Emergency medicine
Zainab mehdi; Daljinderjit Kaur; Parv kamra; Narinder kaur; Nidhi arora
Articles in Press, Accepted Manuscript, Available Online from 13 April 2024
Abstract
Objective: Dependency on agriculture and the unregulated sale of paraquat makes it an easyalternative for homicidal and suicidal use in developing nations. It kills by multiorgan failure,predominantly pulmonary fibrosis, and ARDS. We report a case of alleged paraquat ingestionwith spontaneous pneumothorax, ...
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Objective: Dependency on agriculture and the unregulated sale of paraquat makes it an easyalternative for homicidal and suicidal use in developing nations. It kills by multiorgan failure,predominantly pulmonary fibrosis, and ARDS. We report a case of alleged paraquat ingestionwith spontaneous pneumothorax, spontaneous pneumomediastinum, and pneumorrhachis.Aim is to reinforce the importance of a high index of suspicion in early diagnosis when theabove findings are present with ARDS in absence of trauma and a history of alleged substanceingestion.Case Presentation: A 35-year-old male presented with loose stool occasionally bloody, oralulcers, yellow discoloration of eyes with fever, and decreased urine output for three days afterconsuming some substance with his seafood. On examination, he had yellow discoloration ofeyes and oral mucosa along with multiple ulcers on the buccal region as well as the dorsumof the tongue and lateral margins with generalized subcutaneous emphysema. In addition,decreased air entry in the bilateral lung field and muffled heart sounds were present. He hadan acute hepatorenal failure and severe metabolic acidosis with respiratory failure. Urine testedpositive for myoglobin and muscle enzymes (creatinine kinase and LDH) were raised. He wasintubated and shifted to the intensive care unit. Injectable N-acetyl cysteine (NAC) for acute liverfailure was started with empirical antibiotics and intravenous fluids. We supplemented thiamineand vitamin K, and hemodialysis was done in view of progressive renal failure. Radiologicalevaluation showed spontaneous pneumothorax, pneumomediastinum, and pneumorrhachiswhich were managed conservatively. His respiratory parameters worsened despite maximalventilatory support. Renal failure and metabolic acidosis worsened in spite of hemodialysis. Hesuccumbed to his illness on day five of admission and seven days after toxin ingestion.Conclusion: We recommend that the sale of paraquat be restricted and regulated to avoid itsuse for suicidal and homicidal purposes. More research is required to find measures to interveneearly and prevent pulmonary fibrosis. We propose that paraquat toxicity be considered early in apatient with the triad in an atraumatic setting with acute respiratory distress syndrome (ARDS)