Drug Safety

, Volume 5, Issue 4, pp 243–251 | Cite as

Paraquat Poisoning

An Overview of the Current Status
  • C. Bismuth
  • R. Garnier
  • F. J. Baud
  • J. Muszynski
  • C. Keyes
Review Article Poisoning Management


Paraquat is a bipyridyl compound with no known chronic toxicity or teratogenicity. It is poorly absorbed when inhaled, but causes severe illness when ingested orally, death usually occurring within 2 days of ingestion of 50 mg/kg. At lower doses death may be delayed for several weeks. The toxic compound accumulates in lung tissue where free radicals are formed, lipid peroxidation is induced and nicotinamide adenine dinucleotide phosphate (NADPH) is depleted. This produces diffuse alveolitis followed by extensive pulmonary fibrosis. The most important prognostic indicator is the quantity of paraquat absorbed, as shown by the plasma paraquat concentration. While renal failure will develop in the majority of those patients who eventually die, it may not, if present alone, indicate a fatal outcome. The absence of caustic burns in the upper digestive tract indicates a good prognosis.

Treatment of paraquat poisoning remains ineffective, but Fuller’s earth, activated charcoal and resins may prevent some absorption of the toxin. When tubular necrosis occurs, renal excretion of the compound decreases rapidly. A 3- compartment pharmacokinetic model has been described following ingestion of tracer doses including a ‘deep’ compartment for active pulmonary accumulation. Haemodialysis, haemoperfusion and forced dialysis have been attempted, with no clear improvement in survival rates. Superoxide dismutase, glutathione peroxidase, N-acetylcysteine and other ‘free radical scavengers’ have failed to alter the outcome in poisoned patients. Other theoretical treatments, such as deferoxamine, immunotherapy, NADPH repletion and lung transplantation still require clinical validation.


