Adherence to the current guidelines in the management of paraquat poisoning

Abstract

Background: Self-poisoning with paraquat (PQ) is a major health problem with 60 -70% fatality. Fuller’s earth is the mainstay of therapy as other treatment modalities are controversial. Current management guidelines of paraquat poisoning recommend the administration of Fuller’s earth / activated charcoal until they are detected in stools and also immunosuppression therapy. The aim of the study was to look at the adherence to the existing guidelines in the management of PQ poisoning by the ward staff. Methods: In this cross-sectional study consecutive patients admitted to two selected hospitals due to PQ poisoning were recruited. Current practice in management of PQ poisoning in these hospitals was compared with the National guidelines. Results: There were 145 patients (111 males) admitted with paraquat poisoning during the study period. Fuller’s earth was given to 130 (89.6%) patients. One patient refused and one died before the treatment. Twelve (8.3%) patients did not receive Fuller’s earth. Among them five died with the median of 3 (range 1-13) days after the hospital admission. Nineteen (14.6%) patients out of 130 who received PQ did not notice Fuller’s earth in their stool. Forty patients either did not observe Fuller’s earth in their stools or the data was not available. Eighty four (58%), 14 (10%) and 57 (39%) patients received cyclophosphamide, dexamethasone andmethyl- prednisolone, respectively. Conclusion: Among the patients who received Fuller’s earth at least 14% did not fulfill the criteria of proper administration. Education of health care people on administration of Fuller's earth may be required. Even though immunosuppression therapy is controversial, more than 50% of patients received it.