Comparative analysis of target organ damage in patients with oral diquat and paraquat poisoning
Objective To analyze the characteristics of target organ damage in patients with diquat and paraquat poisoning in order to provide scientific basis for further improving the clinical treatment level.Methods The clinical data of 88 patients with simple oral diquat(diquat group)and 80 patients with paraquat poisoning(paraquat group)were retrospectively collected,including age,sex,poisoning dose,time from poisoning to admission,poisoning induced vomiting and diarrhea,time from poisoning to gastric lavage,clinical manifestation,time from poisoning to first hemperfusion,number of hemoperfusion,hospitalization days,liver and kidney function[alanine aminotransferase(ALT),total bilirubin(TBIL),creatinine(Cr)],blood coagulation function[prothrombin time(PT)],white blood cell count(WBC),indicators of lung injury[oxygenation index(PO2/FiO2)],indicators of myocardial injury[creatine kinase(CK),creatine kinase isoenzyme(CK-MB),troponin I(cTnI)],blood lactic acid(Lac),pH value and final prognosis.Comparison was made on the difference of the above clinical indicators between diquat group and paraquat group,the target organ damage in patients who died in diquat group and paraquat group,and the poisoning doses of diquat and paraquat in dead and surviving patients.Results In the diquat group,the maximum age was 73 years old and the minimum age was 15 years old;in the paraquat group,the maximum age was 59 years old and the minimum age was 14 years old;in the diquat group,there were 34 cases of males(38.64%)and 54 cases of females(61.36%);in the paraquat group,there were 37 cases of males(46.25%)and 43 cases of females(53.75%).Throat pain,nausea,vomiting and epigastric pain were the main clinical manifestations in both groups after poisoning.A few patients with low dose of poisoning had no symptoms.In paraquat group,patients with poisoning dose more than 50 ml showed symptoms of chest tightness and shortness of breath,while in diquat group,patients with poisoning dose more than 50 ml showed symptoms of irritability,drowsiness,delirium or even convulsions,coma and so on.There was no significant difference between the two groups in terms of sex,average age,average poisoned dose,average time from poisoning to admission,rate of poisoning induced vomiting and diarrhea,average time from poisoning to gastric lavage,average time from poisoning to the first hemoperfusion,and average number of hemoperfusion(P>0.05).The average hospitalization days in the diquat group was(4.86±1.81)d,which was significantly shorter than(7.85±1.13)d in the paraquat group(P<0.05).The survival rate of the diquat group was higher than that of the paraquat group at poisoning doses of 21-50 ml and 51-100 ml(P<0.05).The overall survival rate of 78.41%in the diquat group was significantly higher than 37.50%in the paraquat group(P<0.05).On the 3rd day after admission,ALT of dead patients in the diquat group was(109.26±63.88)U/L,TBIL was(40.29±10.39)μmol/L,PT was(12.24±1.56)s,Lac was(1.54±1.09)mmol/L,and WBC was(13.24±3.43)×109/L,which were lower than(327.12±127.86)U/L,(68.38±48.55)μmol/L,(17.39±2.73)s,(4.53±1.54)mmol/L,and(23.32±4.56)×109/L of dead patients in the paraquat group;Cr of dead patients in the diquat group was(308.44±156.87)μmol/L,PO2/FiO2 was(207.32±76.10)mm Hg(1 mm Hg=0.133 kPa),CK was(456.56±101.39)U/L,CK-MB was(63.29±21.39)U/L,cTnI was(11.56±1.31)ng/ml,which were higher than(201.93±87.01)μmol/L,(153.25±64.25)mm Hg,(50.29±21.39)U/L,(47.21±12.22)U/L,(4.29±4.21)ng/ml of dead patients in the paraquat group(P<0.05).The poisoning doses of diquat and paraquat in dead patients were significantly higher than those in the surviving patients(P<0.05).The poisoning dose of diquat in dead patients was greater than that of paraquat(P<0.05).There was no significant difference in the poisoning doses of diquat and paraquat in surviving patients(P>0.05).Conclusion The age of the patients with diquat and paraquat poisoning is more common in young and middle-aged women under 40 years old,all patients with oral poisoning have digestive tract symptoms such as sore throat,nausea,vomiting;patients with large doses of diquat poisoning will have consciousness changes including irritability,lethargy,convulsion,coma,while patients with large doses of paraquat poisoning will have chest tightness,shortness of breath and other symptoms.Taking the same dose of poisoing,the survival rate of diquat was higher than that of paraquat;diquat has the most significant damage to kidney,myocardium and nervous system and is closely related to the prognosis of patients.Paraquat poisoning mainly damages lung,liver and kidney and the overall mortality rate of patients poisoned by diquat is lower than that of paraquat poisoning.