Drinking paraquat will definitely lead to death? Ningbo man escaped by luck! What did he experience in the past 28 days?

"This is already the lethal dose of paraquat for adults. Family members should be mentally prepared!" This was the first reaction of all medical staff, including Deputy Chief Physician Du Liwen of the Emergency Department of Ningbo Second Hospital. The patient in front of them, Xiao Zhang (a pseudonym), drank a large sip of the "water of death" paraquat kept at home 5 hours before being sent to the emergency room.

So far, there is no specific antidote for paraquat. Taking it is a nightmare for patients and their families, and a huge test for the medical team.

But 28 days later, a miracle happened.

After the strenuous treatment of the emergency department team of Ningbo Second Hospital, Xiao Zhang has been successfully discharged from Ningbo Second Hospital.

In this tug-of-war for life, how did Xiao Zhang escape by chance? How did the medical staff try their best to treat him?

Man vomits after drinking paraquat

Urine is all black

One night in mid-September, an ambulance roared into the emergency department of Ningbo Second Hospital, and a young man was carried out of the car. He was Xiao Zhang. At that time, he couldn't stop vomiting, and the dark green vomit looked creepy .

As soon as the family member spoke, the emergency doctor on duty was shocked, "He drank a big mouthful of paraquat and has had his stomach washed once." The doctor on duty immediately contacted Deputy Chief Physician Du Liwen, who focused on poisoning research. In 2022, he went to the Poisoning Department of Qilu Hospital of Shandong University, the largest paraquat treatment center in the country, for further training.

The key to treating paraquat poisoning is to remove the poison in time. A "tough battle" began. Du Liwen instructed the emergency team to immediately use bedside urine rapid semi-quantitative testing for paraquat concentration. When they saw the urine turn black instantly after encountering the reagent , all the doctors couldn't help but gasp. " The darker the color, the higher the paraquat concentration in the body ." Du Liwen said that the subsequent mass spectrometry results of the laboratory also showed that Xiao Zhang's paraquat content was greater than 100ug/ml, far exceeding the lethal dose.

The mainstream method for treating paraquat poisoning is the "Taishan Expert Consensus" on the diagnosis and treatment of paraquat poisoning (referred to as "Taishan Consensus"). The emergency team acted decisively and methodically adopted the "white + black" plan of Taishan Consensus to perform repeated full gastrointestinal lavage and treatment.

"The 'white plus black' plan uses montmorillonite powder plus medicinal activated carbon powder to absorb paraquat in the body, and performs hemoperfusion to remove paraquat from the plasma. The earlier it is used, the higher the survival rate." Du Liwen recalled that at 11 p.m. that night, 2 a.m. the next morning, 5 a.m., and 7 a.m., Xiao Zhang received four uninterrupted hemoperfusions, which was equivalent to the blood in his body being "washed" several times.

The next morning, the emergency team was delighted to find that Xiao Zhang's semi-quantitative urine test gradually became clear.

Transferred to the general ward one week later

The doctor hinted to the family that the patient was "still in danger"

Although the paraquat concentration in Xiao Zhang's body has decreased after a night of "detoxification", the challenge has just begun.

Starting from the second day, the paraquat inflammatory storm "arrived as expected", and Xiao Zhang gradually suffered damage to multiple organs such as kidneys and liver. "Liver and kidney function indicators, including creatinine, urea nitrogen, and transaminase, all rose rapidly. The most difficult thing was that Xiao Zhang also felt chest tightness and shortness of breath, which was a manifestation of acute lung injury after taking paraquat."

"White + Black" plan for repeated lavage of the entire stomach

Du Liwen explained that lung damage caused by paraquat poisoning is its most prominent manifestation. In the early stages of poisoning, the symptoms of lung damage may not be obvious, but with the occurrence of pulmonary fibrosis after lung damage, patients will experience progressively worsening breathing difficulties, and in severe cases, die from respiratory failure.

The difficulty in treating paraquat is that almost all targeted treatment methods are "double-edged swords." Du Liwen took the immunosuppressants and hormones needed to prevent pulmonary fibrosis as an example, "They are the 'ace drugs' for treating various acute organ failures, but they have significant side effects. When should they be used? How long should they be used? It's different for each person and each stage."

After careful discussion, Lv Weixing and Du Liwen from the poisoning subspecialty team of the emergency department decided to boldly use hormones and immunosuppressants to alleviate the inflammatory storm caused by the poison. "At that time, we increased the dosage and adjusted it in time according to the condition and key organs."

Every day since then, Xiao Zhang has become the "key focus" of the poisoning team: they closely monitor him every day, adjust the treatment plan in a timely manner, and at the same time comfort Xiao Zhang's emotions.

Medical staff operating the blood perfusion machine

A week later, Xiao Zhang's kidney function was preserved and his liver function gradually recovered. The day after Xiao Zhang was transferred to the general ward, his family secretly contacted Du Liwen and said, "Doctor Du, we searched online on our mobile phones and found many cases of paraquat poisoning, and the results were not good. We transferred him to the general ward in just one week. Is he out of danger?" Facing the concerned eyes of his family, Du Liwen could only hint that Xiao Zhang was still in the "dangerous period". "Before 14 days, if someone asked what the chances of surviving paraquat poisoning were, there was no answer."

Du Liwen is not exaggerating. " Clinically, patients who are judged to be curable may gradually get better after half a month . There are also a few who cannot get better after 21 days."

Fortunately, after surviving the critical period, Xiao Zhang's condition gradually improved.

After 28 days of hard work, Xiao Zhang's poisoning was effectively controlled and he was truly "reborn". "He is very lucky. His liver and kidney functions have returned to normal. His lungs only showed slight fibrosis and he has basically no symptoms. He has just been discharged from the hospital and will be followed up in the future."

Take precautions

Stay away from paraquat poisoning

Du Liwen has been a doctor for 13 years and has seen all kinds of patients in the emergency room, but he still has lingering fears about patients who drink large doses of paraquat. Until now, he still remembers a 14-year-old girl he treated a few years ago. After drinking a large amount of paraquat, she watched helplessly as she waited for death in despair.

"The successful treatment this time achieved a breakthrough in the treatment of paraquat poisoning at Ningbo Second Hospital, which gave us a great sense of accomplishment." Du Liwen said that the result was the joint efforts of the emergency poisoning sub-specialty and even the multidisciplinary team of the entire hospital. For example, the emergency blood purification team provided 24-hour, all-weather, multi-means blood purification technology, such as mass spectrometry and semi-quantitative testing to provide rapid and accurate diagnosis and efficacy evaluation, and the support of multidisciplinary teams such as testing and psychology.

Du Liwen said that paraquat poisoning patients like Xiao Zhang who were successfully rescued are after all very few. In daily life, everyone should do a good job in prevention and education to avoid the occurrence of poisoning incidents .