The news that shocked me the most in 2021 really shocked me, that is, the brother-in-law's poisoning case. It wasn't a brother-in-law at all, it was a criminal. Whatever the purpose, poisoning and the most poisonous poison is heinous, but these legal issues I am not good at, do not analyze, let's talk about medicine.
The event went like this:
After drinking two cups of cold medicine handed by her brother-in-law, mengmeng, an 18-year-old girl, had serious symptoms of poisoning, and she recalled that the two cups of cold medicine were particularly difficult to drink at that time, and as soon as she entered the mouth, she vomited out, which was very irritating.
Not long after, Meng Meng had severe symptoms of poisoning, went to the hospital, the doctor treatment effect was not good, and did not know which doctor was so powerful, thought of the possibility of poisoning, and then a variety of investigations, and later found paraquat ingredients in the patient's urine, which was too scary. How could a good-looking person have the ingredient paraquat, a highly toxic herbicide, measured in the urine? Someone must have been poisoned.
It may be that Meng Meng recalled the two cups of cold medicine that her brother-in-law gave herself that were particularly difficult to enter, or there were other clues, anyway, after calling the police, the police quickly solved the case. The two so-called cold medicines were identified by the police as diluted paraquat, a highly toxic pesticide.
The suspect was arrested on suspicion of intentional homicide.
Poor Meng Meng, an 18-year-old flower girl, is dying at this moment.
1. Is paraquat poisoning certain to death?
It was confirmed that paraquat poisoning was equivalent to the death penalty in the eyes of many people, because many people on the Internet said that paraquat poisoning was inevitable, even if it was a small sip, it would be poisoned to death, and many patients were suffocated because of pulmonary fibrosis and so on.
In fact, paraquat poisoning, while terrible, is not certain to die.
Let's look at the book "Concord Emergency Medicine" published in China in 2010:
Putting aside the dosage to talk about medicinal properties or toxicity is not rigorous, so we say that paraquat poisoning is not static, drinking very little, there is still a chance of survival; drinking more, it is almost the Great Luo Immortal can not do it. The book Concord Emergency Medicine divides paraquat poisoning into three levels: mild, severe, critical, see no, no moderate, no moderate, no moderate.
Why is there no emphasis on neutrality? Because even mild paraquat poisoning can cause death, and why moderate, in addition to mild, the rest is severe and critical, which is to emphasize the dangers of paraquat.
The 2013 edition of the Expert Consensus on the Diagnosis and Treatment of Acute Paraquat Poisoning states that paraquat poisoning affects multiple organs, the lungs are the main target organs, lung lesions are the main cause of death, there is no effective detoxification drug, and the case fatality rate is as high as 50%-70%.
This is the most authoritative data we can see, with a mortality rate of 50%-70% for paraquat poisoning. Although the case fatality rate is extremely high, it is not 100%, and there is no so-called one-touch death. You can search on CNKI or Wanfang Database, there are many prognostic analysis studies of paraquat poisoning, and no one has a mortality rate of 100%.
The reason why everyone rumors that paraquat poisoning will undoubtedly die, the mortality rate is 100%, one is to hope to fear this herbicide, there is nothing not to drink it, even if the quarrel is not open for a while to try to scare each other, do not touch paraquat, because the mortality rate is too high. In addition, if you really accidentally drank a lot, then you are really dead. Because of this, paraquat is rumored to die when it is touched.
But as a popular science, we should still have a saying, be more rigorous, and speak with data.
Paraquat poisoning is not inevitable death, and the manufacturer in order to avoid human misdirection, in the production of paraquat deliberately made the taste very unpleasant, difficult to swallow, irritating, just like the news of meng meng, just drink immediately vomited, too difficult to drink, but even so, she still ingested a lot.
As long as a small amount is consumed, it may have reached a lethal amount (usually the amount of a bite has reached the lethal amount, many patients claim that although imported but swallowed, but the blood can still detect high concentrations of paraquat, even fatal), from this point of view, paraquat is really terrible, but it is not equivalent to staining and dying, can only say that it is very likely to die.
If you just can't think about it for a while, if you want to drink pesticides to scare your family, don't touch paraquat. This statement is true.
2. Paraquat poisoning, what will happen, how did the doctor solve the case?
In the news, Meng Meng's condition gradually worsened, and there was poor breathing, lack of oxygen, breath holding, very weak, and multi-organ dysfunction.
