Correlating the severity of paraquat poisoning with specific hemodynamic and oxygen metabolism variables

Objective: To investigate the hemodynamics and oxygen metabolism of patients with varying degrees of severity of paraquat poisoning. Design: Prospective, observational, clinical study. Setting: Intensive care unit in a university hospital. Patients: Forty-three consecutive patients with paraquat and/or diquat poisoning were classified into three groups by the severity index of paraquat poisoning (SIPP; hr/mg/L). interventions: Standard treatments included specific respiratory management, fluid resuscitation, and aggressive circulatory support. Measurements and Main Results: Serum paraquat and diquat levels were measured at arrival, and SIPP was calculated. The cardiac index (CI), left ventricular stroke work index (LVSWI), systemic vascular resistance index (SVRI), oxygen delivery index ((D) over dot o(2)I), oxygen consumption index ((V) over dot o(2)I), and oxygen extraction ratio (O2ER) were measured at 6, 12, 24, 36, 48, 72, and 96 hrs postadmission. A significant inverse correlation between SIPP and survival time was found in 31 fatal cases (r(2) = .85; p < .001). In the SIPP 10-50 group, Cl, (D) over dot o(2)I, (V) over dot o(2)I, and O2ER were maintained at higher levels than in the SIPP group of <10 (p < .05), whereas SVRI decreased significantly (p < .05) in the SIPP group of >50, Cl, LVSWI, SVRI, (D) over dot o(2)I, and (V) over dot o(2)I decreased, whereas O2ER had a tendency to increase progressively. There was a significant correlation between SVRI and SIPP, O2ER and SIPP, and O2ER and SVRI 24 hrs after admission, respectively (p <.001). Conclusions: Paraquat poisoning is characterized by high oxygen consumption with high oxygen extraction, with the degree of derangement based on the severity index. The development of a marked imbalance between increased oxygen demand and decreased oxygen supply because of myocardial depression might be a possible cause of death in circulatory failure.