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Paraquatintoxikation

Fallbericht und Literaturüberblick

Paraquat poisoning

Case report and overview

Medizinische Klinik - Intensivmedizin und Notfallmedizin volume 107, pages 270–274 (2012)Cite this article

Zusammenfassung

Die Paraquatintoxikation ist in Deutschland ein seltenes Krankheitsbild. Der Zusammenhang zwischen Plasmaspiegel und Prognose ist von herausragender Bedeutung. Eine Übereinstimmung mit der ingestierten Menge ist nicht zwingend und macht Spiegelbestimmungen obligat. In der präklinischen Behandlungsphase liegt großes Potenzial, einen letalen Verlauf abzuwenden; die infauste Prognose höherer Plasmaspiegel erfordert die rigorose Aktivkohleapplikation und ggf. Intubation. Da Paraquat über die Haut resorbiert wird, ist dem Selbstschutz entsprechende Beachtung beizumessen.

In der klinischen Phase kann der kontrollierte Versuch einer Elimination durch forcierte Diurese erfolgen; dies ist jedoch ebenso wie die präventive Anwendung extrakorporaler Verfahren nicht unumstritten. Im Rahmen der pulmonalen Toxizität sollte nur die minimal erforderliche inspiratorische Sauerstoffkonzentration verwendet werden. Bezüglich der häufig zum Tode führenden Lungenfibrose ist bei hohen Plasmakonzentrationen eine Behandlung mit Cyclophosphamid und Methylprednisolon erfolgversprechend. Vor dem Bild des Oxidanzienungleichgewichts ist die Applikation von Ascorbinsäure und N-Acetylcystein eine einfache und nebenwirkungsarme Option.

Abstract

Paraquat poisoning in Germany is rare. Because plasma levels do not necessarily match the ingested amount of paraquat, repeated measurement of plasma levels is imperative. There is a large potential in the prehospital phase to improve prognosis: further resorption must be terminated by rigorous charcoal administration and early tracheal intubation if necessary. Because paraquat can be resorbed by dermal contact, steps to ensure sufficient protection of emergency medical personnel must be taken.

As soon as further resorption has been prevented sufficiently, forced diuresis, renal replacement therapy, and hemoperfusion can be of help, but still remain controversial. To reduce pulmonary fibrosis, inspiratory oxygen concentrations must be adjusted to the minimal amount needed to ensure satisfactory tissue oxygenation. Data supporting the advantageous use of cyclophosphamide combined with methylprednisolone for the treatment of pulmonary fibrosis were recently published. Since the toxic mechanism implies a mismatch of oxidants and anti-oxidants, co-administration of ascorbic acid and N-acetylcysteine are simple treatments with few side effects.

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  1. II. Medizinische Abteilung/Kardiologie, Asklepios-Klinik St. Georg, Lohmühlenstr. 5, 20099, Hamburg, Deutschland

    T. Spangenberg, H. Grahn, H. van der Schalk & K.H. Kuck

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  1. T. Spangenberg
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  2. H. Grahn
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  3. H. van der Schalk
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  4. K.H. Kuck
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Correspondence to T. Spangenberg.

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T. Spangenberg und H. Grahn haben zu gleichen Teilen zu dieser Arbeit beigetragen.

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Spangenberg, T., Grahn, H., van der Schalk, H. et al. Paraquatintoxikation. Med Klin Intensivmed Notfmed 107, 270–274 (2012). https://doi.org/10.1007/s00063-011-0074-x

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  • DOI: https://doi.org/10.1007/s00063-011-0074-x

Schlüsselwörter

  • Herbizide
  • Intoxikation
  • Giftelimination
  • Lungenfibrose
  • Akutes Nierenversagen

Keywords

  • Herbicides
  • Poisoning
  • Elimination
  • Acute kidney injury
  • Pulmonary fibrosis