Management of Accidental Paraquat Ingestion in a Child

Abstract

AIM: To report on the management of a toddler who had accidental ingestion of an unknown amount of paraquat, with treatment including continuous renal replacement therapy (CRRT), steroids and antifibrinolytics at a tertiary-level health system. METHODS: A 16-month-old child weighing 10 kg accidentally ingested an unknown amount of Gramoxone containing paraquat. The child was transferred to a tertiary centre Paediatric Intensive Care Unit (PICU) where she was electively intubated and commenced on CRRT at 7 hours and 15 minutes post-ingestion. She was also treated with activated charcoal, methylprednisolone, N-acetylcysteine infusion and pirfenidone. Paraquat blood and urine samples were monitored throughout her PICU admission. RESULTS: The child did not exhibit respiratory distress or significant hypoxia during the admission. She developed ulceration of the lips, mouth and tongue on day 2 which improved after 48 hours. Feed intolerance and pneumatosis intestinalis were managed conservatively. Interstitial changes were noted on chest x-ray on day 3 and pirfenidone was initiated to minimise the risk of pulmonary fibrosis. The child was discharged from PICU to the general ward for further observation. At follow-up, there has been no evidence of pulmonary fibrosis up to 6 months post-discharge. CONCLUSIONS: This case highlights the toxicity of Paraquat and importance of early management and urgent transfer of paraquat poisoning cases to specialised medical centres. Prompt interventions including activated charcoal, N-acetylcysteine, CRRT and pirfenidone can improve patient prognosis and reduce the risk of long-term complications such as pulmonary fibrosis in paediatric paraquat toxicity.