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POISON & DRUGPOISON & DRUGPOISON & DRUGPOISON & DRUGPOISON & DRUG

INFORMATION BULLETININFORMATION BULLETININFORMATION BULLETININFORMATION BULLETININFORMATION BULLETIN

April-June 2005 Vol.13, No.2

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ÀÒÇÐà»ç¹¾Ôɨҡ Paraquat.... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .ÀÒÇÐà»ç¹¾Ôɨҡ Paraquat.... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .ÀÒÇÐà»ç¹¾Ôɨҡ Paraquat.... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .ÀÒÇÐà»ç¹¾Ôɨҡ Paraquat.... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .ÀÒÇÐà»ç¹¾Ôɨҡ Paraquat.... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1717171717

To⌧Case Conference.... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .To⌧Case Conference.... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .To⌧Case Conference.... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .To⌧Case Conference.... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .To⌧Case Conference.... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2020202020

Paraquat poisoning

¼ÅÔµÀѳ±ì·⌫ è㪠é㹺éÒ¹àÃ×͹.... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .¼ÅÔµÀѳ±ì·⌫ è㪠é㹺éÒ¹àÃ×͹.... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .¼ÅÔµÀѳ±ì·⌫ è㪠é㹺éÒ¹àÃ×͹.... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .¼ÅÔµÀѳ±ì·⌫ è㪠é㹺éÒ¹àÃ×͹.... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .¼ÅÔµÀѳ±ì·⌫ è㪠é㹺éÒ¹àÃ×͹.... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2323232323

¼ÅÔµÀѳ±ìÊÓËÃѺàÊé¹¼Á

page P&D Information Bulletin / Vol. 13, No. 2, 2005

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â·ÃÊÒÃ :â·ÃÊÒÃ :â·ÃÊÒÃ :â·ÃÊÒÃ :â·ÃÊÒÃ : 0-2201-1084

Email :Email :Email :Email :Email : poisrequest@hotmail.com

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Tetrahydrocannabinol (THC)

Cannabis

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ture labor, abruption placenta Êèǹ·ÒáÍÒ¨¨ÐÁÕ¢¹Ò´áÅйéÓ˹ѡµÑǹéÍ ·Ñé§Âѧ¾ºÇèÒ·ÒáÁÕÅѡɳзҧ¤ÅÔ¹Ô¡à»ç¹ fetal al-cohol syndrome áµèÂѧäÁèÁÕ¡ÒÃÈÖ¡ÉÒ·Ò§ÃкҴÇÔ·ÂÒ·Õè վͨЪèÇÂÂ×¹Âѹ à¹×èͧ¨Ò¡¼ÙéàʾÂì¡Ñ­ªÒÁÑ¡àʾÂìÊÒÃÍ×è¹æ ÃÇÁ·Ñé§ ×èÁàËÅéÒ éÇ·ÓãËéá¡ÍÍ¡¨Ò¡ÊÒà˵ØÍ×è¹ä éÂÒ¡

ÁÕ¡ÒÃÈÖ¡ÉÒ¡ÅØèÁà ç¡ÍÒÂØ 10 »Õ·ÕèáÁèàʾÂì¡Ñ­ªÒÃÐËÇèÒ§µÑ駤ÃÃÀ쾺ÇèÒÍÒ¨¨ÐÁÕ¤ÇÒÁÊÑÁ¾Ñ¹¸ìÃÐËÇèÒ§¡ÒÃàʾÂì¡Ñ­ªÒ¢Í§áÁè¡èͤÇÒÁ¼Ô´»¡µÔ¢Í§¾ÄµÔ¡ÃÃÁàÁ×èÍâµ¢Öé¹

