Surgical scar on the victim’s arm one month after the surger
y to remove the toxic substance, which if allowed to remain
would have proved fatal
Nothing short of a miracle
The groundbreaking surgery that saved the life of a
paraquat poison victim:
When life flowed unexpectedly into the dying veins of a young woman,
poisoned by the highly toxic weedicide, Paraquat, the ground breaking
surgery, which saved her life was justifiably hailed as ‘nothing short
of a miracle’. And it continues to be hailed a miracle several months
The miracle unfolded in a small sterile white walled operating
theatre of a leading private hospital in Colombo. The patient was a
teenager - a 19 year old school girl - who angered by her parents’
objection to her love affair with a fellow classmate, had resorted to
the ultimate form of retaliation by attempting to end her life.
Driven by these emotionally immature feelings and acting on impulse
rather than rational thinking, she had reached out for the most readily
available poisoning agent in the house – paraquat - and injected herself
with a generous dose of the lethal poison.
Had it not been for the competent and speedy post toxic treatment she
had received, both by the admitting doctors and the surgeon to whom she
was finally referred to, the teenager might have kept her tryst with
death. For, as medical evidence has proved, the herbicide causes serious
morbidity and mortality when ingested. And survival is rare. Never, if
the dose is high.
Admitted to the hospital ten hours after she had injected a near
lethal dose of the poison to her left forearm, she had been already
showing symptoms of complications. “She was complaining of feeling
faint. The injection site was red and swollen. We knew we had to act
fast and immediately, even though previous attempts at saving such
patients had not been successful,” recalls Senior Professor of Forensic
Medicine and Toxicology, University of Colombo, Prof. Ravindra Fernando.
Gift of life
Professsor Ravindra Fernando
He referred her to the Consultant Surgeon Nawaloka Hospital, where
she had been admitted and it was under the competent and experienced
care of the burly sporting doctor that the young woman received her gift
of life, a life she carelessly tried to throw away.
With supreme confidence honed by years of experience the surgeon
deftly removed the toxic material which if allowed to remain could have
proved fatal. He removed the skin and underlying subcutaneous and muscle
tissue with a 7 cm long incision.
“The histology of the tissue showed necrosis. The urine was positive
for paraquat with the dithionite test. The syringe and needle showed
residual paraquat with the same test,” says Prof. Fernando, explaining
that the liver and renal function tests showed no abnormality and that
the teen had an uneventful recovery. “She left the hospital seven days
later and was in good health after six months of recovery.”
Paying a tribute to the surgeon, he says, “There is no doubt the
recovery of this patient was due to the immediate surgical removal of
the paraquat containing tissue.”
So pleased with the unexpected and fortunate turn of events, the
former head and founder of the National Poisons Centre at the National
Hospital says he has recommended this procedure for subcutaneous and
intramuscular paraquat injections in future.
Effects of ingesting Paraquat
Head, Poisons Information Centre, National Hospital,
Dr Waruna Gunathileke
is an extremely lethal poison. One of the commonest ways of
ingesting it is via the mouth. If swallowed even in tiny
doses, it can have severe health effects. Usually the
results are unpredictable and in most cases fatal. But if
the patient is lucky to survive, he /she could have mouth
ulceration and it could cause long term fibrosis and good
pump (oesophagus) failure. It can also effect the liver and
Although Paraquat was banned in the
country several months ago, Dr Gunathileke is concerned that
the National Hospital is still seeing some patients being
admitted after swallowing or injecting themselves with
paraquat. “Recently we had a case where a man from
Mapiatigama, Galle, swallowed it under the influence of
liquor. Luckily he had taken only one sip and threw it away
when he found out what he was drinking! But he ended up with
severe ulceration of the mouth. We don’t know what other
long term consequences there may be even though he ingested
only a small dose.
He said they had informed the Registrar of
Pesticides about this and hoped there would be more
vigilance and tighter control over the sale of this lethal
and now illegal agro chemical compound.
Giving some insights and the history of this widely used herbicide
compound seen in almost every home in Sri Lanka’s agricultural regions
that cut across North to South, East to West, Prof. Fernando, explains
that Paraquat is a highly toxic bipyridyl compound widely used as a
herbicide. “It causes morbidity and mortality when ingested. Death
occurs within two days of ingestion of 50 mg/kg. At lower doses death
from pulmonary fibrosis delayed for a few weeks as the toxic compound
accumulates in lung tissue where free radicals are formed, lipid
peroxidation (cell damage) is induced and nicotinamide adenine
dinucleotide phosphate (NADPH) is depleted.
History and Impact
He recalls that the first case of fatal paraquat poisoning by
subcutaneous injection was reported in 1967 and that since then a few
more cases of parenteral (intravenous or intramuscular) injection
paraquat poisoning have been reported, and all were fatal.
Prof. Fernando said paraquat ingestion is a leading cause of fatal
poisoning in most parts of Asia, Pacific nations and the Americas.
Studies have shown that the rapidly acting non-selective herbicide is
also relatively inexpensive and safe to use for agricultural purposes,
he says warning that accidental or deliberate ingestion has an extremely
high case – fatality rate.
Due to the high human toxicity and difficulty in managing patients
with paraquat poisoning, the Registrar of Pesticides banned its imports
into the country in 2010.
Agricultural and Consumer Affairs Authority officials on grounds of
anonymity say that despite its ban, many weedicides rejected in other
countries are now increasingly being smuggled into the country. “Much of
the hidden stocks are now being circulated at enhanced prices to
farmers, fighting to save their crops from the prevailing drought and
rains. This is being done with the encouragement of stake holders who
include several local politicians. The government and Agricultural
Ministry must take implement the existing regulations as ingesting the
harmful chemicals they contain can cause water pollution, cancer,
nervous disorders, stunted growth , hormone deficiency and pregnancy
problems,” concerned health official charge.