When I first saw this news, out of professional sensitivity, I was very curious about how the doctor found out that the patient was poisoned, and the doctor was a bit of a bully. Because patients come to the hospital with various symptoms, but there is no clear history of taking drugs, unlike those who commit suicide, the family will cry and say that they have drunk paraquat, and the diagnosis is particularly easy. And the Meng Meng in the news is poisoned by the brother-in-law, I estimate that the patient is a short period of time with multi-organ dysfunction, ordinary infections and so on can not be explained, can only consider poisoning.
High concentrations of paraquat are difficult to swallow because the irritation is very strong, the tongue and throat may burn, even if diluted are still very bad, just like in the news, the brother-in-law's paraquat is diluted, but it is still irritating and difficult to swallow, and it is extremely toxic.
Paraquat in addition to damage to the digestive tract, vomiting, abdominal pain, diarrhea, blood in the stool, hematemesis, etc., the most critical is to damage the lungs (the lungs will have a very high concentration of paraquat aggregation, is dozens of times in the blood), the lungs are paraquat poisoning is the most prominent and most serious changes, there will be chest pain, cyanosis, breathing difficulties, after taking the drug there is a relatively asymptomatic period, there may be a few days to feel bad, at this time the patient can still walk and talk and laugh, but after this stage, the lung condition gradually aggravates, the patient will have chest tightness, breath holding Then it worsened rapidly, ARDS appeared, pulmonary fibrosis, to put it in layman's terms, the lungs hardened, there was no way to inhale oxygen, and finally died of respiratory failure.
In addition to the symptoms of the digestive tract and respiratory tract, there will also be damage to the nervous system, heart, kidneys and other organs.
The attending physician can think of poisoning, and leave urine to find toxins, and can successfully find paraquat, or quite powerful. Now people look back and think it's nothing, but if you put you at that point in time, everything is unknown, and you know how hard it is to diagnose.
3. How to rescue paraquat?
We cite the most authoritative materials, Concordia Emergency Medicine, and the Expert Consensus on the Diagnosis and Treatment of Acute Paraquat Poisoning.
Paraquat poisoning has no specific effect and requires early and comprehensive management.
First: it is to immediately prevent the toxin from continuing to absorb, if it is drunk, it must be immediately induced, thorough gastric lavage as soon as possible, at home you can first cut the throat to induce vomiting, come to the emergency room to quickly wash the stomach. Then drainage, diuresis, all to speed up the elimination of toxins.
Second: serious immediately live in the ICU, while washing the stomach, as soon as possible blood perfusion, that is, the two can be carried out at the same time, do not wait for the gastric lavage to come back to perfusion, you can start at the same time. The so-called blood perfusion, the principle is very simple, is to inject, the patient's blood out, in vitro perfusion (a machine) after washing, and then the blood back into the body, the treatment process is a bit like hemodialysis, but the use of machine filter is not the same, the purpose is to wash out the toxins.
Third: use of glucocorticoids and immunosuppressants as early as possible. Because paraquat poisoning triggers intense inflammation that targets all organs, hormones and immune-suppressing drugs are critical.
There is a special noteworthy that when we rescue patients with respiratory failure, we usually give oxygen, but when paraquat poisoning patients have chest tightness and hypoxia symptoms, they do not routinely give oxygen (when I first saw this description, I was also blinded), generally do not advocate oxygen, why? Why is hypoxia not given oxygen therapy? Because paraquat poisoning can form a large number of oxygen radicals in the lungs, existing studies are worried that oxygen inhalation will aggravate paraquat toxicity, add poison to poison, and exacerbate lung damage, so it is recommended that paraquat poisoning be unconventional oxygen therapy.
No oxygen therapy does not mean that oxygen cannot be inhaled. If the patient is about to die of lack of oxygen, and if he does not inhale oxygen and die immediately, inhaling oxygen will increase the risk of death, how does the doctor choose? Needless to say, it must be oxygen. Therefore, the current guidelines recommend that oxygen should be considered unless the patient's partial pressure of blood oxygen is < 40 mmHg (normal 90-100 mmHg, < 60 is considered for respiratory failure), and it is to be inhaled at low concentrations. Very severe patients may require endotracheal intubation with ventilator-assisted ventilation, but studies have shown that ventilators do not increase survival, but only dying struggles.
