Isha Ishrat Tahsin, Alam Z H M Nazmul, Shaha Bidur Kanti, Bari Md Shafiqul, Bari Mohammad Zabed Jillul, Chowdhury Fazle Rabbi
Department of Medicine, Sylhet M.A.G Osmani Medical College Hospital, Medical College Road, Sylhet, 3100, Bangladesh.
Department of Medicine, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh.
BMC Res Notes. 2018 May 30;11(1):344. doi: 10.1186/s13104-018-3425-3.
Since Bangladesh government issued a ban on the use of highly toxic WHO Class I pesticides, annual consumption of herbicides like Paraquat have been sharply increasing in the markets. Paraquat poisoning is an emerging public health threat and its high mortality rate is responsible for a significant number of deaths. Diagnostic limitations and unavailable sample at presentation have resulted in under-reporting and lack of awareness among the treating physicians, making Paraquat poisoning one of the most neglected toxicological emergencies. Herein, we present a case of Paraquat induced multi-organ failure and emphasis on pitfalls in the management.
An 18-years-old healthy male was admitted in Sylhet M.A.G Osmani Medical College Hospital with history of attempted suicide by Paraquat ingestion. On admission, he had high serum creatinine but otherwise asymptomatic. He was discharged on day 10 when his renal functions returned to normal. But On day 15, he started having respiratory symptoms-unresponsive to any of the local treatments he received, and by day 30, he developed overt lung fibrosis. We present sequential blood picture, radiographs and CT scans demonstrating Paraquat induced kidney and lung injury over the course of 30 days.
Paraquat poisoning can lead to death and fatal long-term consequences. All cases of Paraquat poisoning, regardless of symptoms, must be hospitalized and observed for early detection of complications. Distribution of Paraquat should be restricted and/or banned as 38 other countries have done so, which we believe will greatly reduce poisoning related mortality.
自孟加拉国政府发布禁令，禁止使用剧毒的世界卫生组织一级农药以来，市场上百草枯等除草剂的年消费量急剧增加。百草枯中毒是一种新出现的公共卫生威胁，其高死亡率导致大量死亡。诊断限制以及就诊时无法获取样本导致报告不足，且治疗医生缺乏认识，使得百草枯中毒成为最被忽视的毒理学紧急情况之一。在此，我们报告一例百草枯诱发多器官功能衰竭的病例，并强调治疗中的陷阱。
一名18岁健康男性因摄入百草枯自杀未遂被收治入锡尔赫特M.A.G奥斯曼尼医学院医院。入院时，他血清肌酐升高，但无其他症状。第10天肾功能恢复正常后他出院了。但在第15天，他开始出现呼吸道症状，对所接受的任何局部治疗均无反应，到第30天，他出现了明显的肺纤维化。我们展示了连续的血常规、X光片和CT扫描，显示了30天内百草枯诱发的肾脏和肺部损伤。
百草枯中毒可导致死亡和致命的长期后果。所有百草枯中毒病例，无论有无症状，均须住院并进行观察，以便早期发现并发症。应像其他38个国家那样，限制和/或禁止百草枯的销售，我们相信这将大大降低中毒相关的死亡率。
