Spectrum of toxic hepatitis following intentional paraquat ingestion: analysis of 187 cases

Introduction This retrospective observational study examined the clinical features, the degrees of toxic hepatitis, physiological markers and clinical outcomes after intentional paraquat poisoning and sought to determine what association, if any, might exist between these findings. Methods A total o...

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Published in:Liver international 2012-10, Vol.32 (9), p.1400-1406
Main Authors: Yang, Chin-Jung, Lin, Ja-Liang, Lin-Tan, Dan-Tzu, Weng, Cheng-Hao, Hsu, Ching-Wei, Lee, Shen-Yang, Lee, Shwu-Hua, Chang, Chia-Ming, Lin, Wey-Ran, Yen, Tzung-Hai
Format: Article
Language:English
Subjects:
Adult
Age Factors
Alanine transaminase
Antidotes - administration & dosage
Charcoal - administration & dosage
Chemical and Drug Induced Liver Injury - etiology
Chemical and Drug Induced Liver Injury - mortality
Chemical and Drug Induced Liver Injury - pathology
Chemical and Drug Induced Liver Injury - therapy
Female
Hemoperfusion
Herbicides - poisoning
Humans
Length of Stay
Liver Function Tests
Male
Paraquat - poisoning
Renal Insufficiency - drug therapy
Renal Insufficiency - etiology
Renal Insufficiency - mortality
Respiratory Insufficiency - diagnosis
Respiratory Insufficiency - etiology
Respiratory Insufficiency - mortality
Retrospective Studies
Severity of Illness Index
suicide
Survival Rate
Taiwan - epidemiology
Tertiary Care Centers
toxic hepatitis
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Summary:Introduction This retrospective observational study examined the clinical features, the degrees of toxic hepatitis, physiological markers and clinical outcomes after intentional paraquat poisoning and sought to determine what association, if any, might exist between these findings. Methods A total of 187 patients were referred for management of intentional paraquat ingestion between 2000 and 2010. Patients were categorized into two groups according to their hepatic complication, i.e. with (N = 87) or without (N = 100) toxic hepatitis. Demographic, clinical and laboratory data were obtained for analysis. Mortality rates were also analysed. Results It was found that patients with toxic hepatitis were younger (39.7 ± 13.7 vs 44.2 ± 16.6 year old, P = 0.046), and suffered from greater incidences of acute respiratory failure (63.2 vs 48.0%, P = 0.037) and acute renal failure (75.9 vs 56.0%, P = 0.004) than patients without hepatitis. The hospitalization period was longer in patients with hepatitis than without hepatitis (16.2 ± 14.6 vs 11.2 ± 12.1 days, P = 0.012), even though there was no difference in mortality rate between both groups (56.3 vs 53.0%, P = 0.649). Notably, the symptoms of toxic hepatitis developed within 6.7 ± 6.3 days of exposure to paraquat with aspartate aminotransferase (AST) 138 ± 156 U/L, alanine aminotransferase (ALT) 127 ± 114 U/L and total bilirubin 2.7 ± 2.6 mg/dL. The hepatitis peaked at 9.5 ± 8.8 days with AST 125 ± 139 U/L, ALT 183 ± 181 U/L and total bilirubin 3.2 ± 3.6 mg/dL. Nevertheless, the symptoms resolved within 17.3 ± 9.8 days of paraquat exposure, and none of the patients died of hepatic complication. Conclusions A substantial proportion of paraquat patients suffered from hepatic complication (46.52%), but the spectrum of hepatitis in these patients seemed mild and transient.
ISSN:1478-3223
1478-3231
DOI:10.1111/j.1478-3231.2012.02829.x