated intragastrically with saline (1 mL). Rats in group C were given intragastrically smecta at 400 mg/kg 10 minutes after administration of PQ, while rats in other two groups were treated intragastrically with 1 mL saline at the same time. Live rats in groups B and C were sacrificed at 2, 6, 24, 48, 72 hours after administration of PQ for the determination of paraquat plasma concentrations and for HE staining of the lung, stomach and jejunum. The rats were executed at the end of trial by the same way in group A.RESULTS:The plasma concentration of paraquat (ng/mL) ranged from 440.314±49.776 to 4320.6150±413.947. Distinctive pathological changes were seen in the lung, stomach and jejunum in group B. Lung injuries deteriorated gradually, edema, leukocyte infiltration, pneumorrhagia, incrassated septa and lung consolidation were observed. Abruption of mucosa, hyperemic gastric mucosa and leukocyte infiltration were obvious in the stomach. The hemorrhage of jejunum mucosa, the abruption of villus, the gland damage with the addition of inflammatory cell infiltration were found. Compared to group B, the plasma concentration of paraquat reduced (P<0.01) and the pathological changes mentioned above were obviously alleviated in group C (P<0.05, P<0.01).CONCLUSION:Smecta reduced the plasma concentration of paraquat and alleviated pathologic injury of rats with PQ poisoning.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Therapeutic effects of smecta or smectite powder on rats with paraquat toxication

Jiang¹,

Ma²,

Wang³

et al. 2013

World Journal of Emergency Medicine

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“…It is impossible for us stop person making use of paraquat, but some new therapy must be considered to control paraquat poisoning. Paraquat poisoning could not be controlled by only one method and combined therapies are needed (Lin et al, 2011). So, it was hypothesized in this study that whole lung lavage will provide a new therapy of acute lung injury caused by paraquat.…”

Section: Hypothesismentioning

confidence: 99%

Whole lung lavage therapy: Treatment for lung injury caused by paraquat poisoning

Kan¹,

Jian²,

Zhang³

et al. 2014

J. Toxicol. Environ. Health Sci.

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Paraquat poisoning is characterized by multi-organ failure and pulmonary fibrosis with respiratory failure, resulting in high mortality and morbidity. To serious paraquat patients, the effectiveness of conventional treatments is unsuccessful. Whole lung lavage is a technique that was developed in the 1960s with the purpose of removing lipoproteinaceous material that accumulates in the bronchi of patients with alveolar proteinosis, leading to clinical and functional improvement. Pneumoconioses are characterized as irreversible, progressive respiratory diseases. No effective therapy exists to prevent progression of these diseases. Whole lung lavage might limit the rate of disease progression through the removal of dust, inflammatory cells, and cytokines. Whole lung lavage is also used successfully to treat other lung diseases such as endogenous lipoid pneumonia and mineral oil lipoid pneumonia. Paraquat poisoning could not be controlled by only one method and combined therapies are needed. So, we hypothesized that whole lung lavage will provide a new therapy of acute lung injury caused by paraquat. On the base of conventional therapy for paraquat poisoning, whole lung lavage could be considered in the early time of poisoning and then followed by glucocorticoid for patients with moderate to severe paraquat poisoning.

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“…1 Attempts to modify the toxicity of paraquat have proven ineffective, and the clinical outcome of poisoning is therefore determined by degree of exposure. [2][3][4][5][6] The primary mechanism of exposure is ingestion, after which paraquat accumulates primarily in the lungs, resulting in acute pulmonary distress. 7 The selective accumulation of paraquat in alveolar cells induces the production of large quantities of toxic free radicals such as reactive oxygen species, leading to lipid peroxidation of cell membranes, exhaustion of nicotinamide adenine dinucleotide phosphate and cell death.…”

Section: Introductionmentioning

confidence: 99%

“…HP is most effective when initiated within 2 h of paraquat injection and 4 h of ingestion and administered continuously for 6-8 h. 11,12 HP is of limited value in cases of severe paraquat poisoning, however. 13,14 Repeated pulses of immunosuppression with methylprednisolone and cyclophosphamide may lower mortality rates, 5 although a multicentre study found that mortality rates remained high in spite of large intercentre variations in treatment (including HP, immunosuppression and antioxidant treatment). 4 Continuous renal replacement therapy, such as continuous venovenous haemofiltration (CVVH), is used to treat patients with acute renal failure and cardiovascular instability and is believed to eliminate excess cytokines and inhibit abnormal enzyme release.…”

Section: Introductionmentioning

confidence: 99%

Early haemoperfusion with continuous venovenous haemofiltration improves survival of acute paraquat-poisoned patients

et al. 2014

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Objective: To determine whether haemoperfusion (HP) with continuous venovenous haemofiltration (CVVH) improves the survival of patients with acute paraquat poisoning, compared with those treated using HP alone. Methods: Medical records of patients with acute paraquat poisoning were analysed. Patients were randomised to undergo HP or HP þ CVVH within 24 h of paraquat ingestion. Mortality rate, survival duration and cause of death were recorded. Results: There were no significant differences in mortality rate between the HP group (n ¼ 458) and the HP þ CVVH group (n ¼ 226) (57.4% and 58.4%, respectively). The mean survival duration was significantly longer in the HP þ CVVH group than the HP group (8.6 AE 3.1 and 5.1 AE 2.3 days, respectively). Early circulatory collapse was a major cause of death in the HP group. The major cause of death in the HP þ CVVH group was late respiratory failure. Conclusion: Combined therapy with HP and CVVH can prevent early death and prolong survival duration following acute paraquat poisoning, providing the opportunity for further treatment.

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Improved survival in severe paraquat poisoning with repeated pulse therapy of cyclophosphamide and steroids

Abstract: Repeated pulses of CP and MP, rather than high doses of CP and DEX, may result in a lower mortality rate in patients with severe PQ poisoning.

Cited by 72 publications

References 26 publications

Therapeutic effects of smecta or smectite powder on rats with paraquat toxication

Therapeutic effects of smecta or smectite powder on rats with paraquat toxication

Whole lung lavage therapy: Treatment for lung injury caused by paraquat poisoning

Early haemoperfusion with continuous venovenous haemofiltration improves survival of acute paraquat-poisoned patients

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