Limits...
A case report of severe paraquat poisoning in an HIV-positive patient: an unexpected outcome and inspiration.

Shang AD, Lu YQ - Medicine (Baltimore) (2015)

Bottom Line: Multiple logistic regression analysis of plasma paraquat concentrations as a predictor of outcome in 375 cases of paraquat poisoning.Unfortunately, the patient was diagnosed as HIV infected, and CD4 lymphocyte count also confirmed that the patient was in a state of mild suppression of immunological function.Immediately, the patient received normative immunosuppressive therapy and hemoperfusion (HP).

View Article: PubMed Central - PubMed

Affiliation: From the Department of Emergency Medicine, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, People's Republic of China.

ABSTRACT
We described and analyzed the treatment process of an HIV-positive patient with severe paraquat (PQ) poisoning. A 34-year-old man ingested about 50 mL of a 20% solution of PQ in a suicide attempt. He was treated with gastric lavage, oral administration of adsorbent, and symptomatic treatments at the local hospital, and was transferred to our emergency department. Ten hours after the exposure, the concentration of plasma PQ was 2.17 mg/L and was substantially above the survival limits of the severity index for PQ poisoning (SIPP) curve (0.30 mg/L). The equation produced by Jones et al (Jones AL, Elton R, Flanagan R. Multiple logistic regression analysis of plasma paraquat concentrations as a predictor of outcome in 375 cases of paraquat poisoning. QJM. 1999:92;573-578) predicted a 20.5% probability of survival at admission. Unfortunately, the patient was diagnosed as HIV infected, and CD4 lymphocyte count also confirmed that the patient was in a state of mild suppression of immunological function. Immediately, the patient received normative immunosuppressive therapy and hemoperfusion (HP). On the 15th day after poisoning, the patient recovered well and was discharged. All along, the evolution of the patient's status was in accordance with the characteristics of PQ poisoning, but the extent and duration of damage was mismatching and drastically alleviative by the previous biological indices. The particular case of treatment may be indirectly supporting the effectiveness of immunosuppressive therapy in treating patients with PQ poisoning.

Show MeSH

Related in: MedlinePlus

Chest CT scans of the patient. (A) Chest CT scans on the fourth day after admission. It revealed scattered flocculent pieces and ground glass shadow with indistinct edges in the lungs. (B) Chest CT scans on the 15th day after admission. It showed nothing abnormal in the lungs. CT = computed tomography.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4554141&req=5

Figure 1: Chest CT scans of the patient. (A) Chest CT scans on the fourth day after admission. It revealed scattered flocculent pieces and ground glass shadow with indistinct edges in the lungs. (B) Chest CT scans on the 15th day after admission. It showed nothing abnormal in the lungs. CT = computed tomography.

Mentions: From the admission, a progressive and moderate deterioration occurred. Two days later, mouth and tongue ulcerations appeared with purulent surface. The patient felt chest distress and tachypnea (respiratory rate 25–30 times/min). On the fourth day, the hypoxemia was major as assessed by a Pao2 equal to 51.6 mm Hg. Chest CT scans showed scattered flocculent pieces and ground glass shadow with indistinct edges in the lungs (Figure 1A). A rapid impairment of renal function occurred with a maximum on the third day (serum Cr reached to 206 μmol/L). HP was performed a total of 6 times following admission. On the seventh day, CTX (total dose of 3 g) and methylprednisolone (total dose of 2 g) were not administrated with gradually reducing dosage, whereas CD4+ lymphocyte count reduced to 252 cells/μL. On the 12th day, the symptoms of the patient disappeared basically except for oropharyngeal ulcers, and the arterial blood gas, renal function, serum CK-MB, and cTn-I returned to normal. On the 15th day after poisoning, chest CT scans showed nothing abnormal in the lungs (Figure 1B), and the patient was transferred to another hospital for AIDS treatment. Fortunately, the survivor lives asymptomatically in our 18-month follow-up by telephone.


