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Resúmenes

El paraquat es un herbicida bipiridílico que actúa por contacto, se presenta en forma líquida en concentraciones del 20% para uso agrícola. Su nombre químico es eI 1-1´-dimetil-4-4- bipiridilo, con el nombre comercial de Gramoxone. La intoxicación por paraquat tiene una tasa de mortalidad elevada. La intoxicación grave se caracteriza por la afectación de múltiples órganos, principalmente los pulmones, los riñones y el hígado. El pulmón es el órgano diana en la intoxicación por paraquat y la insuficiencia respiratoria con fibrosis pulmonar aguda es la causa más común de muerte.

Intoxicación; Paraquat; pulmón; fibrosis pulmonar

Paraquat (1-1´-dimetil-4-4-bipyridylium dichloride) is still widely used in Costa Rica as a contact herbicide and is marketed as a 20% aqueous solution (Gramoxone) .Paraquat poisoning carries a high mortality rate. Severe paraquat poisoning is characterized by multiple-organ involvement, mainly the lungs, kidneys, liver. The lung is a major target organ in paraquat poisoning, and respiratory failure from acute pulmonary fibrosis is the most common cause of death.

intoxication; Paraquat; lung; lung fibrosis

^*+

Costa Rica as a contact herbicide and is marketed as a 20% aqueous solution (Gramoxone) .Paraquat poisoning carries a high mortality rate. Severe paraquat poisoning is characterized by multiple-organ involvement, mainly the lungs, kidneys, liver. The lung is a major target organ in paraquat poisoning, and respiratory failure from acute pulmonary fibrosis is the most common cause of death.

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Figura 1

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Figura 2

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^{Imagen 1}), perforación esofágica con mediastinitis, vómito y diarrea. Se presenta fallo multiorgánico, así como coma y convulsiones, produciéndose la muerte en un lapso de uno a siete días. (^1-2,¹¹)

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<>La aparición de una insuficiencia renal rápida es de mal pronóstico, ya que altera la eficiencia del tratamiento. La fibrosis pulmonar es irreversible.

