Date of Award

Winter 1-4-2020

Document Type

Dissertation

Degree Name

PharmD

Department

Department of Pharmacy Practice

First Advisor

Dr. Vijayanarayana K

Second Advisor

Dr. Shivashankar KN

Abstract

Introduction Paraquat poisoning is a major medical problem in many parts of Asia, Pacific nations, and America [1] . It is rapidly-acting, nonselective and relatively inexpensive due to which widespread use in the developing world is.An increased rate of morbidity and mortality is associated with Paraquat poisoning. General treatment includes gastrointestinal decontamination like treatment with activated charcoal and fuller's earth given to minimize the absorption Haemodialysis and Hemoperfusion also plays important role for elimination of poison. Immunosuppression is also widely practised with Dexamethasone, Cyclophosphamide and Methylprednisolone. Many evidences showed antioxidants such as N-Acetylcysteine also beneficial. However, there are no clear studies stating benefits of individual or combination of regimens with respect to outcomes. This study is carried out to compare the efficacy and safety profile of various Extra Corporeal Removal method and other treatment regimens in our hospital setting. Objectives This study was planned to assess the effectiveness of various treatment strategies with the outcome in Paraquat poisoning Methodology A retrospective study was conducted in the medical record section of tertiary care hospital, South India. Patients diagnosed with Paraquat poisoning admitted during the period 2012-19 were enrolled in the study. Patients were identified through medical records with International Classification of Diseases (ICD) code T60.3X1D corresponding to herbicide and fungicide poisoning. Patient’s demographical details, clinical symptoms, treatment and outcomes were collected in a suitably designed case report form (CRF). Data was entered in the Statistical Package for the Social Sciences (SPSS) 20.0 and analyzed. Results A total of 206 patients were enrolled in the study with mean age 28.14±11.35 years (Mean ± Standard Deviation). Majority of the patient population were males (63.6%) and intension of selfharm (96.6%) most common type of poisoning. Majority of the study population belongs to daily wagers (27.7%) followed by agriculturists (26.2%) comprised a larger part of the study population. Treatment pattern showed a majority treated with ECR methods alone (45.6%), followed by NAC [Type here] 16 and other antioxidants alone (27.7%) and various combination therapies NAC+Steroids57 (27.7%), ECR+NAC+Steroids 43(20.9%) and ECR+NAC+Steroids+Antibiotics 35(17.0%)). Outcome analysis with respect to various ECR methods revealed that Hemoperfusion (43.9%) showed better results which is followed by combination of Hemodialysis + Hemoperfusion (21.2%), when compared to other ECR methods such as HD (7.4%) alone and Hemofiltration (0) whose results were not significant with respect to outcome of the patient. Secondary outcome like the ICU days (4.66±3.43), ventilator days (0.63±1.61), and secondary complications (7.6%) was comparatively less in the group treated with Hemoperfusion. The addition of NAC and other antioxidants was not found to be beneficial in terms of primary outcome. Conclusion The treatment analysis revealed extracorporeal removal of the Paraquat by Hemoperfusion ensured better clinical outcomes in terms of primary and secondary outcomes. However, addition of NAC and other antioxidants did not improve the overall outcomes of the patients. Furthermore, HP showed lower incidence of secondary complications Acute Kidney Injury, Multiple Organ Dysfunction Syndrome, Upper Gastrointestinal bleeding and other complications compared to other groups

Download

Share

COinS