Use of low-molecular-weight heparin in severe paraquat poisoning: a case report

Abstract

Background Acute paraquat ingestion remains a leading cause of mortality in developing countries. There is currently no evidence that treatment with high-dose immunosuppressants and antioxidants improves survival in patients with paraquat poisoning, and better options are urgently needed. Here, we describe the unexpected survival and recovery of a patient with a potentially fatal paraquat poisoning. Case presentation After ingesting 28 mL of paraquat (20% ion w/v), confirmed by a deep blue color in the urine dithionite test (UDT), a 17-year-old Hispanic Colombian boy was treated according to the hospital protocol with cyclophosphamide, methylprednisolone, N-acetylcysteine, vitamin E and propranolol. Gastrointestinal endoscopy showed extensive ulceration and necrosis. As a novelty, enoxaparin at a single dose of 60 mg was added to his treatment. Despite the evidence of severe mucosal burns in the gastrointestinal tract and high paraquat concentrations found in the UDT, the clinical condition began to improve after 1 day of treatment, with full recovery and discharge from hospital after 21 days. Conclusions Although the amount of paraquat ingested by the patient was large and the UDT indicated severe poisoning with a somber prognosis, unexpected survival of the patient was observed, and the addition of enoxaparin was the only change from the standard treatment.

Pulmonary histopathology in fatal paraquat poisoning

“…In a sheep model of pneumonia and smoke inhalation induced lung injury, inhaled heparin significantly reduced lung vascular leak compared to systemic heparin administration. 23 Montoya Giraldo et al 24 reported a case of severe paraquat toxicity unexpectedly survived due to the addition of enoxapene, a low molecular weight heparin with the standard treatment. From these findings, we hypothesize that inhalation antithrombin therapy in the exudative phase of acute paraquat poisoning may reduce lung vascular leakage and fibrin deposition.…”

Characterization of Morganella sp. for its Paraquat Degradation Potential

“…For example, it is known that paraquat is concentrated in the alveolar epithelium of the lung. Small amounts, even if taken from the stomach or spat out, may still lead to asphyxiation from fibrous tissue in the lungs, even if they are eliminated from the body [12][13][14][15].…”