Bismuth Paraquat Clofibrate Deferoxamine Human Toxicology 
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  1. Addo E, Poon-King DB. Leucocyte suppression in the treatment of 72 patients with paraquat poisoning. Lancet 1: 1117–1120, 1986PubMedCrossRefGoogle Scholar
  2. Akahori F, Oehme FW. Inhibition of collagen synthesis as a treatment of paraquat poisoning. Veterinary and Human Toxicology 25: 321–327, 1983PubMedGoogle Scholar
  3. Baud FJ, Houze P, Bismuth C, Scherrmann JM, Jaeger A, et al. Toxicokinetics of paraquat through the heart-lung block: six cases of acute human poisoning. Journal of Toxicology — Clinical Toxicology 26: 35–50, 1988PubMedCrossRefGoogle Scholar
  4. Bismuth C, Baud FJ, Garnier R, Muczynski J, Houze P. Paraquat intoxication: biological presentation. Journal de Toxicologie Clinique Expérimentale 8: 211–218, 1988Google Scholar
  5. Bismuth C, Garnier R, Dally S, Fournier PE, Scherrmann JM. Prognosis and treatment of paraquat poisoning: a review of 28 cases. Journal of Toxicology — Clinical Toxicology 19: 461–474, 1982PubMedCrossRefGoogle Scholar
  6. Bismuth C, Michelson AM, Surugue R. Indications théoriques de l’administration de superoxyde dismutase et de glutathion-peroxydase sous inclusion liposomale dans l’intoxication par le paraquat. Congrès des Centres Anti-Poisons Français, Bordeaux, 1983Google Scholar
  7. Bismuth C, Scherrmann JM, Garnier R, Baud FJ, Pontal PG. Elimination of paraquat. Human Toxicology 6: 63–67, 1987PubMedCrossRefGoogle Scholar
  8. Brown OR, Heitkamp M, Song C. Niacin reduces paraquat toxicity in rats. Science 212: 1510–1512, 1981PubMedCrossRefGoogle Scholar
  9. Bus JS, Aust SD, Gibson JE. Lipid peroxidation: a possible mechanism for paraquat toxicity. Research Communications in Chemical Pathology and Pharmacology 11: 31–38, 1975PubMedGoogle Scholar
  10. Cadot R, Descotes J, Cuilleron CY, Grenot C, Evreux JC. Evaluation of active specific immunisation against paraquat toxicity in rats. Veterinary and Human Toxicology 28: 226–229, 1986PubMedGoogle Scholar
  11. Cadot R, Descotes J, Grenot C, Cuilleron CY, Evreux JC. Increased plasma paraquat levels in intoxicated mice following antiparaquat F(ab′) treatment. Journal of Immunopharmacology 7: 467–477, 1985PubMedCrossRefGoogle Scholar
  12. Chester G, Ward RJ. Occupational exposure and drift hazard during aerial application of paraquat to cotton. Archives of Environmental Contamination and Toxicology 13: 551–563, 1984PubMedCrossRefGoogle Scholar
  13. Chollet A, Bismuth C, Pham J, Bolo A, Muczinsky J, et al. Hypoxygenation avec hypothermie dans l’intoxication humaine par le paraquat: à propos de 6 cas. Toxicological European Research 5: 71–75, 1983PubMedGoogle Scholar
  14. Conning DM, Fletcher K, Swan AAB. Paraquat and selected tripyridyls. British Medical Bulletin 25: 245–249, 1969PubMedGoogle Scholar
  15. Cooke NKJ, Flenley DC, Matthew H. Paraquat poisoning: serial studies of lung function. Quarterly Journal of Medicine 42: 683–692, 1973PubMedGoogle Scholar
  16. Cramp TP. Failure of N-acetylcysteine to reduce renal damage due to paraquat in rats. Human Toxicology 4: 107, 1985Google Scholar
  17. Dunbar JR, AcufT RV, Deluccia AJ. Co-administration of paraquat and putrescine to rats via miniosmotic pump: effects on lung glutathione antioxidant system and paraquat content. Federation Proceedings 44: 1024, 1985Google Scholar
  18. Dunbar JR, Deluccia AJ, Acuff RV, Ferslew KE. Prolonged intravenous paraquat infusion in the rat: I. Failure of coinfused putrescine to attenuate pulmonary paraquat uptake, paraquat-induced biochemical changes, or lung injury. Toxicology and Applied Pharmacology 2: 207–220, 1988CrossRefGoogle Scholar
  19. Editorial. Cyclophosphamide for paraquat poisoning. Lancet 2: 375–376, 1986 Fairshter RD, Rosen SM, Smith WR, Glauser FL, McRae DM, et al. Paraquat poisoning: new aspects of therapy. Quarterly Journal of Medicine 180: 551–565, 1976Google Scholar
