Therapy with high‑dose long‑term antioxidant free radicals for severe paraquat poisoning: A pilot study

Abstract

This study investigated the effects of high-dose long-term antioxidant free radicals on the mortality rate, creatinine (Cr) value, partial pressure of oxygen (PaO2), alanine aminotransferase (ALT), as well as the incidence rates of lung fibrosis and dysfunction in the treatment of patients with severe paraquat (PQ) poisoning [toxic dose, 20 ml stock solution (20% w/v)]. A total of 23 cases of severe PQ poisoning treated in Xiangyang First People's Hospital, Hubei University of Medicine were collected (group 1), and they received conventional treatments such as immunosuppressive agents and/or hemoperfusion. Six patients were given high-dose long-term antioxidant therapy on the basis of conventional treatments (group 2). After treatment, 6 out of the 23 patients in group 1 survived, and all the 6 patients in group 2 survived, with the survival rate of 26.1 vs. 100% (p<0.01). The lowest PaO2 value in group 1 was lower than that in group 2 (70.26±16.38 vs. 91.17±3.43 mmHg, p<0.01). The highest ALT value in group 1 was higher than that in group 2 (216.74±126.23 vs. 52.50±24.83 U/l, p<0.01). There was no significant difference in the incidence rate of lung fibrosis between the two groups of survived patients, but there were 6 patients that died of severe lung fibrosis in group 1. Besides, the incidence rate of lung dysfunction in patients in group 2 was significantly lower than that in survived patients in group 1 (p<0.01). High-dose long-term antioxidants are the most critical treatment option to improve the survival rate of high-dose PQ poisoning, they increase the patient's PaO2, enhance liver function, reduce lung fibrosis and refine lung dysfunction.

The Protective Effect of Aspirin Eugenol Ester on Paraquat-Induced Acute Liver Injury Rats

“…PQ poisoning is caused by the selective accumulation of PQ molecules that can cause multiple organ failure and can cause severe damage to the liver (15). Although progress has been made in the comprehensive treatment of PQ poisoning, the mortality rate remains high due to the lack of effective treatment (40,41). The underlying mechanism of PQ poisoning has not been fully elucidated, but it may be multifactorial.…”

Paraquat Poisoning: Survival after Oral Ingestion

“…-For more severe poisoning, patients receiving both glucocorticoids and cyclophosphamide may have a lower death rate [27] -Acetylcysteine is renally protective with a low adverse reaction profile [28] -High-dose long-term antioxidants could potentially be a critical component improving the survival rate in severe paraquat poisoning [30] -Limiting oxygen therapy for patients with a PaO 2 > 50 can prevent free radical formation.…”

“…Systematic Review Li LR, et al [27] Prospective Cohort Tepel M, et al [28] Case Series Hu S, et al [30] and treatment options for paraquat poisoning is important to reduce morbidity and mortality in these cases.…”

“…Thus, it may be used in paraquat toxicity with a low adverse reaction profile and is presumed to work on the basis that it replenishes glutathione stores and may inhibit free radical production [29]. High-dose long-term antioxidants may increase the PaO 2 , enhance liver function, reduce lung fibrosis, and minimize lung dysfunction in patients with paraquat poisoning [30].…”

Curcumin relieves paraquat‑induced lung injury through inhibiting the thioredoxin interacting protein/NLR pyrin domain containing 3‑mediated inflammatory pathway

“…The lungs are usually one of the most damaged organs; accumulation of PQ in the lungs induces pulmonary edema, hemorrhage and alveolar epithelial cell destruction, ultimately leading to acute lung injury (ALI), one of the most frequent causes of PQ poisoning-associated mortality (6,7). Numerous therapeutic strategies have been developed to target the pathological mechanisms of PQ poisoning; however, their clinical efficacies have not been satisfactory (8–10).…”