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Open Access Case report

Tissue concentration of paraquat on day 32 after intoxication and failed bridge to transplantation by extracorporeal membrane oxygenation therapy

Anna Bertram1*, Sascha Sebastian Haenel1, Johannes Hadem2, Marius M Hoeper3, Jens Gottlieb3, Gregor Warnecke4, Stanislav Kaschinski5, Carsten Hafer1, W Nikolaus Kühn-Velten6, Detlef Günther7 and Jan T Kielstein1

Author Affiliations

1 Department of Nephrology, Hannover Medical School, Carl Neuberg Street 1, Hannover 30625, Germany

2 Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Carl Neuberg Street 1, Hannover 30625, Germany

3 Department of Pneumology, Hannover Medical School, Carl Neuberg Street 1, Hannover 30625, Germany

4 Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Carl Neuberg Street 1, Hannover 30625, Germany

5 Institute for Radiology, Hannover Medical School, Carl Neuberg Street 1, Hannover 30625, Germany

6 Medical Laboratory of Bremen, Haferwende 12, Bremen 28357, Germany

7 Hannover Medical School, Institute for Forensic Medicine, Carl Neuberg Street 1, Hannover 30625, Germany

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BMC Pharmacology and Toxicology 2013, 14:45  doi:10.1186/2050-6511-14-45

Published: 6 September 2013

Abstract

Background

Paraquat is a highly toxic herbicide, which not only leads to acute organ damage, but also to pulmonary fibrosis. There are only anecdotal reports of rescue lung transplantation, as paraquat is stored and only slowly released from different tissues. Bridging the time to complete depletion of paraquat from the body could render this exceptional therapy strategy possible, but not much is known on the time interval after which transplantation can safely be performed.

Case presentation

We report on a case of accidental paraquat poisoning in a 23 years old Caucasian man, who developed respiratory failure due to pulmonary fibrosis. The patient was listed for high urgency lung transplantion, and extracorporeal membrane oxygenation was implemented to bridge the time to transplantation. The patient died 32 days after paraquat ingestion, before a suitable donor organ was found. In postmortem tissue specimen, no paraquat was detectable anymore.

Conclusion

This case report indicates that complete elimination of paraquat after oral ingestion of a lethal dose is achievable. The determined time frame for this complete elimination might be relevant for patients, in which lung transplantation is considered.

Keywords:
Paraquat; Poisoning; Extracorporeal membrane oxygenation; Lung transplantation