Abstract
Introduction
Paraquat remains one of the common substances involved in intentional ingestions in Thailand. However, data on outcomes of paraquat ingestion during pregnancy is rarely available and the management is controversial.
Case report
A 17-year-old female in 36+ weeks of gestation attempted suicide by ingesting 1/2 a glass of Gramozone™ (paraquat 27.6 % w/v) 5 hours prior to arrival to the hospital. Gastric aspiration and lavage was performed and she was given 50 g of activated charcoal and 150g of Fuller’s Earth suspension. A male infant, weighing 2,390g with an Apgar score of 71 1010, was delivered via emergency caesarean section 7 hours after ingestion. Due to presence of paraquat in the gastric lavage fluid, the mother was placed on dexamethasone/cyclophosphamide therapy. She developed mild renal insufficiency 63 hours after the ingestion. The infant developed tachypnea immediately after birth that self-resolved. The infant developed tachypnea again on day 6 of life. A chest x-ray revealed right lower lobe infiltration that progressed to diffuse interstitial pattern; subsequent chest x-rays showed evidence of fibrosis. Both mother and infant survived and the infant was discharged and sent home with oxygen 0.5 LPM. Upon follow up at 10 months of age, he still had evidence of chronic lung disease clinically and on chest x-ray.
Conclusion
Paraquat ingestion during the third trimester of pregnancy usually carries a very poor prognosis. Review of reported literature suggests that this case report represents only the second survival of mother and child.
Keywords: paraquat, neonatal exposure, poisoning, fetus, transplacental, herbicide
Full Text
The Full Text of this article is available as a PDF (144.8 KB).
Footnotes
There was no outside funding of any kind used for this study.
References
- 1.The Ramathibodi Poison Center Toxic Exposure Surveillance System Report. Bangkok: Ramathibodi Poison Center, Mahidol University;2000–2003.
- 2.Tominack RL, Pond SM. Goldfrank’s Toxicologic Emergencies. 7th. New York: McGraw-Hill; 2002. Herbicides; pp. 1393–410. [Google Scholar]
- 3.Musson FA, Porter CA. Effect of ingestion of paraquat on a 20-week gestation fetus. Postgrad Med J. 1982;58(685):731–2. doi: 10.1136/pgmj.58.685.731. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 4.Talbot AR, Fu CC, Hsieh MF. Paraquat intoxication during pregnancy: a report of 9 cases [erratum appears inVet Hum Toxicol. Jun 1988;30(3):245] Veterinary & Human Toxicology. 1988;30(1):12–7. [PubMed] [Google Scholar]
- 5.Fennelly JJ, Gallagher JT, Carroll RT. Paraquat poisoning in a pregnant woman. Br Med J. 1968;3(620):722–3. doi: 10.1136/bmj.3.5620.722. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 6.Raynal P, Bossard AE, Carles G. Paraquat poisoning at the beginning of pregnancy. Gynecologie, Obstetrique & Fertilite. 2003;31(5):449–51. doi: 10.1016/S1297-9589(03)00099-7. [DOI] [PubMed] [Google Scholar]
- 7.Ingebrigtsen K, Nafstad I, Andersen RA. Distribution and transplacental transfer of paraquat in rats and guinea-pigs. Gen Pharmacol. 1984;15(3):201–4. doi: 10.1016/0306-3623(84)90159-9. [DOI] [PubMed] [Google Scholar]
- 8.Anderson D, McGregor DB, Purchase IF. Dominant lethal studies with paraquat and diquat in male CD-1 mice. Mutation Research. 1976;40(4):349–58. doi: 10.1016/0165-1218(76)90033-1. [DOI] [PubMed] [Google Scholar]
- 9.Randell S, Young S. Structure of alveolar epithelial cells and the surface layer during development. In: Polin R, Fox W, editors. Fetal and neonatal physiology. Philadelphia, London, New York, St. Louis, Sydney, Tokyo: W.B. Saunders Company; 1998. pp. 1275–82. [Google Scholar]
- 10.Ekins B, Geller R. Paraquat and diquat. In: Ford M, Delaney K, Ling L, Erickson T, editors. Clinical Toxicology. Philadelphia, London, New York, St. Louis, Sydney, Toronto: W.B.Sauders Company; 2001. pp. 841–7. [Google Scholar]
- 11.Prasarnphanich T, Chinawong P, Somlaw S, Kosalwat N. Neonatal paraquat poisoning: a case report. J Med Assoc Thai. 1988;71(12):694–8. [PubMed] [Google Scholar]
- 12.Jenq CC, Wu CD, Lin JL. Mother and fetus both survive from severe paraquat intoxication. Clin Toxicol (Phila). 2005;43(4):291–5. [PubMed] [Google Scholar]
- 13.Takeuchi K, Takayama K, Tomichi N, Kan E, Yagawa K, Iwabuchi K. Paraquat poisoning in a pregnant women (author’s transl) Nihon Kyobu Shikkan Gakkai Zasshi Japanese Journal of Thoracic Diseases. 1980;18(10):747–52. [PubMed] [Google Scholar]