Paraquat poisoning: the down spiraling Maze

Abstract

Paraquat is a commonly used herbicide that has lethal consequences even on minimal consumption. It is now becoming an emerging toxicological problem in Bangladesh. The clinical course in paraquat poisoning is often protracted causing a spectrum of complications including acute respiratory distress syndrome, renal failure, hepatotoxicity, and pulmonary fibrosis. There is no known antidote for this toxin. The effectiveness of hemoperfusion (with toxin-specific cartridges) is time limited (within 4 hours of exposure to the poison). Though immunosuppressants and antioxidants are conventionally used with the hope of intervening the pathophysiological process, there is a gap in evidence to prove survival benefit. The new drug, Edaravone, a free radical-scavenging antioxidant, beneficial for protecting the kidneys and liver from paraquat poisoning, delayed pulmonary fibrosis thus prolonging the survival time but had no significant effect on the survival rate. The case fatality for paraquat poisoning is far more than poisoning with other pesticides in Bangladesh. From public health view banning its use in agriculture and replacing it with less toxic substitutes is urgently needed to reduce mortality and morbidity.

Bangladesh J Medicine 2026; Vol. 37, No. 2(1): pp.192-193