  20. Fogt F, Zilker T. Total exclusion from external respiration protects lungs from development of fibrosis after paraquat intoxication. Human Toxicology 8: 465–474, 1989PubMedCrossRefGoogle Scholar
  21. Frank L. Superoxide dismutase and lung toxicity. Trends in Pharmacological Sciences 14: 124–128, 1983CrossRefGoogle Scholar
  22. Frank L, Nerishi K, Sio R, Pascual D. Protection of paraquat-induced lung damage and lethality in adult rats pretreated with clofibrate. Toxicology and Applied Pharmacology 66: 269–277, 1982PubMedCrossRefGoogle Scholar
  23. Gamier R, Bismuth C. Paraquat. Encyclopédie Médico-Chirurgicale (Paris, France). Intoxications 16048 C 15, 1984Google Scholar
  24. Glass M, Sutherland MW, Forman HJ, Fisher AB. Selenium deficiency potentiates lipid peroxidation in isolated perfused rat lung. Journal of Applied Physiology 619–622, 1985Google Scholar
  25. Guyon F, Bismuth C, Leclerc JP, Dauchy F. Intoxication massive par le paraquat mortelle en moins de 24 h: données toxicologiques et anatomocliniques. Journal Européen de Toxicologie 7, 3: 182–187, 1974Google Scholar
  26. Hampson ECGM, Pond SM. Failure of haemoperfusion and haemodialysis to prevent death in paraquat poisoning. Medical Toxicology 3: 64–71, 1988PubMedGoogle Scholar
  27. Hart TB. Paraquat: a review of safety in agricultural and horticultural use. Human Toxicology 6: 13–18, 1987PubMedCrossRefGoogle Scholar
  28. Hawksworth GM, Bennett PN, Davies DS. Kinetics of paraquat elimination in the dog. Toxicology and Applied Pharmacology 57: 139–145, 1981PubMedCrossRefGoogle Scholar
  29. Jaeger A, Ledig JM, Houze P, Sauder P, Kopferschmitt J, et al. Pulmonary Superoxide dismutase activity in four cases of lethal paraquat poisoning. Human Toxicology 7: 100–101, 1987Google Scholar
  30. Kalmholz S, Veith FJ, Mollenkopf F, Montefusco C, Niehlsen-Cannarella S, et al. Single lung transplantation in paraquat intoxication. New York State Journal of Medicine 84: 81–85, 1984Google Scholar
  31. Kohen R, Chevion M. Paraquat toxicity is enhanced by iron and reduced by desferrioxamine in laboratory mice. Biochemical Pathology 34: 1841–1843, 1985CrossRefGoogle Scholar
  32. Maling MM, Saul W, Williams MA, Brown EAB, Gillette JR. Reduced body clearance as the major mechanism of the potentiation of •-adrenergic agonists of paraquat lethality in rats. Toxicology and Applied Pharmacology 43: 57–72, 1978PubMedCrossRefGoogle Scholar
  33. Matthew H, Logan A, Woodruff MFA, Heard B. Paraquat poisoning: lung transplantation. British Medical Journal 3: 759–763, 1968PubMedCrossRefGoogle Scholar
  34. Meredith TJ, Vale JA. Treatment of paraquat poisoning in man: methods to prevent absorption. Human Toxicology 6: 49–55, 1987PubMedCrossRefGoogle Scholar
  35. Nagao M, Takatori T, Wu B, Terazawa K, Gotouda H, et al. Immunotherapy for the treatment of acute paraquat poisoning. Human Toxicology 8: 121–123, 1989PubMedCrossRefGoogle Scholar
  36. Nokata M, Tanaka T, Tsuchiya K, Yamashita M. Alleviation of paraquat toxicity by Kayexalate* and Kalimate in rats. Acta Pharmacologica Toxicologica 55: 158–160, 1984CrossRefGoogle Scholar
  37. Osherrof MR, Schaich KM, Drew RT, Borg DC. Failure of desferrioxamine to modify the toxicity of paraquat in rats. Journal of Free Radicals in Biological Medicine 1: 71–82, 1985CrossRefGoogle Scholar
  38. Pasi A. The toxicology of paraquat, diquat and morfanquat, Hans Huber Publishers, Bern, 1978Google Scholar
  39. Proudfoot AT, Stewart MS, Levitt T, Widdop B. Paraquat poisoning: significance of plasma paraquat concentrations. Lancet 2: 330–332, 1979PubMedCrossRefGoogle Scholar
  40. Redetzki M, Wood C, Grafton W. Vitamin E and paraquat poisoning. Veterinary and Human Toxicology 22: 395–397, 1980PubMedGoogle Scholar
  41. Rose MS, Smith LL, Wyatt I. Evidence for energy-dependent accumulation of paraquat into rat lung. Nature 252: 314–315, 1974PubMedCrossRefGoogle Scholar
