Lethal diquat poisoning manifesting as central pontine myelinolysis and acute kidney injury: A case report and literature review

Jihong Xing, Zhe Chu, Dongfeng Han, Xiaoming Jiang, Xiuxian Zang, Yajie Liu, Song Gao, Lichao Sun, Jihong Xing, Zhe Chu, Dongfeng Han, Xiaoming Jiang, Xiuxian Zang, Yajie Liu, Song Gao, Lichao Sun

Abstract

Diquat is a nonselective herbicide that is used as a contact and preharvest desiccant to control terrestrial and aquatic vegetation. Increasing numbers of cases of diquat poisoning have recently been reported. Organs commonly affected by diquat poisoning include the kidney, liver, and lung. Neurological involvement of diquat poisoning is relatively rare. A 21-year-old man ingested 100 mL of diquat (20 g/100 mL) 5 hours before admission. Fifteen minutes after ingestion, he developed nausea and vomiting. The patient was sent to the emergency intensive care unit, and gastric lavage was performed. Continuous renal replacement therapy and continuous venovenous hemodiafiltration with hemoperfusion were performed, and methylprednisolone was administered. Five days after admission, the patient developed disturbance of consciousness and positive bilateral Babinski signs. Head computed tomography demonstrated hypodensity in the pons. At 11 days after admission, brain magnetic resonance imaging showed acute pontine demyelination. At 15 days after admission, the patient died of multiple organ dysfunction syndrome. We encountered a case of diquat poisoning with central pontine myelinolysis and acute kidney injury. This case highlights the clinical value of neuroimaging examination for early diagnosis of central pontine myelinolysis.

Keywords: Diquat poisoning; acute kidney injury; central pontine myelinolysis; consciousness disorder; multiple organ dysfunction; neuroimaging.

Figures

Figure 1.
Figure 1.
Brain magnetic resonance imaging. Brain magnetic resonance imaging showed a pontine lesion, which appeared hyperintense on (a) T2-weighted imaging and (b) fluid-attenuated inversion-recovery imaging. The lesion showed heterogeneous intensities on (c) diffusion-weighted imaging and (d) apparent diffusion coefficient imaging.

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