Failure of radiotherapy to reverse progressive pulmonary fibrosis caused by paraquat

Abstract

Pulmonary fibrosis following poisoning by paraquat almost invariably proves fatal. A recent case report suggested that the pulmonary damage might be reversed by whole-lung irradiation (Webb et al, 1984). We describe a patient whom we treated in a similar manner, without success. A student aged 20 years was admitted approximately 3 h after deliberate ingestion of 50–100 ml of Gramoxone (containing 10–20 g of paraquat). Stomach wash-out was performed on admission. He was then treated with Fuller's earth and an oral mannitol purge; 7.5 h after ingestion, the plasma paraquat was 980 μg/1. At 36 h after ingestion he was transferred to our care for charcoal column haemoperfusion (CHP). He was drowsy and unwell with gross oro-pharyngeal ulceration and a temperature of 38.0°C.