  42. Savy FP, Duval G, Her B, Canu P, Fintelz P. Echec de la chimiothérapie et de la radiothérapie au cours des fibroses pulmonaires dues au paraquat. Annales Françaises d’Anesthésie et de Réanimation 7: 159–161, 1988PubMedCrossRefGoogle Scholar
  43. Scherrmann JM, Galliot M, Garnier R, Bismuth C. Acute paraquat poisoning: prognostic significance and therapeutical interest of blood assay. Toxicological European Research 5: 141–145, 1983Google Scholar
  44. Scherrman JM, Houze P, Bismuth C, Bourdon R. Prognostic value of plasma and urine paraquat concentration. Human Toxicology 6: 91–93, 1987CrossRefGoogle Scholar
  45. Shum S, Hale TW, Habersang R. Reduction of paraquat toxicity by N-acetylcysteine. Veterinary and Human Toxicology 6: 31–36, 1982Google Scholar
  46. Smith LL. The identification of an accumulated system for diamines and polyamines into the lung and its relevance to paraquat toxicity. Archives of Toxicology (Suppl. 5): 1–14, 1982Google Scholar
  47. Smith LL. Mechanism of paraquat toxicity in lung and its relevance to treatment. Human Toxicology 6: 31–36, 1987PubMedCrossRefGoogle Scholar
  48. Smith LL, Rose MS. Biochemical changes in lungs exposed to paraquat. In Autor AP (Ed.) Biochemical mechanisms of paraquat toxicity, Academic Press, New York, 1977Google Scholar
  49. Talbot AR, Barnes MR. Radiotherapy for the treatment of pulmonary complications of paraquat poisoning. Human Toxicology 7: 325–332, 1988PubMedCrossRefGoogle Scholar
  50. Toronto Lung Transplant Group. Sequential bilateral lung transplantation for paraquat poisoning: a case report. Journal of Thoracic and Cardiovascular Surgery 89: 734–742, 1985Google Scholar
  51. Vaishampayan A. Strong mutagenic action of a bipyridium herbicide in a N2-fixing blue-green algae. Experientia 40: 1016–1019, 1984CrossRefGoogle Scholar
  52. Van Asbeck BS, Hillen FC, Boonen HCM, De Jong Y, Dormans JAMA, et al. Death following paraquat intake in the rat is completely prevented by deferoxamine. Abstract 0111 IIIrd World Congress of the World Federation of Associations of Clinical Toxicology and Poison Control Centres, Brussels, 27–30 August, 1986Google Scholar
  53. Van Asbeck BS, Hillen FC, Sangster B. Continuous intravenous infusion of deferoxamine reduces mortality by paraquat in vitamin E deficient rats. American Review of Respiratory Diseases 139: 769–773, 1989Google Scholar
  54. Vincken W, Huyghens L. Schaedevyl W, Verbeglen D, Come L. Paraquat poisoning and colchicine treatment. Annals of Internal Medicine 95: 391–392, 1981PubMedGoogle Scholar
  55. Williams MV, Webb DB. Paraquat lung: is there a role for radiotherapy? Human Toxicology 6: 75–81, 1987PubMedCrossRefGoogle Scholar
  56. Wright AF, Green TP, Robson RT, Niewola Z, Wyatt I, et al. Specific polyclonal and monoclonal antibody prevents paraquat accumulation into rat lung slices. Biochemical Pharmacology 36: 1325–1331, 1987PubMedCrossRefGoogle Scholar
  57. Yamashita M, Naito H, Takagi S. The effectiveness of a cation resin (Kayexalate) as an absorbent of paraquat: experimental and clinical studies. Human Toxicology 6: 89–90, 1987PubMedCrossRefGoogle Scholar
  58. Yonei S, Noda A, Tachibana A, Akasak S. Mutagenic and cytotoxic effects of oxygen free radicals generated by methyliologen (paraquat) on Escherichia coli with different DNA-repair capacities. Mutation Research 163: 15–22, 1986PubMedCrossRefGoogle Scholar

Copyright information

© Adis International Limited 1990

Authors and Affiliations

  • C. Bismuth
    • 1
    • 2
  • R. Garnier
    • 1
    • 2
  • F. J. Baud
    • 1
    • 2
  • J. Muszynski
    • 1
    • 2
  • C. Keyes
    • 1
    • 2
  1. 1.Réanimation Toxicologique, Clinique ToxicologiqueHôpital Fernand WidalParis Cedex 10France
  2. 2.Department of Internal MedicineCedars-Sinai Medical CenterLos AngelesUSA

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