High dosage cyclophosphamide and dexamethasone treatment of paraquat poisoning with 75 percent survival

The mortality from paraquat poisoning is usually very high, and even in the best centres it exceeds 60 percent. In this paper, we report a treatment regimen with the surival of fifteen of twenty patients (75 percent) who had ingested 15 ml to 250ml of 20 percent and 24 percent paraquat. They were treated for 2 weeks with high doses of cyclophosphamide amd dexamethasone, forced diuresis with intravenous frusemide, triamterine and hydrochlorothiazide and liberal potassium supplements in addition to the routine measures for the elimination of paraquat from the gut with Fuller's Earth, activated charcoal and magnesium sulphate. The regimen is based on our hypothesis that the damage to the pulmonary alveolar capillary membrane is caused by superoxide produced by paraquat, and that this process triggers off further immunological changes with the activation of neutrophils and production of toxic oxygen metabolites by the immune complexes, and that the immunological mechanisms causing activation of the neutrophils are suppressed by cyclophosphamide and dexamethasone (AU)

Cyclophosphamide, dexamethasone and postassium in the treatment of paraquat poisoning - abstract

Paraquat, used extensively as a herbicide, is a potent human poison with a high mortality, 90 percent in our experience. As there is no antidote, treatment has been directed to rapid elimination from the body. Between July and November 1983, 8 of 11 cases were treated successfully using the regime reported in this paper. The diagnosis of paraquat poisoning was confirmed in all patients by the presence of oropharyngitis, positive test for paraquat in urine and evidence of renal and hepatic damage. Patients ingesting less than 5 ml, with negative tests for urinary paraquat on day 1-2, were excluded. Regime (1) Stomach washout followed by 60g of Fuller's Earth in 150 ml water, alternating with 10 tablets of activated charcoal 4-hourly for one week, oral fluids being encouraged. (2) Forced diuresis with frusemide 60 mg. stat followed by Dyazide (hydrochlorothiazide with triamterene) 1 tablet twice daily for one week, then one daily for one week. (3) Magnesium sulphate 15 ml. 8-hourly for one week. (4) Intravenous fluids (dextrosaline with added KC1 40 mEq/1) 4.31/d, for two weeks, followed by oral potassium, 8mEq 8-hourly for two weeks. (5) Intravenous dexamethasone 8 mg 8-hourly for two weeks, then 0.5mg. 8-hourly for two weeks. (6) Intravenous cyclophosphamide 5 mg/Kg to a total dose of 4 to 5 g. Treatment was started within 2 to 4 hours in all but three patients and all except for three had a stomach washout. The three fatalities were in males who ingested paraquat after taking rum. All died from mediastinitis following oesophageal rupture. All the survivors are well and have returned to normal activity with no evidence of residual hepatic, renal or pulmonary damage (AU)

Myocardial infarction: a two-year study at the San Fernando Hospital

Heart disease is responsible for approximately 20 percent of all deaths in Trinidad, and 50 percent of these cases are classified as arteriosclerotic and degenerative heart disease. The total number of patients admitted to the medical wards in 1966 was 1374, of which 616 (45 percent) were diagnosed as arteriosclerotic and degenerative heart disease. This report deals only with cases of myocardial infarction confirmed by the electrocardiogram or at autopsy. Two hundred and eighteen (218) cases of myocardial infarction were admitted to the medical wards in 1966 and 1967. The presenting clinical features are described. Males were affected twice as often as females. 75 percent of all the patients were of East Indian extraction, and 25 percent were diabetics. Most of the patients were from the lower socio-economic group and were labourers. The mortality rate was approximately 20 percent. This study also suggests that myocardial infarction is commoner in Trinidad than in Jamaica (AU)