Indian Journal of Forensic and Community Medicine 2020;7(4):210–215 Content available at: https://www.ipinnovative.com/open-access-journals Indian Journal of Forensic and Community Medicine Journal homepage: https://www.ipinnovative.com/journals/IJFCM Original Research Article Clinical and pathological profile of paraquat poisoning cases - A cross-sectional study in Odisha, India Manas Ranjan Sahu 1 , Mukul Sharma 1, *, Biplab Rath 1 , Tony Joseph 1 , Kimi Soumya Padhy 1 1 Dept. of Forensic Medicine and Toxicology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India ARTICLE INFO Article history: Received 30-12-2020 Accepted 01-01-2021 Available online 08-01-2021 Keywords: Paraquat Herbicide Pulmonary fibrosis Multi organ failure ABSTRACT Introduction: Agriculture being the primary mode of occupation in Odisha leads to the rampant and widespread use of chemical pesticides and herbicides. Paraquat is a widely used herbicide. Ingestion of PQ irrespective of the quantity could be fatal with life-threatening effects on the gastrointestinal (GI) tract, kidney, liver, lungs, and other organs. Death is usually associated with respiratory insufficiency due to an oxidative insult to the Type-II alveolar epithelium with subsequent fibrosis. Materials and Methods: All cases of paraquat ingestion coming to AIIMS, Bhubaneswar casualty from July 2020 to November 2020 were studied for their clinical findings. The fatal cases were subjected to autopsy and findings noted. Results: Men were most commonly involved. All of the patients had self-harm intent while consuming. The most common presenting symptoms were difficulty in swallowing, Respiratory system was most commonly affected. The cause of death was attributed to respiratory and multi-organ failure. Discussion: Paraquat is widely marketed for its efficacy and low environmental toxicity. Lack of a specific antidote increases the fatality. The most common cause of death is respiratory failure. Paraquat causes renal failure by causing hypovolemia, circulatory failure, septicemia, and direct toxicity. The mainstay of treatment is supportive though the use of immune-suppressants has shown some positive results. © This is an open access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/) which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. 1. Introduction Agriculture is the primary occupation of the people of Odisha with majority of population involved in it. This leads to wide and rampant use of chemical pesticides and herbicides which are easily available in the market. Paraquat (PQ) is N, N’-dimethyl-4, 4 ′ -bipyridinium dichloride, a synthetic quaternary nitrogenous organic compound. 1 Its oxidative reactions were known and used in various chemical reactions. The herbicidal properties were not recognized until 1955 and then marketed in early 1962 under the name ‘Gramoxone’, and is today amongst the most commonly used herbicides. 2 It is a broad spectrum nonselective herbicide which acts on contact, destroys the * Corresponding author. E-mail address: mukul.med@gmail.com (M. Sharma). unwanted green plants by the formation of superoxide anion during photosynthesis. 3 Paraquat dichloride of 24% SL strength is registered in India with the Central Insecticide Board and Registration Committee (CIBRC). 4 Paraquat is a pungent corrosive liquid available in market commonly as ‘All Quit’, ‘Finish’, ‘Gramex’, ‘Gramo’, ‘Gramoxone’, etc. in India. 5 Ingestion of PQ irrespective of the quantity could be fatal with life-threatening effects on the gastrointestinal (GI) tract, kidney, liver, lungs and other organs. 6 Death is usually associated with respiratory insufficiency due to an oxidative insult to the Type-II alveolar epithelium with subsequent fibrosis. 7 There are no specific antidotes and none of the current treatments have proven successful in acute fulminant PQ poisoning. 8 Several studies have been done on PQ poisoning globally. 9–14 So far original articles with large sample sizes explaining various clinical scenarios https://doi.org/10.18231/j.ijfcm.2020.043 2394-6768/© 2020 Innovative Publication, All rights reserved. 210