Treatment of Paraquat Poisoning with the Membrane Oxygenator

SUMMARY A fatal case of progressive pulmonary fibrosis in a 13­ year-old boy, due to poisoning by the weed-killer para­ quat, is described. Attempted treatments included extra­ corporeal circulation. The management is discussed in the light of the histological observations, and the pathophy­ siology of the condition. S. Afr. med. J., 51, 203 (1977). Paraquat (1,1 '-dimethyl-4,4'- bipyriHium chloride) is a herbi­ cide which is used throughout the world.'-' It is marketed commercially as a 20% concentrate (Gramoxone), a reddish-brown liquid. Cases of paraquat poisoning have been widely reported and over 200 deaths have occurred after accidental or intentional ingestion of the chemical. The lethal dose is not known, but ingestion of very small amounts, estimated at 15 - 20 ml paraquat, has caused death. We recently treated a patient with paraquat poison­ ing. To our knowledge, this is the first case of paraquat poisoning to be reported in South Africa. This herbicide is readily available to the farming community. We believe the extremely severe toxicity of this substance has not been appreciated in South Africa.