Paraquat Toxicity in Humans: Advances in Diagnosis, Management and Prevention

Background: Paraquat, a widely used herbicide, remains one of the most lethal pesticides for humans due to its high toxicity and lack of a definitive antidote. Ingestion, even in small amounts, often leads to multi-organ failure and death, particularly in resource-limited settings.

Objective: Objectives of this review was updated synthesis of the current understanding of paraquat toxicity, with a focus on recent advances in diagnosis, therapeutic management, and preventive strategies.

Methods: Relevant literature was retrieved through a comprehensive search of PubMed, Scopus, and Google Scholar databases using terms such as “paraquat poisoning,” “diagnosis,” “treatment,” and “prevention.” Articles published from 2000 to 2025 were considered, with emphasis on clinical trials, observational studies, and recent guidelines. As there were limited publications about paraquat poisoning, we took some articles published before 2000.

Results: Early diagnosis using plasma or urine paraquat levels, supported by prognostic tools such as the Proudfoot and Hart nomograms, improves clinical decision-making. Management strategies now include aggressive decontamination, immunosuppressive therapy (e.g., cyclophosphamide, corticosteroids), antioxidants (e.g., N-acetylcysteine), and early hemodialysis in selected cases. However, outcomes remain poor in severe cases. Recent public health efforts have focused on restricting paraquat use, improving labeling, and enhancing community awareness to prevent intentional and accidental exposure.

Conclusion: While advances in diagnostic and treatment modalities offer some hope in managing paraquat poisoning, prevention remains the most effective strategy. Continued research, policy regulation, and education are crucial to reducing the global burden of paraquat-related morbidity and mortality.