Suicide victim of paraquat poisoning make suitable corneal donor

Abstract

This report addresses the possibility of expanding transplant corneal donor pool by inclusion of more patients who have suffered poisoning with paraquat pre-mortem. A 27-year-old depressed man committed suicide by ingesting 50 mL of 24% paraquat (Gramoxone, Syngenta, Taiwan). He was treated aggressively with gastric lavage, with large amounts of normal saline, followed by infusion of activated charcoal and magnesium citrate. Blood paraquat level was 1.90 μg/mL. Charcoal hemoperfusion was performed for 8 hours using a charcoal-containing dialysis machine. Furthermore, pulse therapies of cyclophosphamide (15 mg/kg/day for 2 days) and methylprednisolone (1 g/day for 3 days) were administered, followed by dexamethasone (20 mg/day for 14 days). Methylprednisolone pulse therapy was repeated since PaO2 on the 15th day of poisoning was <60 mm Hg. Chest radiography demonstrated diffuse ground glass opacities of both lungs, with thickening of the intralobular interstitium, compatible with interstitial pneumonitis. Arterial blood gas found persistent hypoxemia and large alveolar-arterial oxygen tension differences. Respiratory failure developed on the 21st day and he was intubated for mechanical ventilatory support. As the patient expressed his wish for organ donation, the corneas were harvested after expiration on the 22nd day. His corneas were transplanted in two recipients and visual acuities of the recipients were doing well at 6 months after transplantation.