Management of Accidental Paraquat Ingestion in a Child

To report on the management of a toddler who had accidental ingestion of an unknown amount of paraquat, with treatment including continuous renal replacement therapy (CRRT), steroids and antifibrinolytics at a tertiary-level health system.

A 16-month-old child weighing 10 kg accidentally ingested an unknown amount of Gramoxone containing paraquat. The child was transferred to a tertiary centre Paediatric Intensive Care Unit (PICU) where she was electively intubated and commenced on CRRT at 7 hours and 15 minutes post-ingestion. She was also treated with activated charcoal, methylprednisolone, N-acetylcysteine infusion and pirfenidone. Paraquat blood and urine samples were monitored throughout her PICU admission.

The child did not exhibit respiratory distress or significant hypoxia during the admission. She developed ulceration of the lips, mouth and tongue on day 2 which improved after 48 hours. Feed intolerance and pneumatosis intestinalis were managed conservatively. Interstitial changes were noted on chest x-ray on day 3 and pirfenidone was initiated to minimise the risk of pulmonary fibrosis. The child was discharged from PICU to the general ward for further observation. At follow-up, there has been no evidence of pulmonary fibrosis up to 6 months post-discharge.

This case highlights the toxicity of Paraquat and importance of early management and urgent transfer of paraquat poisoning cases to specialised medical centres. Prompt interventions including activated charcoal, N-acetylcysteine, CRRT and pirfenidone can improve patient prognosis and reduce the risk of long-term complications such as pulmonary fibrosis in paediatric paraquat toxicity.