Case Series: Forensic Analysis of Paraquat Poisoning Fatalities

Abstract

Paraquat, a highly toxic bipyridinium herbicide is also a leading cause of fatal poisoning in agricultural communities with more mortality rates exceeding around60%. This case series examines three fatal cases of paraquat poisoning in a tertiary care hospital in South India focusingonmainly the clinical presentations, biochemical profiles, toxicological confirmation, and also the histopathological findings. All cases presentedwith acute renal failure, hepatic dysfunction, and progressive pulmonaryfibrosis, confirmed through autopsy and HPE. Biochemical markers included elevated serum creatinine (2.8–4.5 mg/dL), liver enzymes (AST120–150 U/L, ALT 95–110 U/L), and metabolic acidosis (pH7.1–7.2). Histopathology revealed characteristic alveolar fibrosis, hepaticcentrilobular necrosis, and renal proximal tubular degeneration. Forensicanalysis highlighted the most importance of toxicological screeningandscene investigation to differentiate intentional from accidental ingestion. Inspite of aggressive interventions like hemodialysis all the cases resultedindeath within 3–5 days due to multi-organ failure. This study underscores some diagnostic challenges of paraquat poisoning and the absence of effective antidotes, and also the need for regulatory restrictions on paraquat access. Forensic medicine doctors play a critical role in documenting thesecases to inform public health strategies. Enhanced toxicological facilities and rapid diagnostic tools are very much essential in improvingtheoutcomes in resourcelimited settings.