figura 3

Referencias bibliográficas

1. Gisbert-Calabuig. J. Medicina Legal y Toxicología.(2001) Quinta edición. Editorial Masson. Barcelona, España. 2001. 925-928.
2. Vargas Alvarado Eduardo. Medicina Legal. (2007). 2da. Edición-México:Trillas. Pags401-403.
3. World Health Organization. (2002). WHO recommended classification of pesticides by hazard and guidelines to classification 2000-2002. WHO/PCS 01.4. Geneve.
4. Nogué, S.; Dueñas, A. (2000). Intoxicación por paraquat: un puzzle al que le faltan piezas. Med Clin (Barc).115, 546-8.
5. Lee, E.Y.; Hwang, K.Y.; Yang, J.O.; Hong, S.Y. (2002). Predictors of survival after acute paraquat poisoning. ToxicolIndHealth.18, 201-6.
6. Houze, P.; Baud, F.J.; Mouy, R.; Bismuth, C.; Bourdon, R.; Scherrmann, J.M. (1990). Toxicokinetics of paraquat in humans. Hum Exp Toxicol. 9, 5-12.
7. Lin, J.L.; Lin-Tan, D.T.; Chen, K.H.; Huang, W.H. (2006). Repeated pulse of methylprednisolone and cyclophosphamide with continuous dexamethasone therapy for patients with severe paraquat poisoning. CritCare Med. 34, 368-73.
8. López, A.M.; Rivero, C.; Galban, C.; Marino, A.; Pineiro, N.; Ferrer, E. (2002). Intoxicaciones por paraquat y hemoperfusión con carbón activado. AnMed Interna.19, 310-2.
9. Dinis-Oliveira, R.J.; Duarte, J.A.; Sanchez-Navarro, A.; Remiao, F.; Bastos, M. L. and Carvalho, F. (2008). Paraquat Poisonings: Mechanisms of Lung Toxicity, Clinical Features, and Treatment. Critical Reviews in Toxicology. 38,13-71.
10. Ariyama, J.; Shimoda, H.; Aono, M.; Tsuchida, H.; Hirai, K.I. (2000). Propofol improves recovery from paraquatacute toxicity in vitro and in vivo. Intensive Care Med. 26, 981-7.
11. Kondle Raghu, Vidavalur Mahesh, Parri Sasidhar, Polam R. Reddy, Vajja Venkataramaniah, Amit Agrawal. (2013) Paraquat poisoning: A case report and review of literature. J FamCommunity Med 20:198-200.
12. Perriëns, J.H.; Benimadho, S.; Lie, I.; Wisse, J.; Chee, H. (1992). High-dose cyclophosphamide and dexamethasone in paraquat poisoning: A prospective study. Human Exp Toxicol. 11, 129-34.
13. Lin, N.C.; Lin, J.L.; Lin-Tan, D.T.; Yu, C,C. (2003). Combined initial cyclophosphamide with repeated methylprednisolone pulse therapy for severe paraquat poisoning from dermal exposure. J Toxicol Clin Toxicol. 41, 877-81.
14. Palomar M, Nogué S. Intoxicación por paraquat. (1989) Med Clín (Barc); 93: 58-60.
15. Winchester JF. Paraquat and diquat herbicides. En: Haddad LM, Winchester JF, eds. (1990) Poisoning and drug overdose. Philadelphia: WB Saunders Co; 1.088-1.099.B.
16. Gawarammana & N. A. Buckley, Medical management of paraquat ingestion, Br J Clin Pharmacol/ 72:5 / 745–757.
17. L. Kolilekas, E. Ghizopoulou, S. Retsou, S. Kourelea, C. Hadjistavrou, (2006) Severe paraquat poisoning. A long-term survivor, Respiratory Medicine Extra 2, 67–70.
18. Kondle Raghu, Vidavalur Mahesh, Parri Sasidhar, Polam R. Reddy, Vajja Venkataramaniah, Amit Agrawal,(2013) Paraquat poisoning: A case report and review of literature. J Fam Community Med;20:198-200.
19. Saravu K, Sekhar S, Pai A, Barkur AS, Rajesh V, Earla JR. Paraquat - A deadly poison. (2013) Report of a case and review. Indian J Crit Care Med;17:182-4.
20. Rio MJ, Velez-Pardo C. (2008) Paraquat induces apoptosis in human lymphocytes: protective and rescue effects of glucose, cannabinoidsand insulin-like growth factor-1. Growth Factors; 26: 49–60.
21. Yang W, Tiffany-Castiglioni E.(2008) Paraquat-induced apoptosisin human neuroblastoma SH-SY5Y cells: involvement of p53 and mitochondria. J ToxicolEnviron Health A; 71: 289–99.
22. Fordel E, Thijs L,Martinet W, Lenjou M, Laufs T, Van Bockstaele D, Moens L, Dewilde S. (2006) Neuroglobin and cytoglobin overexpression protects human SH-SY5Y neuroblastoma cells against oxidative stress-induced cell death. Neurosci Lett; 410: 146–51.
23. Denicola A, Radi R. (2005) Peroxynitriteand drug-dependent toxicity. Toxicology; 208: 273–88.
24. Dinis-Oliveira RJ, Sousa C, Remiao F, Duarte JA, Navarro AS, Bastos ML, Carvalho F (2007). Full survival of paraquat-exposed rats after treatment with sodium salicylate. Free Radic BiolMed; 42: 1017–28.
25. Y.-G. Min et al. (2011)Prediction of prognosis in paraquatpoisoning. Clinical Toxicology, 49, 840–845.
26. León-Verastegui, Á. (2012). Enfermedad de Parkinson por exposición ocupacional a paraquat. (Spanish). Revista Medica Del IMSS, 50(6), 665-672.

^* Médico residente de Medicina Legal. Departamento de Medicina Legal. Poder Judicial. Correo electrónico: gviales@poder-judicial.go.cr

Fechas de Publicación

Publicación en esta colección
20 Oct 2014
Fecha del número
Dic 2014

Histórico

Recibido
02 Jul 2014
Acepto
15 Jul 2014

[1] 1. Gisbert-Calabuig. J. Medicina Legal y Toxicología.(2001) Quinta edición. Editorial Masson. Barcelona, España. 2001. 925-928.

[2] 2. Vargas Alvarado Eduardo. Medicina Legal. (2007). 2da. Edición-México:Trillas. Pags401-403.

[3] 3. World Health Organization. (2002). WHO recommended classification of pesticides by hazard and guidelines to classification 2000-2002. WHO/PCS 01.4. Geneve.

[4] 4. Nogué, S.; Dueñas, A. (2000). Intoxicación por paraquat: un puzzle al que le faltan piezas. Med Clin (Barc).115, 546-8.

[5] 5. Lee, E.Y.; Hwang, K.Y.; Yang, J.O.; Hong, S.Y. (2002). Predictors of survival after acute paraquat poisoning. ToxicolIndHealth.18, 201-6.

[6] 6. Houze, P.; Baud, F.J.; Mouy, R.; Bismuth, C.; Bourdon, R.; Scherrmann, J.M. (1990). Toxicokinetics of paraquat in humans. Hum Exp Toxicol. 9, 5-12.

[7] 7. Lin, J.L.; Lin-Tan, D.T.; Chen, K.H.; Huang, W.H. (2006). Repeated pulse of methylprednisolone and cyclophosphamide with continuous dexamethasone therapy for patients with severe paraquat poisoning. CritCare Med. 34, 368-73.

