Paradoxical systemic toxicity by inhaled paraquat poisoning: A case report

Abstract

Rationale: Multi-organ failure is a symptom of paraquat poisoning, resulting in high mortality and morbidity rates. Though paraquat is widely available, poisoning through inhalation is rare. Patient's Concern: A 37-year-old male reported to the emergency department with complaints of vomiting after an alleged history of inhalation of paraquat while at work. Diagnosis: Paraquat poisoning. Interventions: Supportive management along with multiple sessions of hemodialysis. Outcomes: Renal complications caused by paraquat were improved after multiple sessions of hemodialysis. However, the patient developed respiratory complications and later due to persistent hypoxemia and non-responsive to supportive therapy, he succumbed to his illness. Lessons: Acute kidney injury is a complication of paraquat poisoning. However, kidney involvement with the inhalational mode is rare. It is caused by reduction and oxidation cycles, as well as the formation of reactive oxygen species, necessitating hemodialysis as the treatment. Without a clear history, a specific clinical trait, or a diagnostic test, diagnosis can be difficult. Our case thus highlights the inhaled paraquat poisoning, presenting with acute kidney injury with late respiratory impairment as a consequence.