A potential role for keratinocyte growth factor and clarithromycin in the treatment of paraquat overdose

A 25-year-old male was admitted to the Accident and Emergency department with a history of a deliberate ingestion of 150–200 ml of 20% Gramaxone (paraquat) solution. Patient’s written informed consent was obtained on admission. Initial qualitative testing of vomitus and urine were strongly positive for paraquat. Activated charcoal therapy was commenced and initial arterial blood gas analysis showed pH 7.30, PaO2 12 kPa, PaCO2 5.0 kPa and base excess −3.9. Paraquat levels were 1.4 µg/ml at 4.5-h post-ingestion and 0.3 µg/ml at 16 h. These levels confirmed that a potentially lethal dose of paraquat had been consumed.1 The patient’s renal function began to deteriorate and he was transferred to the intensive care unit and commenced on continuous renal replacement therapy. The following intravenous treatment regimes were initiated: ascorbic acid 1 g every 6 h; n -acetylycysteine 1200 mg daily; methylprednisolone 1 g daily for 3 days and dexamethasone 8 mg every 8 h.2,3 On day 2 of admission to intensive care, intravenous cyclophosphamide 1 g daily for 2 days and α-tocopherol (vitamin E) were added.2,3 Unfortunately, despite these interventions, the patient’s condition …