àÍ¡ÊÒûÃСͺ¡ÒÃàÃÕºàÃÕ§1. Anonymous. Cannabis. Erowid. Availble at http://www.erowid.org//plants/cannabis/cannabis.shtml. AccessedJune 2, 2004.2. Otten EJ. Marijuana. In Goldfrank LR, Flomenbaum NE,Lewin NA, Howland MA, Hoffman RS, Nelson LS, eds.Goldfrank�s Toxicologic Emergency. 7th ed. New York;McGrow-Hill:1054-8.3. Frishman WH. Del Vecchio A. Sanal S. Ismail A. Car-diovascular manifestations of substance abuse: part 2: alco-hol, amphetamines, heroin, cannabis, and caffeine. HeartDisease 2003;5:253-71.4. Sidney S. Cardiovascular consequences of marijuana use.J Clin Pharmacol 2002;42:64S-70S.5. Jones RT. Cardiovascular system effects of marijuana. JClin Pharmacol 2002;42:58S-63S.6. Khalsa JH. Genser S. Francis H. Martin B. Clinicalconsequences of marijuana. J Clin Pharmacol 2002;42:7S-10S.7. Shih WJ. Carmona JJ. Coupal JJ. Lee JK. Marked lunguptake of Tc-99m HMPAO in a polysubstance-abusingmarijuana and tobacco smoker. Clin Nuclear Med1996;21(2):156.8. Cabral GA. Dove Pettit DA. Drugs and immunity:cannabinoids and their role in decreased resistance toinfectious disease. J Neuroimmunol 1998;83:116-23.9. Napiorkowski B. Lester BM. Freier MC. Brunner S.Dietz L. Nadra A. Oh W. Effects of in utero substanceexposure on infant neurobehavior. Pediatrics 1996;98:71-5.10. Tronick EZ. Frank DA. Cabral H. Mirochnick M.Zuckerman B. Late dose-response effects of prenatal cocaineexposure on newborn neurobehavioral performance. Pediat-rics. 1996;98:76-83.

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ÀÒÇÐà»ç¹¾Ôɨҡ PARAQUATÀÒÇÐà»ç¹¾Ôɨҡ PARAQUATÀÒÇÐà»ç¹¾Ôɨҡ PARAQUATÀÒÇÐà»ç¹¾Ôɨҡ PARAQUATÀÒÇÐà»ç¹¾Ôɨҡ PARAQUATÈ.¹¾.ÊÁÔ§ à¡èÒà¨ÃÔ­

ÃÙ»·Õè 1 ¡ÒÃà¡Ô ¾ÂÒ ÔÊÀÒ¾¨Ò¡ÀÒÇÐà»ç¹¾Ôɢͧ paraquat áÅÐÍÒ¡ÒÃáÊ´§

Paraquat + O2 Ô Tissue injuryGastrointestinal symptomsAcute tubular necrosisHepatocellular damageLung fibrosis

Paraquat + O2 Ô Tissue injuryGastrointestinal symptomsAcute tubular necrosisHepatocellular damageLung fibrosis

µÒÃÒ§·Õè 1. »Ñ Ѻ͡¶Ö§¤ÇÒÁÃعáç¢Í§ÀÒÇÐà»ç¹¾Ôɨҡ paraquat

1. ¢¹Ò´¢Í§ÂÒ·Õèä éÃѺ2. ÍÒÂØ3. ӹǹàÁç àÅ×Í´¢ÒÇ4. ÃРѺ¤ÇÒÁà¢éÁ¢éÁ¢Í§ paraquat ã¹àÅ×Í´5. ¡ÒôÓà¹Ô¹ÍÒ¡ÒâͧÀÒÇÐà»ç¹¾ÔÉ

page P&D Information Bulletin / Vol. 13, No. 2, 2005 18

multiple organ failure àªè¹ äµÇÒ ËÑÇã¨àµé¹¼Ô »¡µÔ coma ªÑ¡áÅÐesophageal perforation áÅÐ ventricular arrhythmias ¼Ùé»èÇÂÁÑ¡¨ÐàÊÕªÕÇÔµÀÒÂã¹ 24-48 ªÑèÇâÁ§ ã¹¼Ùé»èǺҧÃÒ¨ÐÁÕÍÒ¡Òâͧhemolysis áÅÐ methemoglobinemia ÃèÇÁ éÇ ¤ÇÒÁÃعáç¢Í§âäáÅÐÍѵÃÒ¡ÒÃàÊÕªÕÇÔµ¢Í§ÀÒÇÐà»ç¹¾Ôɨҡ paraquat ¹Ñé¹¢Öé¹ÍÂÙè¡ÑºËÅÒ»Ѩ¨Ñ (µÒÃÒ§·Õè 1) ·ÕèÊӤѭ·ÕèÊØ´ä´éá¡è »ÃÔÁÒ³·Õè¼Ùé»èÇÂÃѺ»Ãзҹà¢éÒä» ¤ÇÒÁà¢éÁ¢é¹¢Í§ paraquat ·Õèãªé ·ÑèÇ令×Í 27.6%¼Ùé»èÇ·ÕèÃѺ»Ãзҹ¹éÍ¡ÇèÒ 15 ml ÁÑ¡¨ÐÃÍ´ªÕÇÔµ áµè¶éÒÁÒ¡¡ÇèÒ50 ml ÁÑ¡¨ÐàÊÕªÕÇÔµ ÃРѺÂҢͧ paraquat ЪèǺ͡¶Ö§ÍѵÃÒµÒÂ(ÃÙ»·Õè 2) â´Â·ÑèÇ件éÒÃдѺÂÒ·Õè 24 ªÑèÇâÁ§¹éÍ¡ÇèÒ 0.1 µg/ml