But if patients have the opportunity to do lung transplantation, then ventilators are still helpful, and even use ECMO (artificial lungs), because these respiratory support techniques can prolong survival, to put it in layman's terms, it is to continue life and wait for lung transplantation.
In the news, Meng Meng had a lung transplant because of severe respiratory failure.
4. Can a lung transplant be done once and for all?
For people with paraquat poisoning, when their lungs are no longer working, the only way to do that is to transplant them. Meng Meng lung transplant surgery is Professor Chen Jingyu (the first person in China' lung transplantation) to do in Beijing, because the lung source is in Beijing, Professor Chen in Zhejiang, overnight flew to Beijing to do surgery, did a double lung transplant.
The operation went well, and the news said that Meng Meng was awake and took pictures.
But there are still three major problems to face after lung transplantation:
First, paraquat poisoning not only damages the lungs, but also damages other organs, as we said earlier, most patients die because their lungs fail, but they may also die because of other organ failure, such as kidney failure, liver failure, heavy bleeding, etc. Severe liver failure and kidney failure are also difficult to deal with. Now we can only expect that in addition to the other organs can be better controlled, otherwise the kidneys are broken or the liver is broken, which is also more troublesome.
However, we estimate that since the patient has even obtained the source of the lung, through the vigorous reporting of the news, everyone focuses on it, the patient can get good medical resources, and everyone is desperately trying to save her, hoping to go smoothly.
Second, take anti-rejection drugs after lung transplantation. After all, the lungs are not our own, it is someone else's, take it and use it will definitely produce a reaction, this is the immune rejection reaction, if there is no anti-rejection treatment, in a short period of time, the new lungs will be attacked by their own immune system to the holes, don't blame our immune system, they are the most loyal guards in our body.
But sometimes the reaction of loyal defenders is not what we want, so we have to suppress this group of loyal guards who overreact, that is, to take anti-rejection drugs. Even then, new lungs don't necessarily adapt well to the body, in other words, patients don't necessarily survive. The data show that the global survival rates of 3 months, 1 year, 3 years and 5 years after lung transplantation are 89%, 80%, 65% and 54%, respectively, and only half of people can survive for 5 years.
Third, after taking anti-rejection drugs, the immune system is suppressed and may face infection problems such as bacteria and viruses. This is difficult to avoid, after all, we ourselves have suppressed our own troops (guards) by force, and we have not even fired guns at the troops, for fear of rebellion. However, in this way, if there is a foreign invasion, the response of the troops will be slow, and the combat effectiveness will be greatly reduced.
The immune system is more or less suppressed, which also affects the subsequent survival of the patient.
I hope the patient can go well.
5. Is there a way out for paraquat?
Nothing more. Paraquat has been banned from sale.
Paraquat is a herbicide that is very powerful, and it is very good to use it to weed, but many people misuse it to kill themselves (many times suicide is just a momentary impulse, and it is too late to regret it), or poisoning, a herbicide at the good end, is hard to drink and can not be sold. It's also a bit sad to say.
Since 2016, the Ministry of Agriculture has announced the cessation of the domestic sale and use of paraquat water agents. On 29 June 2017, the Ministry of Agriculture issued a response to Recommendation No. 3326 of the Fifth Session of the Twelfth National People's Congress, which mentioned that the registration of paraquat products would no longer be approved.
On September 25, 2020, the General Office of the Ministry of Agriculture and Rural Affairs issued the Notice on Effectively Strengthening the Special Rectification of Paraquat.
However, according to news reports, on April 10, 2019, 1.8 tons of paraquat were seized in Guizhou, disguised as "enemy grass fast" and sold. See? Paraquat is banned on the surface, but because paraquat works too well, you may not be effective with other herbicides, customers do not like to buy, the manufacturer may add paraquat into it, but the name is changed, hanging sheep's head to sell dog meat. This is also quite dangerous, when some people commit suicide, thinking that drinking enemy grass is fast, but in fact drinking paraquat.
There is also a frightening thing, on October 16, 2021, the female anchor "Luo Kitten cat" was coaxed by netizens during the live broadcast, drank paraquat and committed suicide, and finally died in vain.
Stricter measures are needed to manage paraquat, and science popularization should be further strengthened.