The level and clinical significance of pancreatic enzymes in survivors of acute paraquat poisoning

INTRODUCTION: Acute paraquat poisoning is often fatal. When ingested, paraquat affects multiple organs including the lung, gastrointestinal tract, pancreas, kidney, heart, and central nervous system. Our center previously found that initial pancreatic function was related to the prognosis of patients with acute paraquat poisoning. However, pancreatic injury after paraquat intoxication has been incompletely studied.

METHODS: This study analyzed the clinical outcome and extent of pancreatic injury in 34 survivors of acute paraquat poisoning. Paraquat exposure was assessed based on a quantitative measure of the plasma level of paraquat by high-performance liquid chromatography. The subsequent variations in the level of pancreatic enzymes, clinical symptoms, and abdominal computed tomography were obtained. Outcomes after acute paraquat poisoning were categorized as pancreatic enzyme elevation group (elevation group: amylase >160 IU/L and lipase >100 IU/L) and nonelevation group.

RESULTS: Pancreatic enzyme elevations occurred in seven cases (20.6%), and the level of pancreatic enzymes peaked at day 7. The elevation in pancreatic enzymes after paraquat ingestion was positively correlated with the plasma paraquat level (p < 0.05 at days 4 and 7). Creatinine was higher in the elevation group. Abdominal computed tomography of the seven cases showed no evidence of pancreatitis, and significant abdominal pain was not observed.

DISCUSSION: Pancreatic enzyme elevation reflects the systemic toxicity and multiorgan involvement following acute paraquat poisoning. CONCLUSIONS: Pancreatic injury was subtle and the elevation of pancreatic enzymes in survivors is clinically benign.

Gil HW, Yang JO, Lee EY, Hong SY.
Department of Internal Medicine, Cheonan Hospital, Soonchunhyang University, Cheonan, Republic of Korea

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