Paraquat and organophosphate poisoning linked to rapid kidney damage
Journal name: World Journal of Pharmaceutical Research
Original article title: Mixed poisoning of paraquat and organophosphorus poisonings associated with accelerated renal damage
The WJPR includes peer-reviewed publications such as scientific research papers, reports, review articles, company news, thesis reports and case studies in areas of Biology, Pharmaceutical industries and Chemical technology while incorporating ancient fields of knowledge such combining Ayurveda with scientific data.
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Girish Thunga, Pramoda Kuluru, Harika Cherukuri, Rohini Devabhaktuni, Muralidhar Varma, Vinay Pandit
World Journal of Pharmaceutical Research:
(An ISO 9001:2015 Certified International Journal)
Full text available for: Mixed poisoning of paraquat and organophosphorus poisonings associated with accelerated renal damage
Source type: An International Peer Reviewed Journal for Pharmaceutical and Medical and Scientific Research
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Summary of article contents:
Introduction
Acute pesticide poisoning is a significant global health issue, especially in developing countries, leading to approximately 300,000 deaths annually. Organophosphates (OPs) and paraquat are the primary culprits in these poisonings, often resulting from easy access and insufficient awareness of their dangers. The existing literature on mixed poisonings involving OPs and paraquat is scarce, highlighting a gap in understanding and managing such cases. This study reports a case of a 21-year-old male who ingested a mixture of monocrotophos (an OP) and Gramoxane (paraquat), leading to pronounced renal failure.
Renal Damage Mechanism
The mechanisms underlying the renal damage observed in cases of OP and paraquat poisoning are critical to understanding the severity of their impact. Monocrotophos, upon ingestion, is rapidly absorbed and accumulates in the liver and kidneys, while paraquat is absorbed through the gastrointestinal tract and can cause severe organ damage due to its quick distribution and high excretion rate via the kidneys. Both compounds lead to oxidative stress, primarily through the generation of free radicals, which results in tubular necrosis and subsequent renal failure. The synergistic effects of these compounds when ingested together may exacerbate renal damage, yet ample literature on this issue is lacking.
Clinical Presentation and Treatment
The clinical presentation of the patient included symptoms such as burning sensations and epigastric tenderness. Initial investigations revealed a low cholinesterase level and elevated white blood cell count, suggesting a severe toxicological profile. The patient received immediate treatment, including atropine, pralidoxime, and immunosuppressants like cyclophosphamide, alongside supportive care. Despite these interventions and subsequent hemodialysis to address the worsening renal function, the patient’s biochemical parameters indicated persistent renal failure. After three days of treatment, despite minor improvements in renal function, the patient was discharged against medical advice due to financial constraints.
Challenges in Management
Management of mixed OP and paraquat poisoning poses challenges due to the lack of standardized treatment protocols specifically targeting dual toxicity. While individual treatments exist for each compound, their combined effect complicates therapeutic strategies. The focus in this case was on supportive care and renal function improvement, with repeated hemodialysis sessions necessary for managing elevated urea and creatinine levels. However, no established evidence-based guidelines exist for treating such mixed poisonings, further complicating patient management and sometimes leading to decisions to discharge against medical advice.
Conclusion
This case illustrates the critical nature of mixed OP and paraquat poisoning and its associated acute renal failure, likely due to the additive effects of the compounds involved. The study emphasizes the urgent need for improved clinical guidelines and therapeutic strategies to address this significant health concern. Continued research into the synergistic effects of these compounds is necessary to develop better treatment protocols and ultimately reduce mortality from such poisonings. Regular training and awareness programs can also help in reducing the incidence of these preventable toxins.
FAQ section (important questions/answers):
What are the main causes of death related to pesticide poisoning?
The major causes of death from pesticide poisoning include organophosphates and paraquat, which lead to acute toxicity and renal failure. Around 300,000 deaths occur annually due to pesticide poisoning globally.
What are the symptoms of paraquat and organophosphate poisoning?
Symptoms may include burning sensations in the throat and abdomen, respiratory distress, and alterations in blood pressure and heart rate. Severe cases can lead to acute renal failure and respiratory acidosis.
How is mixed poisoning of paraquat and organophosphates treated?
