A Case of Acute Tubular Necrosis Induced by Paraquat (Gramoxon) Intoxication

ABSTRACT

Paraquat (1, 1'-dimethy-14, 4' dipyridium chloride: Gramoxon(r)) was first discovered in England in 1955. It has been widely distributed for use in Korea since 1970 as a pesticide and also often the cause of accidental intoxications. The authors would like to report the following case of paraquat intoxicatio in a 13 year old female child admitted via emergency room with complaints of epigastric pain, vomiting and hematuria of four days duration. On admission the data of laboratory evaluation were as follows: BUN/Cr 126/11.6 mg/dl; sGOT/sGPT 641/641 IU/L; total bilirubin/direct bilirubin 3.9/2.4 mg/dl; alkaline phosphatase 396.1 U/L; fecal occult blood test-positive; pH 7.428, pCO2 26.2 mmHg, pO2 131.4 mmHg, base excess -5.0 mmol/L on arterial blood gas analysis (ABGA). Gastroendoscopy revealed esophageal ulcers, and as symptoms of renal failure could not be relieved by hemodialysis, kidney biopsy was performed on the otherwise previously healthy child to establish the cause of renal failure. The result of biopsy revealed tubular necrosis with eosinophilic infiltrations. A more detailed retrograde probe of the child's past medical history evoked that the patient had ingested paraquat in a suicidal attempt. Supportive therapy and hemodialysis were continued thereafter, but the symptoms of renal failure could not be reversed, and the patient eventually died due to acute respiratory distress syndrome.