Urine Dithionite-guided Hemoperfusion in Acute Paraquat Poisoning: A Retrospective Observational Study from South...

Paraquat (PQ) poisoning has a mortality rate of 50-90% with no specific antidote. Hemoperfusion (HP) is used for PQ removal, but evidence for its efficacy is limited, and optimal strategies for guiding HP remain poorly defined. The study aims to describe a urine sodium dithionite test (UDT)-guided HP protocol and evaluate clinical outcomes in patients with acute PQ poisoning.

A retrospective observational study of 27 consecutive patients with acute PQ poisoning admitted to a tertiary intensive care unit (ICU) in South India was conducted. Serial UDT was used to guide HP initiation, continuation, and cessation. Clinical data, treatment details, and outcomes were analyzed. Survivors and non-survivors were compared.

Mean age was 30.5 ± 11.2 years (74.1% male). Fourteen patients (51.9%) survived. Ingestion-to-door (I-to-D) time ≤4 h was present in 71.4% of survivors vs 20% of non-survivors. Urine sodium dithionite test negative conversion within 10 h occurred in 77.8% of survivors vs 16.7% of non-survivors. Survivors received more HP sessions (mean: 3.3 vs 2.6). Acute kidney injury (AKI) occurred in 80% of non-survivors vs 14.3% of survivors.

Early presentation combined with a UDT-guided HP protocol was associated with favorable outcomes. Serial UDT provides a practical, low-cost tool for guiding extracorporeal treatment (ECTR) in resource-limited settings.

The UDT-guided HP protocol offers intensivists a bedside decision-making tool that replaces costly plasma PQ assays, enabling evidence-based ECTR decisions in Indian ICU settings where quantitative assays are unavailable.