Lethal diquat poisoning manifests as acute central nervous system injury and circulatory failure: A retrospective cohort study of 50 cases

Zhou, Jia-Ning; Lu, Yuan-Qiang

doi:10.1016/j.eclinm.2022.101609

Cited by 24 publications

(8 citation statements)

References 32 publications

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“…To determine the type and severity of poisoning, the blood concentration of the poison is considered the gold standard. A retrospective cohort study of 50 patients confirmed a relationship between plasma DQ concentrations and in-hospital mortality (AUC = 0.97 [0.91, 1.00], cutoff = 3516.89 ng/ml [sensitivity, 90.90%; specificity, 96.00%]) [ 33 ]. In contrast, some patients did not receive complete continuous treatment, which may have affected the study’s results.…”

Section: Discussionmentioning

confidence: 94%

“…The concentration of toxicants in the blood is considered to be the gold standard for theoretically evaluating a patient’s condition [ 33 ]. We recorded the plasma DQ concentrations at the time of admission in 57 patients because some patients were tested only for urine DQ concentrations.…”

Section: Discussionmentioning

confidence: 99%

“…First, the small sample size and single-center retrospective design of this study limit the amount of data collected, which may introduce bias that affects the universality of the research results. Furthermore, despite the inclusion of many variables in this study to cover all the influencing factors as much as possible, certain specificity indicators identified in prior research, such as body mass index [ 37 ], neutrophil gelatinase-associated lipocalin [ 38 , 39 ], serum toxicant concentration [ 33 ], and lactate concentration [ 10 ], were not adequately captured for various reasons. Finally, although the prediction model demonstrated a certain degree of accuracy, the initial clinical data within 24 h after admission did not fully reflect the degree of organ damage caused by DQ.…”

Section: Discussionmentioning

confidence: 99%

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Construction of a mortality risk prediction model for patients with acute diquat poisoning based on clinically accessible data

Lv,

2024

J Occup Med Toxicol

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Background To examine the risk factors associated with mortality in individuals suffering from acute diquat poisoning and to develop an effective prediction model using clinical data. Methods A retrospective review was conducted on the clinical records of 107 individuals who were hospitalized for acute diquat poisoning at a tertiary hospital in Sichuan Province between January 2017 and September 30, 2023, and further categorized into survivor and nonsurvivor groups based on their mortality status within 30 days of poisoning. The patient’s demographic information, symptoms within 24 h of admission, and details of the initial clinical ancillary examination, as well as the APACHE II score, were documented. The model was developed using backward stepwise logistic regression, and its performance was assessed using receiver operating characteristic curves, calibration curves, Brier scores, decision curve analysis curves, and bootstrap replicates for internal validation. Results Multifactorial logistic regression analysis revealed that blood pressure (hypertension, OR 19.73, 95% CI 5.71–68.16; hypotension, OR 61.38, 95% CI 7.40–509.51), white blood count (OR 1.35, 95% CI 1.20–1.52), red cell distribution width-standard deviation (OR 1.22, 95% CI 1.08–1.38), and glomerular filtration rate (OR 0.96, 95% CI 0.94–0.97) were identified as independent risk factors for mortality in patients with diquat. Subsequently, a nomogram with an area under the curve of 0.97 (95% CI: 0.93–1) was developed. Internal bootstrap resampling (1000 repetitions) confirmed the model’s adequate discriminatory power, with an area under the curve of 0.97. Decision curve analysis demonstrated greater net gains for the nomogram, while the clinical impact curves indicated greater predictive validity. Conclusion The nomogram model developed in this study using available clinical data enhances the prediction of risk for DQ patients and has the potential to provide valuable clinical insights to guide patient treatment decisions.

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Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Construction of a mortality risk prediction model for patients with acute diquat poisoning based on clinically accessible data

Lv,

2024

J Occup Med Toxicol

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“…Notably, in the United States, between 1998 and 2013, 300 acute illnesses were associated with paraquat, while 144 were linked to DQ exposure, with herbicide spillage or splashing being a signi cant cause of such illnesses [17]. Furthermore, DQ exposure has been shown to damage multiple organs, including the kidneys, lungs, small intestines, liver, and central nervous system [18][19][20][21].…”

Section: Discussionmentioning

confidence: 99%

Selenium Yeast Mitigates Diquat-Induced Oxidative Stress in Rooster Testicles and Preserves Reproductive Performance

Xiong,

Liu,

et al. 2023

Preprint

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Background:Diquat (DQ) is a pro-oxidant that generates free radicals in cells through redox reactions, leading to the induction of oxidative stress. It is widely utilized in agricultural production across many countries. During the processes of growth and reproduction, poultry are particularly vulnerable to oxidative stress. Selenium yeast (SeY) serves as an organic selenium source characterized by high activity and low toxicity, imparting antioxidant effects. The objective of this study was to assess the protective effects of SeY against DQ-induced oxidative stress in rooster testicles and its impact on reproductive performance. A cohort of 60 healthy Kangle yellow roosters participated in this investigation. These roosters were randomly and equally divided into four groups: the control group, the DQ group, the SeY and DQ group, and the SeY group. Results: The results demonstrated that SeY pretreatment mitigated DQ-induced oxidative damage in the testes. This mitigation encompassed the alleviation of inhibited spermatogenesis, reduced spermatogenic cell abundance, decreased expression of genes related to testosterone synthesis, and amelioration of impaired reproductive performance. Specifically, SeY pretreatment counteracted DQ-induced oxidative stress by activating the Nrf2/HO-1 antioxidant signaling pathway, enhancing the activity of antioxidant enzymes such as catalase (CAT) and total superoxide dismutase (T-SOD), and reducing the concentration of malondialdehyde (MDA). Furthermore, SeY pretreatment attenuated DQ-induced spermatogonia apoptosis by modulating the expression of apoptosis-related genes and proteins, including Bax, Bcl-2, Caspase3, and NF-κB. Additionally, SeY restored the proliferative capacity of spermatogenic cells by promoting the expression of the proliferation-related protein Ki67. Conclusions: The aforementioned findings signify that SeY effectively safeguards the testes against DQ-induced damage through mechanisms involving the reduction of oxidative stress, inhibition of apoptosis, promotion of proliferation, and the preservation of reproductive performance in roosters. This study lays a solid theoretical foundation for future research aimed at safeguarding the reproductive health of male poultry exposed to agricultural pesticides.

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“…For severe diquat poisoning cases, multiple organ injuries can occur within a few hours after ingestion, and the clinical manifestations and prognosis are mainly related to the dose of the poison. Zhou and Lu ( 8 ) observed that the high mortality in diquat poisoning cases is primarily associated with serious brain and vascular injury. Consciousness disorder, paralytic ileus, myocardial damage, acute kidney failure, and rhabdomyolysis were important clinical findings in our cases.…”

Section: Discussionmentioning

confidence: 99%

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

Wang²,

Jian³

et al. 2022

Front. Public Health

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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.

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Lethal diquat poisoning manifests as acute central nervous system injury and circulatory failure: A retrospective cohort study of 50 cases

Cited by 24 publications

References 32 publications

Construction of a mortality risk prediction model for patients with acute diquat poisoning based on clinically accessible data

Construction of a mortality risk prediction model for patients with acute diquat poisoning based on clinically accessible data

Selenium Yeast Mitigates Diquat-Induced Oxidative Stress in Rooster Testicles and Preserves Reproductive Performance

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

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