Paraquat intoxication and seizures, case report from a health institution from Pasto-Nariño
Main Article Content
Abstract
A clinical case of a 20 year-old man from a rural area of Llorente-Nariño, who consulted a local health center after 36 hours of accidental ingesting Gramoxone (paraquat dichloride, 20-30 mL), while under the influence of alcohol, that provoked digestive symptoms, hyperbilirubinemia, elevation of creatinine and hemogram with leukocytosis and neutrophilia, is referred to the third level of health attention in the city of Pasto. During the hospital course he presents epistaxis, kidney failure with need of hemodialysis, oral burns, hyperthermia and two episodes of convulsive seizures clonic-tonic generalized with arterial blood gases, electrolytes, glycemia and other para-clinics within normal ranges during the seizures. It’s important to try to give elements to build a clinical criteria to explain neurologic compromise, because is exceptionally strange and complex this type of clinical presentation in cases of intoxication with paraquat.
Article Details
References
Wang X, Souders C, Zhao Y, Martyniuk C. Paraquat affects mitochondrial bioenergetics, dopamine system expression, and locomotor activity in zebrafish. Chemosphere. 2018; 191:106- 17.
Kang C, Kim SC, Lee SH, Jeong JH, Kim DS, Kim DH. Absolute lymphocyte count as a predictor of mortality in emergency department patients with paraquat poisoning. Plos One. 2013; 8(10): e78160.
World Health Organization. WHO recommended classification of pesticides by hazard and guidelines to classification 2000-2002. WHO/PCS 01.4. 2002.
Angulo NY. Intoxicación por paraquat. En: Peña LM, Arroyave CL, Aristizábal JJ, Gómez UE, editors. Toxicología clínica. 1a ed. Medellín: CIB; 2010. p. 135-46.
Calzada UE. Conferencia: Manejo actual de la intoxicación por paraquat en Colombia. Medellín; 2018:1-21.
Orozco R, Ceballos C. Incidencia de intoxicaciones por sustancias químicas en el departamento de Antioquia año 2013. Medellín: Secretaría Seccional de Salud y Protección Social. 2013:1-31.
Ministerio de Salud de Colombia [Internet]. Instituto Nacional de Salud. Boletín epidemiológico. Semana 52 [citado el 10 de octubre de 2019]. Disponible en: https://www.ins.gov.co/buscadoreventos/BoletinEpidemiologico/2019_Boletin_epidemiologico_semana_52.pdf.
Delirrad M, Majidi M, Boushehri B. Clinical features and prognosis of paraquat poisoning: A review of 41 cases. Int J Clin Exp Med. 2015; 8(5):8122-8.
Gil H, Hong J, Jang S, Hong S. Diagnostic and therapeutic approach for acute paraquat intoxication. J Korean Med Sci. 2014; 29(11):1441-9.
Schenker M, Stoecklin M, Lee K, Lupercio R, Zeballos R, Enright P, et al. Pulmonary function and exercise-associated changes with chronic low-level paraquat exposure. Am J Respir Crit Care Med. 2004; 170(7):773-9.
Gómez U, Cuesta F, Benavides C, Angulo N, Llinás V, Quiceno L, et al. Impacto en la mortalidad de un tratamiento conjugado en pacientes intoxicados no ocupacionalmente con paraquat en el Hospital Universitario San Vicente de Paúl de Medellín, entre agosto de 2002 y agosto de 2003. IATREIA. 2004; 17(1):24-33.
Lee Y, Lee JH, Seong AJ, Hong CK, Lee HJ, Shin DH, et al. Arterial lactate as a predictor of mortality in emergency department patients with paraquat intoxication. Clin Toxicol. 2012; 50(1):52-6.
Weng C, Chen H, Hu C, Huang W, Hsu C, Fu J, et al. Predictors of acute kidney injury after paraquat intoxication. Oncotarget. 2017; 8(31):51345-54.
Lin J, Lin-Tan DT, Chen KH, Huang WH. Repeated pulse of methylprednisolone and cyclophosphamide with continuous dexamethasone therapy for patients with severe paraquat poisoning. Crit Care Med. 2006; 34(2):368-73.
Zhao X, Wang R, Xiong J, Yan D, Li A, Wang S, et al. JW antagonizes paraquat-induced neurotoxicity via activation of Nrf2. Toxicol Lett. 2017; 277:32-40.
Li K, Cheng X, Jiang J, Wang J, Xie J, Hu X, et al. The toxic influence of paraquat on hippocampal neurogenesis in adult mice. Food Chem Toxicol. 2017; 106(Pt A):356-66.
Bhardwaj N, Ashutosh S. Paraquat treatment modulates integrin associated protein (CD47) and basigin (CD147) expression and mitochondrial potential on erythroid cells. Environ Toxicol Pharmacol. 2018; 58:37-44.
Viales G. Intoxicación por paraquat. Med Leg Costa Rica. 2014; 31(2):88-94.
Rzezniczak TZ, Douglas LA, Watterson J, Merritt TJ. Paraquat administration in Drosophila for use in metabolic studies of oxidative stress. Anal Biochem. 2011; 419(2):345-7.
Suntres ZE. Exploring the potential benefit of natural product extracts in paraquat toxicity. Fitoterapia. 2018; (131):160-7.
Blanco T, Andérica AC, Pedraza J. New insights into antioxidant strategies against paraquat toxicity. Free Radic Res. 2014; 48(6):623-40.
Saravu K, Sekhar S, Pai A, Barkur AS, Rajesh V, Earla JR. Paraquat. A deadly poison: Report of a case and review. Indian J Crit Care Med. 2013; 17(3):182-4.
Mandel JS, Adami HO, Cole P. Paraquat and Parkinson’s disease: An overview of the epidemiology and a review of two recent studies. Regul Toxicol Pharmacol. 2012; 62(2):385-92.
Hou L, Sun F, Sun W, Zhang L, Wang Q. Lesion of the locus coeruleus damages learning and memory performance in paraquat and maneb-induced mouse Parkinson’s disease model. Neuroscience. 2019; (419):129-40.
Huang C, Ma J, Li BX, Sun Y. Wnt1 silencing enhances neurotoxicity induced by paraquat and maneb in SH-SY5Y cells. Exp Ther Med. 2019; 18(5):3643-9.
Cartagena S, Díaz I, Gutiérrez C, Dreyse J, Florenzano M, Palavecino M, et al. Fibrosis pulmonar aguda asociada a intoxicación por paraquat: caso clínico. Rev Med Chile. 2018; 146(7):938-41.
Angarita LA, Lema GL, Restrepo MV, Arroyave CL. Efecto del tratamiento combinado con esteroides y ciclofosfamida sobre la mortalidad en intoxicación por paraquat. Meta análisis. Med UPB. 2010; 29(2):99-108.
Marín-Cuartas M, Berrouet-Mejía MC. Intoxicación por paraquat. Rev CES Med. 2016; 30(1):114-21.
