Department of General Medicine, SDM College of Medical Sciences and Hospital, Shri Dharmasthala Manjunatheshwara University, Dharwad, Karnataka, India.
Resident, Infectious diseases, All India Institute of Medical Sciences, New Delhi, India.
Natl Med J India. 2021 May-Jun;34(3):138-142. doi: 10.25259/NMJI_383_19.
Background Paraquat is an inexpensive herbicide used in agriculture because it is easily available and the cost of labour for manual clearance of weeds is prohibitive. Paraquat is toxic to human beings and is also used for committing suicide. We studied the reasons for under-reporting of paraquat poisoning including those related to the training of doctors. Methods In this mixed-methods study, we describe a series of patients with paraquat poisoning. We recorded their demographic data, clinical features, treatment and outcome with an intention to explore the reason for an initial misdiagnosis. We also explored whether deficiencies in curricula contributed to the misdiagnosis. Results The patients of paraquat poisoning (n=28) were mostly young illiterate men driven by impulsive behaviour rather than chronic depression. Paraquat was consumed by patients from non-agricultural background as well, implying easy access to the poison. Many patients could not name the agent and so initial treatment was directed at organophosphorus poisoning. The diagnostic signs included paraquat tongue, renal failure and jaundice. Most of the casualty medical officers and residents were unfamiliar with the symptoms and signs of paraquat poisoning as was evident by their answers to the questionnaire. Knowledge of medical students about paraquat poisoning was not assessed in the theory examinations and viva. Conclusion Factors contributing to the limitation in establishing the diagnosis are illiteracy and ignorance of the patients, lack of specific signs and lack of training of medical officers in treating patients with paraquat poisoning.
百草枯是一种廉价的除草剂，在农业中广泛使用，因为它容易获得，而且人工除草的劳动力成本过高。百草枯对人体有毒，也被用于自杀。我们研究了百草枯中毒报告不足的原因，包括与医生培训相关的原因。
在这项混合方法研究中，我们描述了一系列百草枯中毒患者。我们记录了他们的人口统计学数据、临床特征、治疗和转归，旨在探讨最初误诊的原因。我们还探讨了课程是否存在缺陷导致误诊。
百草枯中毒患者（n=28）主要是年轻的文盲男性，受冲动行为驱动，而非慢性抑郁。非农业背景的患者也会接触到百草枯，这表明这种毒药很容易获得。许多患者无法说出毒物名称，因此初始治疗针对有机磷中毒。诊断标志包括百草枯舌、肾衰竭和黄疸。许多急救医疗官员和住院医师不熟悉百草枯中毒的症状和体征，这从他们对问卷的回答中可以明显看出。医学学生对百草枯中毒的了解并没有在理论考试和口试中进行评估。
导致诊断受限的因素包括患者的文盲和无知、缺乏特定的症状和缺乏对急救医疗官员治疗百草枯中毒患者的培训。