[8] 8. López, A.M.; Rivero, C.; Galban, C.; Marino, A.; Pineiro, N.; Ferrer, E. (2002). Intoxicaciones por paraquat y hemoperfusión con carbón activado. AnMed Interna.19, 310-2.

[9] 9. Dinis-Oliveira, R.J.; Duarte, J.A.; Sanchez-Navarro, A.; Remiao, F.; Bastos, M. L. and Carvalho, F. (2008). Paraquat Poisonings: Mechanisms of Lung Toxicity, Clinical Features, and Treatment. Critical Reviews in Toxicology. 38,13-71.

[10] 10. Ariyama, J.; Shimoda, H.; Aono, M.; Tsuchida, H.; Hirai, K.I. (2000). Propofol improves recovery from paraquatacute toxicity in vitro and in vivo. Intensive Care Med. 26, 981-7.

[11] 11. Kondle Raghu, Vidavalur Mahesh, Parri Sasidhar, Polam R. Reddy, Vajja Venkataramaniah, Amit Agrawal. (2013) Paraquat poisoning: A case report and review of literature. J FamCommunity Med 20:198-200.

[12] 12. Perriëns, J.H.; Benimadho, S.; Lie, I.; Wisse, J.; Chee, H. (1992). High-dose cyclophosphamide and dexamethasone in paraquat poisoning: A prospective study. Human Exp Toxicol. 11, 129-34.

[13] 13. Lin, N.C.; Lin, J.L.; Lin-Tan, D.T.; Yu, C,C. (2003). Combined initial cyclophosphamide with repeated methylprednisolone pulse therapy for severe paraquat poisoning from dermal exposure. J Toxicol Clin Toxicol. 41, 877-81.

[14] 14. Palomar M, Nogué S. Intoxicación por paraquat. (1989) Med Clín (Barc); 93: 58-60.

[15] 15. Winchester JF. Paraquat and diquat herbicides. En: Haddad LM, Winchester JF, eds. (1990) Poisoning and drug overdose. Philadelphia: WB Saunders Co; 1.088-1.099.B.

[16] 16. Gawarammana & N. A. Buckley, Medical management of paraquat ingestion, Br J Clin Pharmacol/ 72:5 / 745–757.

[17] 17. L. Kolilekas, E. Ghizopoulou, S. Retsou, S. Kourelea, C. Hadjistavrou, (2006) Severe paraquat poisoning. A long-term survivor, Respiratory Medicine Extra 2, 67–70.

[18] 18. Kondle Raghu, Vidavalur Mahesh, Parri Sasidhar, Polam R. Reddy, Vajja Venkataramaniah, Amit Agrawal,(2013) Paraquat poisoning: A case report and review of literature. J Fam Community Med;20:198-200.

[19] 19. Saravu K, Sekhar S, Pai A, Barkur AS, Rajesh V, Earla JR. Paraquat - A deadly poison. (2013) Report of a case and review. Indian J Crit Care Med;17:182-4.

[20] 20. Rio MJ, Velez-Pardo C. (2008) Paraquat induces apoptosis in human lymphocytes: protective and rescue effects of glucose, cannabinoidsand insulin-like growth factor-1. Growth Factors; 26: 49–60.

[21] 21. Yang W, Tiffany-Castiglioni E.(2008) Paraquat-induced apoptosisin human neuroblastoma SH-SY5Y cells: involvement of p53 and mitochondria. J ToxicolEnviron Health A; 71: 289–99.

[22] 22. Fordel E, Thijs L,Martinet W, Lenjou M, Laufs T, Van Bockstaele D, Moens L, Dewilde S. (2006) Neuroglobin and cytoglobin overexpression protects human SH-SY5Y neuroblastoma cells against oxidative stress-induced cell death. Neurosci Lett; 410: 146–51.

[23] 23. Denicola A, Radi R. (2005) Peroxynitriteand drug-dependent toxicity. Toxicology; 208: 273–88.

[24] 24. Dinis-Oliveira RJ, Sousa C, Remiao F, Duarte JA, Navarro AS, Bastos ML, Carvalho F (2007). Full survival of paraquat-exposed rats after treatment with sodium salicylate. Free Radic BiolMed; 42: 1017–28.

[25] 25. Y.-G. Min et al. (2011)Prediction of prognosis in paraquatpoisoning. Clinical Toxicology, 49, 840–845.

[26] 26. León-Verastegui, Á. (2012). Enfermedad de Parkinson por exposición ocupacional a paraquat. (Spanish). Revista Medica Del IMSS, 50(6), 665-672.

Intoxicación por Paraquat

Resúmenes

Referencias bibliográficas

Fechas de Publicación

Histórico