Citation

Mehta AM, Bakkannavar SM, Nayak D. Rom. J. Leg. Med. 2023; 31(1): 71-75.

Copyright

(Copyright © 2023, Romanian Legal Medicine Society)

DOI

10.4323/rjlm.2023.71

PMID

unavailable

Abstract

Background. Despite the high incidence of paraquat poisoning in developing countries such as India, there is limited literature describing its hepatic implications. Thus, this case report aims at bridging the gap in the knowledge of the hepatic effects of paraquat consumption.

OBJECTIVE. To elucidate a rare case of acute cholestatic hepatitis following paraquat consumption. Case History. A 65-year-old male, who allegedly consumed pesticide secondary to depression, was brought to local Hospital from where he was shifted to tertiary care teaching hospital in South India for further treatment. He died two days later while under treatment. Postmortem examination revealed diffuse visceral congestion. Internal examination of the gastrointestinal tract revealed congestion of the esophageal mucosa and 30 ml of creamy mucoid fluid with no identifiable food particles and no abnormal perceptible odor in the stomach and proximal small intestine. Post-mortem toxicologic studies revealed serum creatinine of 1.36 mg/dL, serum sodium of 132 mmol/L, total bilirubin of 1.48 mg/dL and direct bilirubin of 0.50 mg/dL. Urine sample tested positive for paraquat. The cause of death from perusal of autopsy findings, hospital findings and histopathology report and RFSL report was attributed to complications secondary to the oral consumption of paraquat and the manner of death was certified as suicide (intentional self-harm).

CONCLUSION. Histopathological studies are paramount in the diagnosis of hepatitis secondary to paraquat consumption. Such an unusual case is one of the first of its kind reported in the Indian scenario, to the best of our knowledge. Further studies are needed to elucidate the mechanisms and types of hepatic injuries caused by paraquat ingestion. © 2023 Romanian Society of Legal Medicine.

Language: en

Keywords

human; suicide; male; aged; resuscitation; forensic autopsy; autopsy; case report; depression; cause of death; paraquat; vomiting; clinical article; human tissue; intensive care unit; noradrenalin; brain edema; hypotension; heart arrest; atropine; thin layer chromatography; acetylcysteine; bicarbonate; Glasgow coma scale; chemical analysis; sodium; creatinine; metabolic acidosis; electrocardiography; respiratory arrest; histopathology; ST segment depression; inotropic agent; vasopressin; kidney injury; Article; blood gas analysis; hemoperfusion; intubation; paraquat poisoning; urine volume; acute hepatitis; hyperemia; return of spontaneous circulation; epinephrine; methylprednisolone sodium succinate; volume controlled ventilation