ÁÑ¡¨ÐÃÍ´ªÕÇÔµ áÅжéÒÁÒ¡¡ÇèÒ 5 µg/ml ÁÑ¡¨ÐàÊÕªÕÇÔµ ¹Í¡¨Ò¡¹Õé»Ñ Ñ·Õè ЪèǺ͡ÇèÒ¼Ùé»èǹèÒ¨ÐÃÍ´ªÕÇÔµ ä éá¡è ÍÒÂØ·Õè¹éÍ áÅÐÃРѺWBC ·ÕèµèÓ¡ÇèÒ 10,000 áÅлÃСÒÃÊØ ·éÒÂä éá¡è ÍÒ¡ÒÃáÊ´§¢Í§âä¶éÒÍÒ¡ÒõѺÇÒ äµÇÒ áÅлʹÇÒÂà¡Ô ¢Öé¹ã¹ÃÐÂÐÊÑé¹æ áÊ´§ÇèÒ¤ÇÒÁÃعáç¢Í§âäÁÒ¡

¡ÒÃÃÑ¡ÉÒ¡ÒÃÃÑ¡ÉÒ¼Ùé»èÇ·Õèä éÃѺ¾Ôɨҡ paraquat (µÒÃÒ§·Õè 2) áÅÐ

(ÃÙ»·Õè 3) ¤ÇÃà¹é¹·Õè¡ÒûÃФѺ»ÃФͧ¼Ùé»èÇ â´Â¡ÒÃà½éÒ´ÙÍÒ¡Òâͧ¼Ùé»èÇÂÍÂèÒ§ã¡ÅéªÔ´áÅСÒÃãËé¡ÒÃÃÑ¡ÉÒ ÍÒ¡ÒÃá·Ã¡«é͹àªè¹µÑºÍÑ¡àʺ ËÃ×ÍäµÇÒ àª×è͡ѹÇèÒ¡ÒÃãËé oxygen ÍÒ¨¨Ð·ÓãËé¾ÔɢͧÊÒà paraquat à»ç¹àÃçÇáÅÐÁÒ¡¢Öé¹ ã¹¼Ùé»èÇ·Õèà¾Ôè§ä éÃѺ paraquat·Ò§»Ò¡ ¤ÇèÐÃÕº·Ó gastric lavage ËÃ×Í·ÓãËéÍÒà¨Õ¹àËÁ×͹¼Ùé»èÇÂä éÃѺÊÒþÔÉÍ×è¹æ â´Â·ÑèÇä» ºÒ§¤¹àª×èÍÇèÒ¡ÒÃ·Ó gastric la-vage éÇ Kayexalate (100 gm ã¹ 1000 ml) ÊÒÁÒöÅéÒ§ paraquatÍÍ¡ä´é´Õ¡ÇèÒ à¾ÃÒÐÇèÒ paraquat ¨Ð¨Ñº¡Ñº Kayexalate 㹡ÒÃÅ´¡Òôٴ«ÖÁ¢Í§ paraquat ã¹·Ò§à´Ô¹ÍÒËÒõéͧãËé´Ô¹à˹ÕÂÇFuller�s earth (60 gm/bottle) 150 gm ¼ÊÁ¹éÓ 1 L ãËé·Ò§»Ò¡ËÃ×Í

ÃÙ»·Õè 2 ¤ÇÒÁÊÑÁ¾Ñ¹ ìÃÐËÇèÒ§»ÃÔÁÒ³¢Í§ paraquat ã¹¾ÅÒÊÁèҡѺâÍ¡ÒÊÃÍ´ªÕÇÔµ¢Í§¼Ùé»èÇÂ

ÃÙ»·Õè 3 ¡ÒÃÃÑ¡ÉÒÀÒÇÐà»ç¹¾Ôɨҡ paraquat

µÒÃÒ§·Õè 2 ¢¹Ò´¢Í§ÂÒ㹡ÒÃÃÑ¡ÉÒÀÒÇÐà»ç¹¾Ôɨҡ paraquatI. Prevent absorption (principle treatment)

