A mouthful of 20% paraquat can kill. Confirm with the urine dithionite test, give activated charcoal early, avoid supplemental oxygen unless SpO2 is very low, support the kidneys, and discuss prognosis honestly; immunosuppression and haemoperfusion are unproven.
At the bedside
Timed steps- 1
Recognise
0 minBurning mouth/throat ulcers (paraquat tongue), vomiting; then AKI and hepatitis (days 1-3) and progressive pulmonary fibrosis (days 3-14).
- 2
Dithionite
TestUrine + sodium dithionite in alkali turns blue (dark blue/navy = high risk). Plasma level against time predicts survival where available.
- 3
Early
DecontaminateActivated charcoal 50 g (or Fuller's earth/bentonite) if within 1-2 h; skin/eye decontamination.
- 4
Restrict
OxygenAvoid supplemental O2 unless SpO2 < ~90% or for palliation; oxygen fuels free-radical lung injury.
- 5
Kidneys and comfort
SupportIV fluids for losses, dialysis for AKI (does not remove significant paraquat once distributed), analgesia for mucosal burns, early palliative care conversation if dithionite strongly positive.
- 6
Discuss
UnprovenCyclophosphamide + methylprednisolone, NAC, haemoperfusion: no convincing RCT benefit; consider only within trials or local protocols.
Paraquat
Step 1 of ~4
Activated charcoal/Fuller's earth if early
Based on Gawarammana IB, Buckley NA. Educational use; follow local protocol.
Evidence
- Gawarammana & Buckley 2011: systematic review of management; no intervention proven to reduce mortality.
🇮🇳 India notes
- Paraquat (e.g. 24% SL formulations) is widely available in south and east India; some states (e.g. Kerala) have restricted it.
References
Test yourself
Module quiz · score 70% to complete the module
Educational reference for trained clinicians. Check doses against your hospital protocol and the patient in front of you.