Survival after massive intentional overdose of paraquat

To the Editor: Survival following oral ingestion of a large volume of paraquat is rare. Our patient ingested approximately 200 ml of paraquat and survived, following aggressive intervention. He developed oral pharyngeal ulceration, acute lung injury, haematemesis, haemoptysis and renal failure. He was treated with a combination of pulse methylprednisolone, vitamins C and E, and N-acetylcysteine. We propose a rationale for high-dose antioxidant treatment in addition to corticosteroids and intensive care.