Multi-resistant salmonella ohio infections at the University Hospital of the West Indies - abstract

This retrospective study assesses the impact of changes in the management of paraquat poisoning presenting within 48 hours. Between November 1981 and October 1984, 17 cases of poisoning with Gramoxone (20 percent solution of paraquat) occurred in Dominica. The incidence is thus 0.25./100,000/yr. Eleven of the cases presented within 48 hrs of ingestion. Their management fell into three groups: (i) analgesics and sedation only, (ii) gastric lavage, (iii) gastric lavage, 4-hourly gastric instillation of Fuller's earth (60-90g), mannitol or magnesium sulphate purgation and forced diuresis. The changes in management have not significantly altered the outcome. All of the 17 patients who took over 20g died within 25 hours. All patients presenting with respiratory symptoms, vomiting or diarrhoea died within 25 hours. The sole survivor, a 17 yr-old male, presented at 4 days and developed renal and hepatic failure but not late respiratory failure. He had had frequent chest X-rays. This may have been significant as radiotherapy has been reported to result in resolution of severe paraquat-induced pulmonary damage. Patients surviving more than 25 hours should probably be referred to a centre where radiotherapy and dialysis facilities are available (AU)