- Title
- Improvement in survival after paraquat ingestion following introduction of a new formulation in Sri Lanka
- Creator
- Wilks, Martin F.; Fernando, Ravindra; Ariyananda, P. L.; Eddleston, Michael; Berry, David J.; Tomenson, John A.; Buckley, Nicholas A.; Jayamanne, Shaluka; Gunnell, David; Dawson, Andrew
- Relation
- PLoS Medicine Vol. 5, Issue 2, p. 0250-0259
- Publisher Link
- http://dx.doi.org/10.1371/journal.pmed.0050049
- Publisher
- Public Library of Science
- Resource Type
- journal article
- Date
- 2008
- Description
- Background: Pesticide ingestion is a common method of self-harm in the rural developing world. In an attempt to reduce the high case fatality seen with the herbicide paraquat, a novel formulation (INTEON) has been developed containing an increased emetic concentration, a purgative, and an alginate that forms a gel under the acid conditions of the stomach, potentially slowing the absorption of paraquat and giving the emetic more time to be effective. We compared the outcome of paraquat self-poisoning with the standard formulation against the new INTEON formulation following its introduction into Sri Lanka. Methods and Findings: Clinical data were prospectively collected on 586 patients with paraquat ingestion presenting to nine large hospitals across Sri Lanka with survival to 3 mo as the primary outcome. The identity of the formulation ingested after October 2004 was confirmed by assay of blood or urine samples for a marker compound present in INTEON. The proportion of known survivors increased from 76/297 with the standard formulation to 103/289 with INTEON ingestion, and estimated 3-mo survival improved from 27.1% to 36.7% (difference 9.5%; 95% confidence interval [CI] 2.0%–17.1%; p = 0.002, log rank test). Cox proportional hazards regression analyses showed an approximately 2-fold reduction in toxicity for INTEON compared to standard formulation. A higher proportion of patients ingesting INTEON vomited within 15 min (38% with the original formulation to 55% with INTEON, p ≺ 0.001). Median survival time increased from 2.3 d (95% CI 1.2–3.4 d) with the standard formulation to 6.9 d (95% CI 3.3–10.7 d) with INTEON ingestion (p = 0.002, log rank test); however, in patients who did not survive there was a comparatively smaller increase in median time to death from 0.9 d (interquartile range [IQR] 0.5–3.4) to 1.5 d (IQR 0.5–5.5); p = 0.02. Conclusions: The survey has shown that INTEON technology significantly reduces the mortality of patients following paraquat ingestion and increases survival time, most likely by reducing absorption.
- Subject
- paraquat; INTEON technology; formulation technology; self-poisoning
- Identifier
- http://hdl.handle.net/1959.13/39614
- Identifier
- uon:4457
- Identifier
- ISSN:1549-1277
- Language
- eng
- Full Text
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