Emergency Department, Centre Hospitalier de l'Ouest Guyanais, Saint-Laurent du Maroni, French Guyana.
Eur Rev Med Pharmacol Sci. 2018 Oct;22(20):7034-7038. doi: 10.26355/eurrev_201810_16175.
Paraquat poisoning has almost disappeared from metropolitan France following its ban from the European market ten years ago. However, due to neighboring countries still authorizing paraquat use, French Guyana seems in a different situation. Here we aimed to report a series of paraquat-poisoned patients admitted to the emergency department of the Western French Guyana Hospital in Saint-Laurent du Maroni, to raise awareness of national health authorities on this persistent major issue.
We conducted a retrospective observational study describing the clinical features, the prognostic factors and the final outcome of paraquat-poisoned patients admitted to the emergency department between January 2008 and August 2014.
Twenty-six paraquat-poisoned patients were included in the study. The median estimated paraquat dose intentionally ingested was 105 mg/kg (interquartile range, IQR: 359). Eighteen patients were treated with the cyclophosphamide/dexamethasone combination and seventeen with N-acetylcysteine in addition to the usual supportive care. Six patients survived and twenty died within a median 36h delay after admission (IQR: 130). Death was associated with cardiovascular (65%) and respiratory (35%) failure. Based on a bivariate analysis, predictive factors of death included (p≤0.05): advanced age, higher ingested paraquat dose, altered renal function, hypokalemia, acidosis, and dark blue dithionite test, observed on hospital admission.
Paraquat poisoning still persists in French Guyana despite its withdrawal from the market. It is possible to determine the probability of death on patient admission based on routine clinical and biological parameters. There is an urgent need to request neighboring countries to ban paraquat with the aim of eradicating this dramatically life-threatening poisoning.
十年前，百草枯在欧洲市场被禁后，几乎从法国大都市消失。然而，由于邻国仍授权使用百草枯，法属圭亚那的情况似乎有所不同。在这里，我们旨在报告一组在马罗尼的圣洛朗德马尔隆西法属圭亚那医院急诊科就诊的百草枯中毒患者，以引起国家卫生当局对这一持续存在的重大问题的关注。
我们进行了一项回顾性观察研究，描述了 2008 年 1 月至 2014 年 8 月期间急诊科收治的百草枯中毒患者的临床特征、预后因素和最终结局。
研究共纳入 26 例百草枯中毒患者。摄入的百草枯剂量中位数为 105mg/kg（四分位距，IQR：359）。18 例患者接受了环磷酰胺/地塞米松联合治疗，17 例患者在常规支持治疗的基础上加用 N-乙酰半胱氨酸。6 例患者存活，20 例患者在入院后中位数 36 小时内死亡（IQR：130）。死亡与心血管（65%）和呼吸（35%）衰竭有关。基于单变量分析，死亡的预测因素包括（p≤0.05）：年龄较大、摄入的百草枯剂量较高、肾功能改变、低钾血症、酸中毒和入院时观察到的深蓝色二硫代硫酸盐试验。
尽管百草枯已从市场上撤出，但法属圭亚那仍存在百草枯中毒。根据常规临床和生物学参数，可以在患者入院时确定死亡的概率。迫切需要请求邻国禁止使用百草枯，以消除这种危及生命的中毒。
