Indian journal of critical care medicine : peer-reviewed, official publication of Indian Society of Critical Care Medicine
August 20, 2026 · via Europe PMC
Indian Society of Critical Care Medicine Position Statement on the Management of Paraquat Poisoning.
Gautam PL, Takkellapati LR, Bhalla A, +23 more, Tyagi R.
AI summary — for doctors, generated from the abstract only
This is an expert consensus position statement, not an original research study; the Indian Society of Critical Care Medicine convened 15 specialists who reached agreement on 31 of 32 clinical statements addressing diagnosis, decontamination, and management of paraquat poisoning, a toxicological emergency with case fatality rates of 50-90%.
What was studied
Not applicable: this is a position statement developed by the Indian Society of Critical Care Medicine's Toxicology working section using a modified Delphi consensus process, in which 15 expert panelists rated 32 clinical statements on paraquat poisoning management across three iterative rounds, rather than a study collecting new patient data.
Key findings
- Consensus (defined as 70% or more agreement) was reached on 31 of the 32 clinical statements, with one statement designated as non-convergent after three Delphi rounds.
- The statement addresses gastrointestinal decontamination, diagnostic tools (urine dithionite test, plasma paraquat assay), imaging for pulmonary prognostication, charcoal hemoperfusion and renal replacement therapy, immunosuppressive pulse therapy (methylprednisolone and cyclophosphamide), oxygen restriction/permissive hypoxemia strategy, antioxidant interventions, and lung transplantation bridged with ECMO.
- The document notes paraquat poisoning has no specific antidote and that India faces a growing burden of cases, compounded by easy accessibility, under-reporting, and limited access to extracorporeal therapies.
Clinical relevance
This may be directly relevant to physicians in India and similar settings managing paraquat poisoning, providing expert-consensus guidance on commonly faced clinical questions where high-quality randomized trial evidence is often lacking; as a consensus statement, its recommendations reflect expert judgment rather than new experimental data.
Who should care
Limitations
This is a Delphi consensus statement reflecting expert opinion rather than a systematic review or clinical trial, so its recommendations are only as strong as the panel's collective judgment and the quality of the underlying (often limited) evidence base for paraquat poisoning management; one of the 32 statements did not reach consensus.
A panel of Indian critical care toxicology experts reached consensus on 31 of 32 recommendations for managing the highly lethal condition of paraquat poisoning, given the lack of a specific antidote and limited high-quality evidence.
This is an AI-generated summary of the published abstract, not a clinical recommendation. It may not reflect the full text or subsequent updates — verify against the original source before acting on it.
Abstract
Paraquat poisoning is among the most lethal toxicological emergencies encountered globally. It is associated with case fatality rates up to 50-90%. There is no specific antidote for paraquat poisoning. India faces a growing burden of paraquat poisoning, compounded by easy accessibility, widespread under-reporting and limited timely access to extracorporeal therapies. Against this backdrop, the Indian Society of Critical Care Medicine (ISCCM) Toxicology working section convened an expert panel of 15 specialists to develop evidence-informed recommendations through a modified Delphi consensus process. Panelists rated 32 clinical statements across three iterative rounds on a five-point Likert scale. The results were presented online to the core group and Delphi panelists after the first Delphi round for discussion and to refine questions based on the suggestions received from the panelists. Consensus (≥70% agreement) was reached on 31 statements; the remaining one was designated as non-convergent. Stability of responses was checked for each statement in sequential rounds. This position statement addresses commonly faced questions by physicians such as gastrointestinal decontamination, diagnostic evaluation including the urine dithionite test and plasma paraquat assay, imaging strategies for pulmonary prognostication, the role of charcoal hemoperfusion and renal replacement therapy, immunosuppressive pulse therapy with methylprednisolone and cyclophosphamide, oxygen restriction and permissive hypoxemia strategy, antioxidant interventions, organ support, lung transplantation bridged with extracorporeal membrane oxygenation (ECMO), and prognostic determinants of mortality.
How to cite this article
Gautam PL, Takkellapati LR, Bhalla A, Peter JV, Mahajan RK, Krishna MR, et al. Indian Society of Critical Care Medicine Position Statement on the Management of Paraquat Poisoning. Indian J Crit Care Med 2026;30(8):632-649.
DOI
10.5005/jp-journals-10071-25250
PMID
42756941
PMCID
PMC13585111
Research metadata (titles, abstracts, authors, publication dates) is sourced from Europe PMC, which aggregates content from PubMed/MEDLINE, PubMed Central, and other providers under the U.S. National Library of Medicine (NLM/NCBI). NLM does not claim copyright on abstracts; the original journal publishers or authors may hold rights to the full articles. AI-generated summaries are derived only from the abstract, never the full text, and are always labeled as AI-generated.
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