Recently, in Xingtaiwei County, Hebei Province, 18-year-old girl Meng Meng drank two cups of cold treatment potion handed by her brother-in-law Chen Mou and vomited up and down diarrhea, and was finally found to be paraquat poisoning after several days of hospital treatment. On the morning of December 28, the cover news reporter interviewed Ms. Guo, a relative of Meng Meng, who said sadly: "The hospital has issued a critical illness notice again, kidney failure." Because the child became ill from December 6 to the treatment, the cause was unknown until December 17, when he was found to be paraquat poisoning by the Hebei Provincial People's Hospital. At present, Meng Meng's brother-in-law Chen Mou has been criminally detained by the police according to law, and the specific reason for the poisoning is still under investigation by the police.
I. Introduction to paraquat
Paraquat is also known as Paraquat and balaquine in Taiwan. Chemical name N, N'-dimethyl-4,4-bipyridine dichloride and methyl disulfate, the chemical formula is (C12H14N2)2+, in the form of divalent cations, the product has two kinds of dichloride and dimethyl sulfate salt, chemically belongs to the bipyridine heterocyclic compound. It belongs to the moderately toxic class, rats have oral LD50 dichloride of 155-203 mg/kg, and dimethyl sulfate salt is 320 mg/kg, which is low toxicity to poultry, fish and bees. It is extremely toxic to humans and has no specific antidotes. The lethal amount of 20% aqueous solution in adults is about 5-15 mL (1 to 3 g) or about 40 mg/kg, and long-term skin exposure to paraquat solution can also be fatal. It is the herbicide with the highest mortality rate from acute poisoning in humans. Among patients who survive paraquat poisoning, the highest blood concentration in the body for 3 h is 2.64 micrograms/mL. All patients with blood concentrations greater than 3.44 micrograms/mL died.
2. What should I do if I eat paraquat by mistake?
Timely medical delivery, accurate diagnosis, and symptomatic treatment
Paraquat's harmful effects on the human body mainly occur between 24-72 hours after ingestion, and the first 24 hours are the golden time for rescue.
First aid measures for paraquat
1. Clean the skin: timely give a full body bath, change clothes, remove poisons that may remain on clothing and skin, and reduce poison absorption and damage.
2. Rapid establishment of intravenous channels: immediately establish one or two intravenous channels, give intravenous fluids and other treatments, diuresis accelerates the discharge of poisons, while maintaining electrolyte balance. Antioxidants such as hormones and vitamins are used to inhibit pulmonary fibrosis and use gastric mucosal protectors.
3. Care of the respiratory system: since the lung damage after paraquat poisoning is the most serious, early poisoning is easy to cause respiratory distress syndrome, attention should be paid to keeping the respiratory tract open, timely cleaning of the respiratory tract, observation of breathing, regular monitoring of blood gas analysis, low oxygen saturation can be given low flow oxygen, if necessary, endotracheal intubation, ventilator assisted breathing. Regular x-rays are done to check the lungs.
4. Care of the digestive tract: temporary diet in the acute stage, indwelling the gastric tube, gastrointestinal decompression, the action should be gentle when placing the gastric tube, record the color, nature and amount of drainage fluid, and observe whether there is gastrointestinal bleeding. Oral care is performed 3 times daily with oral liquid to prevent oral infection. Observe the number, color, nature and amount of stools in patients, and make a record. Monitor the electrolyte to prevent electrolyte disturbances.
5. Nursing of deep venous catheterization: instruct the patient to stay in bed, minimize flexion movement of the right lower limb, observe whether there are signs of redness, swelling, exudation and bleeding in the local area of the puncture, keep the puncture catheter properly fixed, and give heparin dilution 5-10 mL to seal the tube after the end of treatment. Puncture points are given regularly to disinfect and change the dressing. Observe sensorimotor movements of the right lower extremities to prevent venous thrombosis.
6. Care of blood perfusion: through blood perfusion can remove the toxic components in the blood, thereby reducing or relieving the damage of poisons to the organ, in the blood perfusion process, the flow rate of the blood pump should be adjusted according to the blood pressure, to ensure that the patient's blood is better heparinized, to prevent pipeline coagulation and air embolism, if necessary, to give warmth. Within 3 hours after the end of perfusion, it is still necessary to pay attention to the patient's hematuria, local bleeding points and other bleeding signs.
7. Monitoring of liver and kidney function: paraquat has different degrees of damage to the liver and kidneys, and the intake of 24 h should be accurately recorded and the liver and kidney function should be monitored regularly.
8. Remove poisons from the mouth: Let the patient gargle with a large amount of normal saline (250-500 mL) to remove the remaining poisons in the mouth, do not induce vomiting, because paraquat can corrode and burn the mouth and its esophageal mucosa, and take a small amount of egg whites orally to reduce damage to the esophageal mucosa.