UNDERSTANDING PARAQUAT POISONING AND ITS LIFE-THREATENING IMPACT AND ROLE OF EARLY INITIATION OF HEMODIALYSIS

Abstract

Background: Acute paraquat poisoning is a severe toxicological emergency characterized by oxidative injury and progressive renal and pulmonary damage. Mortality remains high, particularly when pulmonary fibrosis develops. The Aim is to evaluate the clinical profile, renal and respiratory complications, timing of hemodialysis, and clinical outcomes in patients with acute paraquat poisoning. Materials and Methods: A hospital-based observational study was conducted among 15 adult patients with acute paraquat poisoning admitted to the Department of General Medicine, Gulbarga Institute of Medical Sciences, Kalaburagi, from January 2025 to May 2026. Clinical features, laboratory findings, timing of dialysis, organ involvement, hospital stay, and final outcomes were assessed. Results: A total of 15 patients with acute paraquat poisoning were included. The largest age group was 41–50 years (5, 33.3%), with a male predominance (10, 66.7%) and majority from rural areas (11, 73.3%). Vomiting was the commonest symptom (14, 93.3%), followed by oral ulceration (12, 80.0%) and dysphagia (11, 73.3%). Respiratory distress occurred in 9 (60.0%), acute kidney injury in 8 (53.3%), and hypotension in 5 (33.3%). Serum creatinine >1.5 mg/dL was present in 12 (80.0%), elevated liver enzymes in 10 (66.7%), pulmonary infiltrates/fibrotic changes in 11 (73.3%), and metabolic acidosis in 10 (66.7%). Hemodialysis was initiated within 6 hours in 6 (40.0%) patients and after 6 hours in 9 (60.0%). Overall, 2 (13.3%) survived, 11 (73.3%) died, and 2 (13.3%) were discharged against medical advice. Early dialysis showed numerically better survival (33.3% vs. 0%), but the association with outcome was not statistically significant. Despite improvement in renal parameters following early dialysis, progressive respiratory complications and pulmonary fibrosis contributed to the high mortality. Conclusion: Early hemodialysis may provide renal and metabolic support, but progressive pulmonary injury remains a major determinant of mortality in acute paraquat poisoning.