Paraquat Poisoning: A Case Series

Paraquat (PQ) poisoning remains a critical public health concern in Nepal due to its high mortality rate and absence of a specific antidote. PQ, first introduced in 1955 as a herbicide, is extremely toxic when ingested. This report presents two incidents involving PQ poisoning managed at Chitwan Medical College Teaching Hospital. The first case involved a 27-year-old woman who ingested approximately 20 mL of 24% PQ in a suicide attempt. Despite prompt gastric decontamination and supportive care, she developed severe respiratory and renal failure, culminating in multi-organ failure and death within 4 days. The second incident concerned a 35-year-old woman who ingested PQ and also administered it to her two sons. After intensive management and psychiatric evaluation, she recovered after 19 days of hospitalization. Her 7-year-old son ingested PQ mixed with milk and received supportive treatment for 8 days, after which he was discharged with improved renal and pulmonary function. The 1-year-old infant, however, presented with acute respiratory distress and neurological impairment and succumbed 7 h after admission despite continuous positive airway pressure and intubation. These cases underscore the severe systemic toxicity of PQ, particularly its pulmonary and renal effects, and the absence of a definitive antidote. Early diagnosis, prompt decontamination, and intensive supportive care remain crucial for survival. Strengthening preventive strategies, regulatory control, and nationwide poisoning surveillance are essential to mitigate the persistently high mortality associated with PQ ingestion in Nepal.