1. Gastric lavage with Kayexalate solution (100 g in NSS 1,000 ml)2. Fuller�s earth (60 g/bottle)

15% (2.5 bottles in water 1,000 ml) solution single dose3. MOM 30 ml every 6 hours until diarrhea

II. Increase elimination1. Forces diuresis

5% N/S 1,000 ml IV up to 250 ml/hr to assure urine output of 3 ml/minand administration of furosemide 20 mg IV qid

2. Hemodialysis/Hemoperfusion as indicatedIII. Modification of tissue toxicities (marginal benefit)

1. Modulate inflammatory responsesCyclophosphamide 5 mg/kg/day intravenously, devided to every 8 hrDexamethasone 10 mg IV q 8 hrChlorpheniramine 4 mg 1 tab oral qid

2. Prevent oxidationVitamin C (500mg/amp) 6 gm/day IVVitamin E (400 i.u./tab) 2 tabs qidN-acetylcysteine (300 mg/amp) 50 mg/kg every 8 hr

page

ãËé 7.5% bentonite 100-150 gm áÅÐãËéÃèÇÁ¡ÑºÂÒÃкÒ MOM30 ml ·Ø¡ 6 ªÑèÇâÁ§¨¹¼Ùé»èǶèÒÂÍب¨ÒÃÐ â´Â·ÑèÇä»áÅéǶ×͡ѹÇèÒ¢Ñ鹵͹¹Õéà»ç¹¢Ñ鹵͹·ÕèÊӤѭ·ÕèÊØ ã¹¡ÒÃÃÑ¡ÉÒÀÒÇÐà»ç¹¾ÔɹÕéà¾ÃÒÐÇèÒÔ¹ÊÒÁÒö inactivate paraquat ä éà»ç¹ÍÂèÒ§ Õ ¡ÒÃãËé Fuller�s

earth â´ÂàÃçǨ֧à»ç¹¡ÒÃÅ´¾ÔÉ·Õ èà¡Ô´¢Ö é¹ÍÂèÒ§ÁÕ»ÃÐÊÔ·¸ÔÀҾᾷÂìËÃ×ͺؤ¤Åҡ÷ҧ¡ÒÃá¾·Âì·Õ 辺¼Ùé»èÇÂà»ç¹¤¹áá¨Ö§ÁÕº·ºÒ·ÊӤѭ·ÕèÊØ ¡ÒÃà¾ÔèÁ¡ÒÃ¡Ó Ñ ÂÒâ´Â¡ÒÃ·Ó forced diure-sis â´Â¡ÒÃãËé¹éÓà¡Å×Í·Ò§ËÅÍ´àÅ×Í´´Ó éÇÂÍѵÃÒ 250 ml/hr ÃèÇÁ¡ÑºÂҢѺ»ÑÊÊÒÇÐ furosemide ©Õ ¨¹·ÓãËé urine ÍÍ¡»ÃÐÁÒ³ 3ml/min ¨ÐªèÇÂà¾Ô èÁ¡ÒáӨѴÂÒ paraquat ÍÍ¡·Ò§äµä´é¢éͤÇÃÃÐÇѧ¤×Í ¨Ðµéͧá¡éÀÒÇÐà¡Å×ÍáÃè¼Ô´»¡µÔáÅеéͧÃÐÇѧÀÒÇйéÓà¡Ô¹ à¾ÃÒÐÇèÒ¼Ùé»èÇÂÍÒ¨¨ÐÁÕÍÒ¡ÒÃäµÇÒ¨ҡ paraquat ·ÓãËé¢Ñº¹éÓÍÍ¡¨Ò¡ÃèÒ§¡ÒÂäÁèä é ¹Í¡¨Ò¡¹ÕéÂѧ¤ÇÃ¾Ô ÒóҡÒÃà¾ÔèÁ¡ÒÃ¡Ó Ñ ÂÒparaquat ÍÍ¡¨Ò¡ÃèÒ§¡ÒÂâ´Â¡ÒÃ·Ó hemoperfusion â´Â੾ÒÐã¹¼Ùé»èÇ·Õèà¾Ôè§ä éÃѺÂÒÁÒÀÒÂã¹äÁèà¡Ô¹ 3 Çѹ áÅÐÍÒ¡ÒÃäÁèà»ç¹áººmultiple organ failure «Öè§ÁÑ¡¨ÐÃÑ¡ÉÒäÁèä é¼Å ¡ÒÃ·Ó hemoper-fusion ÍÒ¨¨Ðµéͧ·Ó«éÓæ ¡Ñ¹ÇѹÅÐ 1-2 ¤ÃÑé§ 3 Çѹ ËÅѧ¨Ò¡¹Ñé¹áÅéÇÂÒÍÒ¨¨Ð¡ÃШÒÂà¢éÒä»ã¹à¹×éÍàÂ×è͵èÒ§æ áÁé Ð·Ó hemoperfusion ¡çäÁèä´é¼Å

