Paraquat Poisoning: A Contemporary Review

Paraquat poisoning remains a major public health problem worldwide due to its high lethality, absence of a specific antidote, and rapid progression toward multiorgan failure. Paraquat is a widely used bipyridyl herbicide whose toxicity is primarily mediated by massive oxidative stress, preferential pulmonary accumulation, and subsequent development of acute lung injury followed by extensive pulmonary fibrosis. Small ingested volumes are sufficient to cause severe systemic damage, and mortality rates remain extremely high despite aggressive supportive care. Current management strategies focus on early decontamination, supportive therapy, and various extracorporeal or pharmacological interventions, although evidence supporting their effectiveness remains limited and inconsistent. This review provides an updated synthesis of the epidemiology, pathophysiological mechanisms, clinical manifestations, prognostic factors, and current therapeutic approaches in acute paraquat poisoning, highlighting recent advances and persistent controversies in its management.