Treatment involves supportive care, gastric decontamination, hemodialysis, and administration of medications such as atropine, pralidoxime, and immunosuppressants. Antioxidants and continuous monitoring of renal function are also critical in management.
What is the effect of organophosphate compounds on health?
Organophosphates inhibit acetylcholinesterase, leading to cholinergic crisis, respiratory failure, and potential renal damage. These effects can be compounded when mixed with other toxic compounds like paraquat.
What challenges are faced in managing mixed pesticide poisonings?
One significant challenge is the lack of established treatment guidelines for mixed poisoning cases. Additionally, combined toxicity complicates patient care, making effective management of renal and liver functions more difficult.
What factors contribute to the severity of pesticide poisoning cases?
The severity may be influenced by the type and quantity of pesticides ingested, the timing of medical intervention, and the patient's overall health. Oxidative stress and combined effects of multiple poisonings further exacerbate the situation.
Glossary definitions and references:
Scientific and Ayurvedic Glossary list for “Paraquat and organophosphate poisoning linked to rapid kidney damage”. This list explains important keywords that occur in this article and links it to the glossary for a better understanding of that concept in the context of Ayurveda and other topics.
1) Toxicity:
Toxicity refers to the degree to which a substance can harm humans or animals. In the context of the report, both organophosphates and paraquat have high toxicity levels, leading to severe health issues like acute renal failure. Understanding toxicity is crucial for assessing risks, especially in agricultural settings where these substances are frequently encountered.
2) Table:
The term 'Table' refers to the structured data presentation within the report, summarizing clinical parameters such as blood gas analysis and renal function tests. Tables offer a clear, concise means to convey complex medical data, thus aiding in quick comprehension of a patient's biochemical changes over time during the study.
3) Blood:
Blood plays a vital role in transporting oxygen and nutrients throughout the body, and its analysis is essential in the medical context. In this case, blood parameters were closely monitored to assess the impact of mixed poisoning, revealing critical information regarding the patient's respiratory and renal function as well as overall health status.
4) Medicine:
Medicine encompasses the science and practice of diagnosing, treating, and preventing diseases. The report discusses various medical interventions employed in the management of pesticide poisoning, highlighting the use of specific antidotes, supportive therapy, and hemodialysis, showcasing the application of medical knowledge in treating acute poisonings.
5) Science (Scientific):
Science represents the systematic study of the natural world based on observation and experimentation. In this case, it refers to the scientific principles underlying the effects of poisonous substances like organophosphates and paraquat on human health, emphasizing the importance of research in developing effective treatment protocols for toxic exposures.
6) Death:
Death signifies the cessation of life, a critical outcome that the report addresses in the context of pesticide poisoning. It highlights the severity of organophosphate and paraquat toxicity, which account for numerous fatalities annually in developing countries, underlining the urgent need for preventive measures and effective treatment strategies.
7) Antibiotic (Antibacterial):
Antibiotics are medications used to treat bacterial infections. In the report, antibiotics were administered to the patient to manage potential infections arising from compromised health conditions due to pesticide poisoning. Their relevance lies in preventing secondary infections, which could further complicate the patient's recovery process.
8) Pesticide:
Pesticides are chemical substances used to eliminate pests, including weeds and insects, but can be highly toxic to humans. This report focuses on organophosphates and paraquat as significant contributors to acute poisoning cases, particularly highlighting their widespread availability and the resulting health risks, including fatalities in developing countries.
9) India:
India is the geographical context of this case report, where organophosphate and paraquat poisonings are prevalent due to agricultural practices. The cultural and social factors influencing pesticide use and the management of poisoning cases in India underscore the need for awareness campaigns and improved health infrastructure for affected populations.
10) Burning sensation:
Burning sensation is a symptom experienced by the patient after consuming the toxic substances, indicating irritation or damage to mucosal surfaces. It serves as a critical clinical clue for healthcare providers to assess toxicity levels and the need for immediate medical intervention, thus reflecting the severity of pesticide exposure.
11) Redistribution:
Redistribution refers to the movement of substances within the body after absorption. Following ingestion, both monocrotophos and paraquat show a redistribution pattern, where the toxins are initially absorbed then deposited in various organs, complicating the clinical picture and responses to treatment, highlighting the need for tailored medical strategies.
