18-year-old girl poisoned with paraquat: emergency hospital transfer, in urgent need of lung transplantation

Lung transplantation may be Meng Meng's only hope.

Written by | Ling Jun

Source | "Medical Community" public account

On January 5, a full month had passed since Hebei girl Meng Meng was poisoned paraquat by her brother-in-law. She urgently needs a lung transplant.

"Jiupai News" reported that Meng Meng has been transferred from Hebei Provincial People's Hospital to the Eighth Medical Center of the General Hospital of the Chinese People's Liberation Army (formerly the 309th Hospital of the Chinese People's Liberation Army) and entered the ICU for follow-up treatment.

On the afternoon of the 3rd, Meng Meng's mother used her mobile phone to take a picture of her daughter's condition. Lying on the hospital bed, Meng Meng was pale and stuck an oxygen tube to maintain her breathing. It was difficult for her to express her physical condition in words, and she could only shake her head.

Highly toxic, lethal dose is only 5-15ml, no specific drug... But paraquat poisoning is not incurable either. At Qilu Hospital of Shandong University, which has the most experience in treating paraquat poisoning in the country, as of 2017, the cure rate of 2966 poisoned people admitted to the treatment was as high as 61.8%.

A patient who drank 100ml of paraquat was successfully treated, and Qilu Hospital concluded in "Successful Treatment of Patients with Paraquat Poisoning in Ultra-Lethal Doses":

Timely gastric lavage (1h), early blood purification (2-4h), timely administration of sufficient hormones, and supplemented by immunosuppressants and other drug therapy.

3 "just in time". A critical care medical doctor in a third-class hospital once told the "medical community" that meng meng poisoning was diagnosed nearly half a month later, and all the toxins that should be absorbed were absorbed, and gastric lavage, blood purification and other means were meaningless.

The target organ of paraquat is the lungs. The doctor said that liver, kidney and other damage are relatively reversible, only pulmonary fibrosis can not. "The lungs of poisoned patients are like 'loofah scoops', full of devastation, relying on life support systems to continue life, but as soon as the machine is withdrawn, many people will not be able to do it immediately."

Lung transplantation in patients with paraquat poisoning

"Unlike common lung transplants, paraquat poisoning patients are not operating on sooner rather than at this point in time." Xu Xin, chief physician of the Department of Thoracic Surgery and Organ Transplantation of the First Affiliated Hospital of Guangzhou Medical University, told the "medical community".

Since 2017, the First Affiliated Hospital of Guangzhou Medical University has successfully completed lung transplantation for 4 paraquat patients in succession, with an average lung replacement time of one month after poisoning, and the postoperative patients have recovered well. As a core member of the treatment team, Dr. Xu Xin introduced:

Paraquat also damages organs such as the liver and kidneys, and if these organs do not recover to a certain level, simply replacing the lungs has a high probability of failure;

Paraquat is metabolized slowly, and even if it is not in the blood, it will still exist in skeletal muscle, fat and other parts, and it needs to be reduced to a certain indicator before surgery.

Dr. Xu Xin told the "medical community" that if he decided to do lung transplantation, the degree of lung damage is not the most important clinical consideration, the key lies in whether the patient can survive the recovery period of other organs through various auxiliary treatments. "Taking the liver as an example, if the liver function is not restored before surgery, the coagulation function will be affected, and it is likely that the bleeding will continue during lung transplantation."

The article "Paraquat Lung Transplant Case and Literature Review" points out that due to the small number of cases, it is not suitable for statistical analysis, but the current situation is that as the number of transplant days increases, the survival time also increases proportionally.

Dr. Xu Xin said that because it is not clear about mengmeng's current clinical treatment, it is impossible to make an accurate judgment, but in general, paraquat patients undergo lung transplantation, and it is not the longer the better.

"Some patients have access to ECMO to maintain life, but ECMO can also affect coagulation function over time. At the same time, the longer the patient 'lies', the more severe the decline in various functions of the body, affecting the success rate of surgery and postoperative rehabilitation. ”

Even if a lung transplant is successful, residual paraquat in the body can affect the prognosis. In many of the reported successful cases of paraquat lung transplantation, a certain amount of paraquat can still be measured in patients until discharge.

"How long the residual toxin is metabolized, and how much the follow-up affects the patient's body, varies from person to person." Dr. Xu Xin said that for Meng Meng, the biggest "advantage" at present is age, young age, liver, kidney and other organs recover relatively fast, postoperative rehabilitation will be better.

"If you can successfully survive the lung transplant, there is still a lot of hope." Dr. Xu Xin said.

Due to the high cost of treatment, Meng Meng's family has launched fundraising online, and as of about 1 p.m. on the 4th, the water drop chip shows that it has raised more than 320,000 yuan.

In China, the average time to wait for a donor for a lung transplant is about 3 months, and it is hoped that Meng Meng can wait for the matching donor to appear as soon as possible.

Source: Medical community

Editor-in-charge: Zheng Huaju

Proofreader: Zang Hengjia

Plate making: Xue Jiao