ROLE OF SERIAL HEMOPERFUSION IN PARAQUAT POISONING

Paraquat remains one of the most lethal herbicides in use today, with ingestion, whether accidental or intentional, often resulting in multiorgan failure and mortality. Amongst the organ systems affected, the lungs and kidneys are particularly vulnerable due to paraquat's selective uptake and oxidative stress-induced injury. Despite advances in critical care, treatment options for paraquat poisoning remain limited and supportive. Hemoperfusion has long been explored as a method for toxin removal in paraquat poisoning, but its clinical effectiveness has been variable. The HA230 hemoperfusion cartridge, a resin-based adsorptive filter, offers a novel approach due to its dual ability to adsorb circulating toxins and pro-inflammatory cytokines. Recent literature suggests that early and serial hemoperfusion may reduce systemic toxicity and improve outcomes in paraquat poisoning. The presence of paraquat toxicity was confirmed using urine sodium dithionite, and was repeated after every session of hemoperfusion to look for clearance. In this article, we present four consecutive cases of paraquat poisoning managed at our center with serial hemoperfusion using the HA230 cartridge. We describe the clinical course, timing of intervention, biochemical trends, and patient outcomes while reviewing the rationale for this emerging therapeutic modality. We aim to contribute real-world clinical data to the evolving understanding of hemoperfusion in the treatment of paraquat toxicity.