Paraquat Poisoning from a Tertiary Care Center in Northern India: A Case Series

Abstract

Paraquat, a nonselective herbicide introduced in the 1960s, remains widely used in agricultural settings in many low- and middle-income countries due to its low cost and effectiveness—despite being classified as a restricted-use pesticide in many parts of the world. Its easy availability contributes to frequent intentional ingestion. Its highly toxic nature, especially when ingested, poses a significant public health challenge, particularly in rural India, where regulatory oversight is limited and public awareness is low. We report a case series of 20 patients with paraquat poisoning who presented to our emergency department over the past 3 y. All patients were between 15 and 35 y of age; 12 were male and 8 were female. Ingestion volumes ranged from 5 to 100 mL of 20% solution. Oral ingestion of as little as 10 to 20 mL of a 20% weight/volume formulation (∼2–4 g of paraquat ion) is considered potentially fatal, whereas ingestion exceeding 30 mL is almost uniformly lethal. All patients in our series reported intentional intake for deliberate self-harm. Common presenting symptoms included nausea, throat pain, dysphagia, abdominal pain, vomiting, and shortness of breath. Two patients experienced seizures and altered sensorium. Despite receiving aggressive management and critical care—including mechanical ventilation, hemodialysis, and antioxidant therapy—only 3 patients survived. One survivor had no organ involvement, whereas the other 2 had reversible acute kidney injury. Paraquat poisoning remains a medical emergency with high mortality due to the absence of a specific antidote and its rapid systemic toxicity. Socially, its easy availability and frequent use in self-harm highlight the urgent need for public education, safe handling practices, and stricter regulations. Improved awareness and early intervention are essential to reduce the burden of this preventable yet often fatal condition.