12) Discussion:
Discussion refers to the section of the report that interprets the clinical findings and their implications. It provides insights into the mechanisms behind renal damage caused by mixed poisoning, emphasizing the importance of understanding the cumulative effects of each compound, which is essential for developing effective treatment protocols.
13) Developing:
Developing countries are characterized by lower income levels and limited healthcare resources. The report mentions the significant mortality rates associated with pesticide poisonings in these areas, highlighting the urgent need for education, stricter regulations on pesticide use, and improved healthcare access to prevent and manage poisoning cases effectively.
14) Accumulation (Accumulating, Accumulate):
Accumulate describes how substances such as monocrotophos and paraquat build up in body tissues after exposure, leading to toxic effects. This accumulation is particularly concerning, as it exacerbates organ damage, necessitating prompt medical intervention and monitoring, which is crucial in treating cases of acute poisoning.
15) Relative:
Relative in this context refers to the family members of the patient. The involvement of relatives is significant in medical decision-making, particularly when patients choose to discharge against medical advice due to financial constraints, highlighting the intersection of healthcare and socio-economic factors that influence treatment outcomes.
16) Pramoda (Pramodā):
Pramoda is one of the co-authors of the report, representing the collaborative nature of medical research. The inclusion of multiple authors signifies a team effort in compiling the findings and insights from this case study, reflecting the importance of multidisciplinary contributions to advancing understanding in clinical practice.
17) Account:
In this context, 'Account' refers to the presentation of clinical observations and findings regarding the mixed poisoning case. It emphasizes the detailed documentation of the patient's experiences and treatment outcomes, contributing to the existing literature on pesticide poisoning and serving as a resource for future medical cases.
18) Burning (Burn, Burned, Burnt):
Burning indicates a specific type of pain or discomfort experienced by the patient after ingestion of toxic substances. This symptom is critical for healthcare providers as it helps gauge the severity of the poisoning and informs immediate clinical decisions to initiate appropriate treatment interventions effectively.
19) Rohini (Rohiṇi, Rohiṇī, Rohinī):
Rohini is another co-author of the case report, signifying the collaborative nature of medical research. The presence of co-authors represents varied expertise and perspectives, which enhance the quality of clinical documentation and strengthen the evidence-based approach to addressing complex health issues, such as pesticide poisoning.
20) Pandita (Paṇḍita, Paṇḍit, Paṇḍitā, Pandit):
Pandit is also a co-author of the study, contributing to the collective insights presented in the report. The collaboration of multiple authors reflects the comprehensive effort involved in researching and addressing public health concerns related to toxic exposures, facilitating improved understanding and management of cases like the one documented.
21) Sugar:
Sugar refers to one of the components analyzed in the urinary examination of the patient. The presence of sugar may indicate underlying metabolic issues or renal dysfunction, crucial for understanding the extent of the patient's condition, thereby guiding further diagnostic and therapeutic interventions in cases of acute poisoning.
22) Pulse:
Pulse is a vital sign measured to assess the physiological status of the patient. In this admission report, it reflects the patient's hemodynamic stability and overall health condition. Monitoring pulse rate helps healthcare providers evaluate the severity of poisoning and the effectiveness of ongoing treatments during hospitalization.
23) Earth:
Earth, in this context, refers to Fuller’s earth, an adsorbent used in the management of paraquat poisoning. It helps reduce systemic absorption of toxins by adsorbing the compound in the gastrointestinal tract, thereby representing an important therapeutic strategy in treating pesticide poisoning cases and enhancing patient outcomes.
24) Study (Studying):
Study denotes the investigation presented in the report, which documents a case of mixed poisoning. It highlights the clinical findings, treatment approaches, and outcomes associated with organophosphate and paraquat poisoning, contributing to the existing body of knowledge and guiding future research on similar cases and their management.
Other Science Concepts:
Discover the significance of concepts within the article: ‘Paraquat and organophosphate poisoning linked to rapid kidney damage’. Further sources in the context of Science might help you critically compare this page with similair documents:
Supportive care, Oxidative stress, Acute toxicity, Systemic toxicity, Hemodialysis, Acute Renal Failure, Antioxidant therapy, Biochemical investigation, Renal function test, Gastric Lavage.