Pre-embarkment prognostication for acute paraquat poisoning

Area of Science:

• Toxicology
• Clinical Chemistry
• Emergency Medicine

Background:

• Acute paraquat poisoning is a severe condition with high mortality.
• Identifying early prognostic indicators is crucial for patient management.
• Previous studies have explored various clinical and laboratory findings.

Purpose of the Study:

• To identify laboratory parameters associated with prognosis in acute paraquat poisoning.
• To evaluate the predictive value of specific biochemical markers and their combinations.

Main Methods:

• Retrospective review of medical records for 160 patients with acute paraquat ingestion.
• Analysis of serum creatinine, potassium, arterial blood bicarbonate, base excess, and pH.
• Assessment of paraquat volume ingested and urinary paraquat test results.
• Development and correlation of a prognostic index (Eq1) with time to admission (T).

Main Results:

• Significant differences in serum creatinine, potassium, bicarbonate, base excess, pH, ingested volume, and urinary paraquat tests were observed between survivors and non-survivors.
• The calculated index Eq1 = ([K+] x [HCO3-])/([Cre] x 0.088) showed a significant correlation with prognosis (P < 0.01).
• Prognostic stratification based on Eq1 and time (T) revealed distinct survival rates: >90% for Eq1 > (1500 - 399 X LogT), 38% for (930 - 399 X LogT) < Eq1 ≤ (1500 - 399 X LogT), and 3% for Eq1 ≤ (930 - 399 X LogT).

Conclusions:

• Serum creatinine, potassium, and arterial blood gas parameters are valuable indicators of prognosis in acute paraquat poisoning.
• The novel prognostic index Eq1, incorporating these laboratory values and time, effectively predicts survival rates.
• This index can aid clinicians in assessing the severity and likely outcome of paraquat poisoning.