¼Ùé»èÇ·Õèà»ç¹¾Ôɨҡ paraquat áÁé ÐÁÕÍÒ¡ÒõѺÇÒ äµÇÒ¡çÍÒ¨¨Ð¿× é¹à»ç¹»¡µÔä´é ´Ñ§¹Ñ 鹡ÒûÃФѺ»ÃФͧ¼Ù é» èǨ֧ÁÕ¤ÇÒÁÊӤѭÁÒ¡ ¼Ùé»èǨÐàÊÕªÕÇÔµ¨Ò¡ÀÒÇСÒÃËÒÂã¨ÅéÁàËÅÇà¹×èͧ¨Ò¡ÁÕ pulmonary edema áÅÐ necrotizing pneumonitisáÁéÇèÒÍÒ¡ÒõѺäµÇÒÂ¨Ð Õ áµè¤ÇÒÁàÊÕÂËÒ¢ͧ»Í´à»ç¹áºº¶ÒÇà ÁÕpulmonary fibrosis ´Ñ§¹Ñ鹨֧ÁÕ¤ÇÒÁ¾ÂÒÂÒÁÍÂèÒ§Áҡ㹡Òèлéͧ¡Ñ¹ÍÒ¡ÒÃá·Ã¡«é͹·Õè»Í´ â´Â¡ÒÃãËéÂÒ¡ÅØèÁ anti-inflamma-tory àªè¹ dexamethasone 5 mg IV ·Ø¡ 6 ªÑèÇâÁ§ áÅÐÂÒ cytotoxicàªè¹ cyclophosphamide 5 mg/kg/day ·Ò§ËÅÍ´àÅ×Í´´Óáºè§ãËé·Ø¡8 ªÑèÇâÁ§ ¼Å¡ÒÃÃÑ¡ÉÒÍÒ¨¨Ð ÕáµèÂѧäÁèÁÕ controlled trial ¾ÔÊÙ ¹ìÍÂèÒ§ªÑ ਹ ¹Í¡¨Ò¡¹ÕéÁÕÃÒ§ҹÇèÒ¡ÒéÒÂáʧ·Õè»Í´ (lung radia-tion) â´ÂãªéÃѧÊÕ¢¹Ò´µèÓÍÒ¨¨ÐÂѺÂÑ駡ÒÃà¨ÃÔ­¢Í§ fibroblast ·ÓãËéfibrosis ¹éÍÂŧ áµè¡Ò÷´Åͧã¹Ë¹Ù¾ºÇèÒäÁèªèÇÂãËéÃÍ´ªÕÇÔµÁÒ¡¢Ö鹨ҡ¡Ò÷Õè paraquat ÍÍ¡Ä· Ôìâ´ÂẺ oxidant Ö§ÁÕ¤ÇÒÁ¾ÂÒÂÒÁãªéÊÒà anti-oxidants ·Ñé§ËÅÒÂÁÒãªé㹡ÒÃÃÑ¡ÉÒàªè¹ vitamin C,vitamin E, niacin, N-acetylcysteine áµè¾ºÇèÒä é¼Å¹éÍÂ

àÍ¡ÊÒûÃСͺ¡ÒÃàÃÕºàÃÕ§1. Addo E, Poon-King T. Leucocyte suppression intreatmemt of 72 patients with paraquat poisoning. Lancet1986; 17: 1117-1120.2. Bateman DN. Pharmacological treatments of paraquat

