Acute Poisonings
Hepatotoxicity Related to Paraquat and Diquat Absorption Through Intact Skin. (30.06.09)
Peiró AM, Zapater P, Alenda C, Ramírez A, Gutiérrez A, Pérez-Mateo M and Such J (2007):Hepatotoxicity Related to Paraquat and Diquat Absorption Through Intact Skin. Digestive Diseases and Sciences. Volume 52, Number 11. November 2007
The patient, a 69-year-old man, a farmer, applied a toxic mix of paraquat/diquat by knapsack sprayers, under a high-temperature and -humidity environment (35–40◦C), wearing light clothing and no appropriate protection (no gloves, rubber aprons, or goggles were used). He was admitted because of continuous right-sided and central abdominal pain. The clinical course was compatible with some previously reported patterns of hepatoxicity as described in experimental models and humans. The case was classified as a probable bipyridyl-induced adverse reaction, according to the Naranjo probability scale (score=7). Bipyridyl herbicides generate superoxide anions and subsequently other redox products that can induce lipid peroxidation.
Both the high lipid peroxide levels observed in the patient and the development of macrocitic anemia are compatible with diquat/paraquat poisoning as previously reported.
Furthermore, the pathological findings are compatible with those observed in severe hepatotoxicity and, conversely, do not suggest alternative causes, such as alcohol, autonimmnunity, and virus.
This case is relevant, because to the knowledge of the scientists it is the first time that a severe liver injury by paraquat/diquat is presented without coexisting lung and kidney toxicity and as a consequence of environmental intact skin exposure— in contrast to a previous case of human hepatotoxicity, which required damaged skin for paraquat absorption.
The patient, a 69-year-old man, a farmer, applied a toxic mix of paraquat/diquat by knapsack sprayers, under a high-temperature and -humidity environment (35–40◦C), wearing light clothing and no appropriate protection (no gloves, rubber aprons, or goggles were used). He was admitted because of continuous right-sided and central abdominal pain. The clinical course was compatible with some previously reported patterns of hepatoxicity as described in experimental models and humans. The case was classified as a probable bipyridyl-induced adverse reaction, according to the Naranjo probability scale (score=7). Bipyridyl herbicides generate superoxide anions and subsequently other redox products that can induce lipid peroxidation.
Both the high lipid peroxide levels observed in the patient and the development of macrocitic anemia are compatible with diquat/paraquat poisoning as previously reported.
Furthermore, the pathological findings are compatible with those observed in severe hepatotoxicity and, conversely, do not suggest alternative causes, such as alcohol, autonimmnunity, and virus.
This case is relevant, because to the knowledge of the scientists it is the first time that a severe liver injury by paraquat/diquat is presented without coexisting lung and kidney toxicity and as a consequence of environmental intact skin exposure— in contrast to a previous case of human hepatotoxicity, which required damaged skin for paraquat absorption.
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