A case report of severe paraquat poisoning in an HIV-positive patient: an unexpected outcome and inspiration.

Shang AD, Lu YQ - Medicine (Baltimore) (2015)

Chest CT scans of the patient. (A) Chest CT scans on the fourth day after admission. It revealed scattered flocculent pieces and ground glass shadow with indistinct edges in the lungs. (B) Chest CT scans on the 15th day after admission. It showed nothing abnormal in the lungs. CT = computed tomography.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4554141&req=5

Figure 1: Chest CT scans of the patient. (A) Chest CT scans on the fourth day after admission. It revealed scattered flocculent pieces and ground glass shadow with indistinct edges in the lungs. (B) Chest CT scans on the 15th day after admission. It showed nothing abnormal in the lungs. CT = computed tomography.
Mentions: From the admission, a progressive and moderate deterioration occurred. Two days later, mouth and tongue ulcerations appeared with purulent surface. The patient felt chest distress and tachypnea (respiratory rate 25–30 times/min). On the fourth day, the hypoxemia was major as assessed by a Pao2 equal to 51.6 mm Hg. Chest CT scans showed scattered flocculent pieces and ground glass shadow with indistinct edges in the lungs (Figure 1A). A rapid impairment of renal function occurred with a maximum on the third day (serum Cr reached to 206 μmol/L). HP was performed a total of 6 times following admission. On the seventh day, CTX (total dose of 3 g) and methylprednisolone (total dose of 2 g) were not administrated with gradually reducing dosage, whereas CD4+ lymphocyte count reduced to 252 cells/μL. On the 12th day, the symptoms of the patient disappeared basically except for oropharyngeal ulcers, and the arterial blood gas, renal function, serum CK-MB, and cTn-I returned to normal. On the 15th day after poisoning, chest CT scans showed nothing abnormal in the lungs (Figure 1B), and the patient was transferred to another hospital for AIDS treatment. Fortunately, the survivor lives asymptomatically in our 18-month follow-up by telephone.

Bottom Line: Multiple logistic regression analysis of plasma paraquat concentrations as a predictor of outcome in 375 cases of paraquat poisoning.Unfortunately, the patient was diagnosed as HIV infected, and CD4 lymphocyte count also confirmed that the patient was in a state of mild suppression of immunological function.Immediately, the patient received normative immunosuppressive therapy and hemoperfusion (HP).

View Article: PubMed Central - PubMed

Affiliation: From the Department of Emergency Medicine, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, People's Republic of China.

ABSTRACT
We described and analyzed the treatment process of an HIV-positive patient with severe paraquat (PQ) poisoning. A 34-year-old man ingested about 50 mL of a 20% solution of PQ in a suicide attempt. He was treated with gastric lavage, oral administration of adsorbent, and symptomatic treatments at the local hospital, and was transferred to our emergency department. Ten hours after the exposure, the concentration of plasma PQ was 2.17 mg/L and was substantially above the survival limits of the severity index for PQ poisoning (SIPP) curve (0.30 mg/L). The equation produced by Jones et al (Jones AL, Elton R, Flanagan R. Multiple logistic regression analysis of plasma paraquat concentrations as a predictor of outcome in 375 cases of paraquat poisoning. QJM. 1999:92;573-578) predicted a 20.5% probability of survival at admission. Unfortunately, the patient was diagnosed as HIV infected, and CD4 lymphocyte count also confirmed that the patient was in a state of mild suppression of immunological function. Immediately, the patient received normative immunosuppressive therapy and hemoperfusion (HP). On the 15th day after poisoning, the patient recovered well and was discharged. All along, the evolution of the patient's status was in accordance with the characteristics of PQ poisoning, but the extent and duration of damage was mismatching and drastically alleviative by the previous biological indices. The particular case of treatment may be indirectly supporting the effectiveness of immunosuppressive therapy in treating patients with PQ poisoning.

Show MeSH
Related in: MedlinePlus