poisoning. Hum Toxicol 1987; 6: 57-62.3. Bismuth C, Scherrmann JM, Garnier R, et al. Elimina-tion of paraquat. Hum Toxicol 1987; 6: 63-67.4. Dasta JF. Paraquat poisoning: a review. Am J Hosp Pharm1978; 35: 1368-1372.5. Fisher HK, Humphries M, Bails R. Paraquat poisoning:recovery from renal and pulmonary damage. Ann Intern Med1971; 75: 731-736.6. Hampson EC, Pond SM. Failure of hemoperfusion andhemodialysis to prevent death in paraquat poisoning. A ret-rospective review of 42 patients. Med Toxicol Adverse DrugExp 1988; 3: 64-71.7. Hart TB, Nevitt A, Whitehead A. A new statistical ap-proach to the prognostic significance of plasma paraquatconcentrations. Lancet 1984; 24: 1222-1223.8. Kaojarern SK, Ongphiphadhanakul B. Predicting outcomesin paraquat poisoning. Vet Hum Toxicol 1991; 33: 115-118.9. Lindenschmidt RC, Seling WM. Patterson CE et al. His-tamine actions in paraquat induced lung injury. Am RewRespir Dis 1986; 133: 274-8.10. Meredith TJ, Vale JA. Treatment of paraquat poisoningin man: methods to prevent absorption. Hum Toxicol 1987;6: 49-55.11. Okonek S, Weilemann LS, Majdanzic J, et al. Successfultreatment of paraquat poisoning: activated charcoal per osand �continuous hemoperfusion�. Clin Toxicol 1982; 19: 807-819.12. Proudfoot AT, Stewart MS, Levitt T, et al. Paraquat poi-soning: significance of plasma-paraquat concentrations.Lancet. 1979; 18: 330-332.13. Saenghirunvattana S, Sermswan A, Piratchvej V,Rochanawutanon M, Kaojarern S, Rattanaenya T. Effects oflung irradiation on mice following paraquat intoxication.Chest 101; 3: 833-5.14. Sequential bilateral lung transplantation for paraquat poi-soning. A case report. The Toronto Lung Transplant group.J Thorac cardiovasc Surg 1985; 89: 734-742.15. Tungsanga K, Sitprija V, Suvanpha R, et al. Paraquatpoisoning: experience in fourteen patients. J Med Ass Thai-land. 1981; 64: 215-222.16. Webb DB, William WV, Davies BH, et al. Resolution afterradiotherapy of severe pulmonary damage due to paraquatpoisoning, Br Med J. 1984; 288: 1259-1260.17. Wright N, Yeoman WB, Hale KA. Assessment of severityof paraquat poisoning. Br Med J. 1976; August 5: 396.18. Yamshita M, Naito H, Takagi S. The effectiveness ofKayexalate as an absorbent of paraquat: experimental andclinical studies. Hum Toxicol 1987; 6: 89-90.

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page P&D Information Bulletin / Vol. 13, No. 2, 2005

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àÍ¡ÊÒûÃСͺ¡ÒÃàÃÕºàÃÕ§1. Proudfoot AT, Stewart MS, Levitt T, Widdop B. Paraquatpoisoning: significance of plasma-paraquat concentrations.Lancet 1979;2(8138):330-2.2. Hart TB, Nevitt A, Whitehead A. A new statisticalapproach to the prognostic significance of plasma paraquatconcentrations. Lancet 1984;2(8413):1222-3.3. Scherrmann JM, Houze P, Bismuth C, Bourdon R.Prognostic value of plasma and urine paraquat concentration.Hum Toxicol 1987;6(1):91-3.4. Kaojarern S, Ongphiphadhanakul B. Predicting outcomesin paraquat poisonings. Vet Hum Toxicol 1991;33(2):115-8.5. Bus JS, Preache MM, Cagen SZ, et al. Fetal toxicity anddistribution of paraquat and diquat in mice and rats. ToxicolAppl Pharmacol 1975;33(3):450-60.6. Musson FA, Porter CA. Effect of ingestion of paraquat ona 20-week gestation fetus. Postgrad Med J 1982;58(685):731-2.7. Prasarnphanich T, Chinawong P, Somlaw S, Kosalwat N.Neonatal paraquat poisoning: a case report. J Med Assoc Thai1988;71(12):694-8.8. Talbot AR, Fu CC, Hsieh MF. Paraquat intoxicationduring pregnancy: a report of 9 cases. Vet Hum Toxicol1988;30(1):12-7.

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àÍ¡ÊÒûÃСͺ¡ÒÃàÃÕºàÃÕ§1. Poisindex staff editorial [Toxicology Information on CD-ROM]. Henna, Lead acetate, Paraphenylenediamine, Hydro-gen peroxide, Thioglycolate, Bromate, Sodium hydroxide,Propylene glycol. Poisindex system. Volume 124. Colorado:Micromedex:Inc, 20052. A guide to the safe use of salon hair products: materailsafety datasheets.Available fromURL : http:// www.greatvistachemicals.com/agrochemicals/pyrida ben.html3. ÂÒÂéÍÁ¼Á Available from URL : http://webdb.dmsc.moph.go.th/ifc_cosmetic/a_ch_ 1_001c. asp?info_id=13