Paraquat - A deadly poison: Report of a case and review
A 16-year-old female patient was admitted to emergency department of our tertiary care hospital with history of alleged consumption of paraquat poison, 13 days before at 19.00 hours at her residence due to failure in matriculation examination. History revealed that after consumption of the poison, she was taken to the local hospital after ½ an hour. Meanwhile, she was reported to have 6 episodes of vomiting. She was treated conservatively; gastric lavage followed by activated charcoal 1 gm/kg was given as an adsorbent and discharged after 6 days from a local hospital. Since then, she was suffering from fever and cough without shortness of breath, orthopnea, chest, and abdominal pain. After 1 week at 21.00 hours, she was brought to our hospital. Her O2 saturation was 40% on room air, pulse rate was 78 beats/minute, respiratory rate 28 beats/minute, and blood pressure was 100/60 mmHg. Respiratory examination revealed bilateral crepitation. Patient was administered O2 by 60% venturi, and her saturation picked up to 95%.\nLaboratory tests showed leukocytosis, neutrophilia, elevated ESR, and metabolic acidosis with normal renal and liver function. On the second day, she was shifted to ICU due to increasing breathlessness. Empirical antibiotic therapy was started with intravenous piperacillin-tazobactam 4.5 gm stat and continued 8th hourly. Antioxidant therapy was initiated on the same day with vitamin E and C. Detoxifying agent N-Acetyl cysteine 600 mg was given orally thrice-daily from second day onwards. In view of persistence hypoxia, she was intubated and put on mechanical ventilator on the 3rd day. Midazolam and Morphine were started on same day and continued for 1 week. She was treated with oral cyclophosphamide 50 mg once-daily on 3rd day till 12th day, and steroid dexamethasone 4 mg i.v. 6 hourly was started on 6th day and stopped after one week. Subsequently, she was treated with linezolid and piperacillin-tazobactam when she developed ventilator-associated pneumonia (VAP). Piperacillin-tazobactam was changed to cefoperazone-sulbactum based on culture and sensitivity of endotracheal aspirate, which grew Klebsiella pneumoniae and Acinetobacters pecies. The serial chest X-rays done are shown in the Figures -. Patient could not afford to continue the treatment; hence, she was discharged against medical advice in a critical condition.