Fatal paraquat poisoning: tissue concentrations and implications for treatment

A 27-year-old male died 30 1/2 hours following ingestion of paraquat. Hemodialysis removed 72 mg of paraquat, which represented only 2% of the calculated absorbed dose; paraquat concentrations were determined in post-mortem tissue and were high in the lungs and kidneys. Prominent histologic changes were already present in the lungs, which showed extensive evidence of alveolar injury, and in the adrenal gland, which showed massive selective necrosis of the zonae fasciculata and reticularis. These findings emphasize the inadequacy of treatment regimens that attempt only to remove paraquat from body tissues. Trials of treatments designed to prevent gastrointestinal absorption, including combinations of absorbents, cathartics and gut lavage, are warranted.