Clinical and Laboratory Profile of Paraquat Poisoning: A Toxicological Crisis in Bangladesh

Fatal self-poisoning with the herbicide paraquat has been reported for decades as an important toxicological and public health concern in several countries, including China and Sri Lanka, and regulatory bans have been associated with subsequent reductions in cases. It is now becoming an emerging toxicological problem in India and Bangladesh. Data were collected in 10 tertiary hospitals in Bangladesh, which serve more than 65% of the population. Data were collected both prospectively from patient files and retrospectively from hospital records. Annual paraquat import (use) data were obtained from the National Board of Revenue of Bangladesh. A total of 1,420 patients were reported across sites between 2013 and 2024, and 257 patients' data were available for analysis. A consistent upward trend was observed in the number of cases, increasing from a single case in 2013 to 493 cases reported across the 10 study sites in 2024. Common presentations included leg swelling from acute kidney failure (183/257; 71.2%), vomiting (169/257; 65.8%), and abdominal pain (149/257; 58.0%). The case fatality rate was 43.2%, with a 95% CI (23.6-27.7). Markers of poor prognosis included male sex, large ingestion, fever, "paraquat tongue," acute kidney failure, and a low Glasgow Coma Scale score. The case fatality rate of paraquat poisoning is far higher than that of poisoning with other pesticides in Bangladesh. Banning its use in agriculture and replacing it with less toxic substitutes is urgently needed to reduce mortality and morbidity.