Treatment of Paraquat Poisoning in Man: Methods to Prevent Absorption

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Abstract
Theoretically, absorption of an ingested dose of paraquat may be reduced by (1) gastric lavage, (2) induced emesis, (3) whole-gut lavage or (4) by the oral administration of adsorbent substances. 1 Animal experiments suggest that paraquat is absorbed poorly from the stomach and absorbed incompletely (< 5%) from the small intestine over a 1-6-h period. Although gastric lavage would therefore seem a logical way to ameliorate the toxicity of an ingested dose of paraquat, peak plasma concentrations are attained rapidly and evidence for the efficacy of gastric lavage in man is poor. 2 In 1977, a potent emetic (PP796) was added to liquid and solid formulations of paraquat because experiments in primates had demonstrated a fivefold reduction in toxicity. In man, ingestion of formulations containing an emetic is more likely to cause spontaneous vomiting within 30 min than non-emetic preparations. However, definite evidence of benefit, as judged by improved patient prognosis, has yet to be established. 3 Gut lavage has been shown to remove only a small proportion of an ingested dose of paraquat. At the flow rates employed in man (75 ml/min), approximately 0.5-1.0 litres of lavage fluid/h may be absorbed across the intestinal wall. Since there is a theoretical risk of increasing paraquat absorption, the use of whole-gut lavage cannot be recommended. 4 Bipyridilium herbicides are adsorbed by soil and clay minerals, and montmorillonite in particular has been shown to be a strong binding agent in vitro. Accordingly, the use of Fuller's Earth (calcium montmorillonite) and Bentonite (sodium montmorillonite) for the treatment of poisoning has been investigated in animal models. Both agents reduce plasma paraquat concentrations and mortality in animals when administered after an oral dose of paraquat. Recently, other adsorbent materials have been found to have high maximum adsorption capacities for paraquat. In particular, activated charcoals and cation-exchange resins have attracted interest. Unfortunately, as yet, there is no evidence that the use of adsorbents in man is of therapeutic value.