Bleaching clay and hemodialysis in the treatment of paraquat poisoning Clinical Experience

Cause:

Nearly 3 years of emergency department treated a total of 20% oral paraquat poisoning patients in 26 cases, oral dose of 50 ~ 200 ml, including 8 male cases, 18 female cases, the age is the smallest 14 years old, the biggest 76 years old, average 36 years old. After the poisoning to the short time of 13 min, the long time is 78 H. Among them

10 cases of patients outside the hospital to hospital days, the shortest was 8 days, the longest 32 days, average 19 days of hospitalization. 8 patients died in hospital (3 case died of pulmonary interstitial fibrosis, and 5 patients died of multiple organ failure), accounting for 30.7%, 8 cases of death were not at the same time, the use of bleaching earth and hemoperfusion and hemodialysis. The remaining patients were used bleaching clay intragastric injection or oral, and adopts the blood perfusion / hemodialysis, 15 patients cured, improved and request to leave the hospital in 3 patients, the success rate of rescue 69. 2%.

Bleaching Clay

Treatment methods

For patients within 24 h were given 1%NaHCO3 gastric lavage paraquat (PQ may be alkaline hydrolysis), until the gastric lavage liquid clean, colorless, tasteless so far. The patients had different degree of vomiting in this group of 26 patients with paraquat poisoning, available ondansetron 8 mg or vitamin B6 10 mg intravenous injection control vomiting, if accompanied by facial and skin medicine traces should be cleaned immediately, gastric lavage after bleaching clay 15% to 300 ~ 350 ml or 2 activated carbon g/kg allows patients to oral or directly through the tube into the stomach, each of the 4 h 1 times, until the stop cinereous stool after discharge. At the same time, since the tube injection 20% mannitol 250 ml, should also be cleaning enema, after 2 h in non dialysis relative contraindications (shock or hypotension, blood pressure less than 80 mmHg, severe myocardial lesions lead to pulmonary edema, heart failure, severe arrhythmia, serious bleeding or hemorrhage, malignant tumor, the extreme failure of psychiatric patients, not cooperation with, or family member and I don’t agree with hemodialysis) under the premise, given hemoperfusion hemodialysis alleviate poison on / toxicity of kidney, in order to reduce the paraquat on oral mucosa and tongue body damage can be give

NaHCO3 solution gargle 0.5%, every time 50 ml, 4 h 1, at the same time with plenty of vitamin C 6 to 8 g/d, eliminating oxygen free radicals, dexamethasone injection 10 ~ 20 mg/d prevention and treatment of pulmonary interstitial fibrosis, protect the digestive tract injury in gastric parietal cells of large area available proton pump inhibitors omeprazole 40 mg, 2 times per day 1 ~ however, the drug allergies are disabled, all drugs should avoid the damage to liver and kidney function, at the same time should closely observe respiratory function, can also be used Human Albumin nutrition respiratory muscle, if there should be timely respiratory failure mechanical ventilation, and maintain water balance

Prevention and treatment of complications:

The main complications of paraquat poisoning for direct damage, gastrointestinal interstitial pulmonary fibrosis, liver and kidney damage and early use of bleaching earth let patients by oral or nasogastric tube into the stomach to paraquat was inactivated, timely use of hemoperfusion and hemodialysis, promote the excretion of toxic substances, pay attention to oral nursing, avoid drug use is toxic to the liver and kidney are very important

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