Indian Society of Critical Care Medicine Position Statement on the Management of Paraquat Poisoning

Paraquat poisoning is among the most lethal toxicological emergencies encountered globally. It is associated with case fatality rates up to 50-90%. There is no specific antidote for paraquat poisoning. India faces a growing burden of paraquat poisoning, compounded by easy accessibility, widespread under-reporting and limited timely access to extracorporeal therapies. Against this backdrop, the Indian Society of Critical Care Medicine (ISCCM) Toxicology working section convened an expert panel of 15 specialists to develop evidence-informed recommendations through a modified Delphi consensus process. Panelists rated 32 clinical statements across three iterative rounds on a five-point Likert scale. The results were presented online to the core group and Delphi panelists after the first Delphi round for discussion and to refine questions based on the suggestions received from the panelists. Consensus (≥70% agreement) was reached on 31 statements; the remaining one was designated as non-convergent. Stability of responses was checked for each statement in sequential rounds. This position statement addresses commonly faced questions by physicians such as gastrointestinal decontamination, diagnostic evaluation including the urine dithionite test and plasma paraquat assay, imaging strategies for pulmonary prognostication, the role of charcoal hemoperfusion and renal replacement therapy, immunosuppressive pulse therapy with methylprednisolone and cyclophosphamide, oxygen restriction and permissive hypoxemia strategy, antioxidant interventions, organ support, lung transplantation bridged with extracorporeal membrane oxygenation (ECMO), and prognostic determinants of mortality. How to cite this article: . Indian Society of Critical Care Medicine Position Statement on the Management of Paraquat Poisoning. Indian J Crit Care Med 2026;30(8):632-649.