Management of paraquat poisoning in an adolescent with progressive acute kidney injury: a case report

Introduction and importance: Paraquat is a highly toxic herbicide commonly used in low- and middle-income countries. Ingestion, even in small amounts, can lead to multiorgan failure, with acute kidney injury being a common and often fatal complication. Although paraquat poisoning is more frequently reported in adults, adolescent cases are underreported. Case presentation: We report the case of a 15-year female who presented with intentional ingestion of paraquat. Initial symptoms included throat pain and irritability. Laboratory investigations revealed rapidly worsening renal function within 24 hours of ingestion. The patient was managed with supportive therapy including fluid resuscitation guided by point-of-care ultrasound. Intravenous antioxidants, N-acetylcysteine, corticosteroids, and furosemide were given. Due to persistent anuria and rising creatinine levels, hemodialysis was initiated. Clinical Discussion: Serum creatinine increased from 0.5 to 9.9 mg/dL over five days. Despite initial transient improvement, she required two sessions of hemodialysis. Following the second session, her urine output improved significantly, exceeding 2 liters/day, and her serum creatinine decreased steadily. She was discharged in stable condition with ongoing improvement in renal function. No respiratory failure was observed, and corticosteroid therapy may have contributed to this outcome. Conclusion: This case underscores the severe nephrotoxicity associated with paraquat poisoning and the potential for renal recovery with timely, supportive interventions, even in adolescents. Early use of adjunctive therapies and hemodialysis, although not curative for paraquat toxicity, plays a critical role in managing complications of AKI. Point-of-care tools and a multidisciplinary approach, including psychiatric support, are essential in optimizing outcomes in such poisoning cases.