{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,8]],"date-time":"2026-05-08T06:16:28Z","timestamp":1778220988852,"version":"3.51.4"},"reference-count":35,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,5,8]],"date-time":"2026-05-08T00:00:00Z","timestamp":1778198400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Science and Technology Program of Guangzhou","award":["2025A03J3854"],"award-info":[{"award-number":["2025A03J3854"]}]},{"name":"Science and Technology Program of Guangzhou","award":["2023A03J0490"],"award-info":[{"award-number":["2023A03J0490"]}]},{"name":"Science and Technology Program of Guangzhou","award":["2024A03J0496"],"award-info":[{"award-number":["2024A03J0496"]}]},{"name":"Science and Technology Program of Guangzhou","award":["2023A03J0502"],"award-info":[{"award-number":["2023A03J0502"]}]},{"name":"Guangzhou Health Science and Technology Major Program","award":["2025A031002"],"award-info":[{"award-number":["2025A031002"]}]},{"name":"Guangzhou Key Medical Discipline","award":["2025\u20132027"],"award-info":[{"award-number":["2025\u20132027"]}]},{"name":"Key Research and Development Project of Guangzhou Science and Technology Bureau","award":["202206010061"],"award-info":[{"award-number":["202206010061"]}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Paraquat (PQ) and diquat (DQ) are highly toxic bipyridyl herbicides, but their dominant organ injury patterns and clinical outcomes are not identical. This study aimed to compare the clinical characteristics, organ injury profiles, and prognosis of acute PQ and DQ poisoning.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This retrospective single-center cohort study included consecutive patients with acute oral PQ or DQ poisoning treated at Guangzhou Occupational Disease Prevention and Treatment Hospital between January 2012 and January 2022. Baseline characteristics, clinical manifestations, admission laboratory findings, and in-hospital outcomes were compared between 270 patients with PQ poisoning and 115 patients with DQ poisoning.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      PQ poisoning was associated with a higher crude in-hospital mortality rate than DQ poisoning (142\/270 [52.6%] vs. 29\/115 [25.2%],\n                      <jats:italic>p<\/jats:italic>\n                      &amp;lt; 0.001), shorter hospital stay, higher admission creatinine levels, and more frequent mediastinal emphysema. In contrast, DQ patients were younger, reported larger ingestion amounts, presented later to the local hospital, and more often showed nausea\/vomiting, disturbance of consciousness, seizures, reduced responsiveness, agitation, dysarthria, anuria, and pleural effusion. The DQ group also had significantly higher CK and CK-MB levels, suggesting more prominent neuromuscular involvement. Kaplan\u2013Meier analysis showed a significant difference in overall survival between the two groups.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>PQ and DQ poisoning show distinct clinical phenotypes and should not be managed as interchangeable toxic syndromes. Rapid toxin identification and toxin-specific monitoring may help guide early risk stratification and supportive care.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2026.1796823","type":"journal-article","created":{"date-parts":[[2026,5,8]],"date-time":"2026-05-08T05:55:09Z","timestamp":1778219709000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["A retrospective analysis of paraquat and diquat poisoning: a single-center experience"],"prefix":"10.3389","volume":"13","author":[{"given":"Yuquan","family":"Chen","sequence":"first","affiliation":[{"name":"Department of Occupational Diseases and Poisoning, Guangzhou Occupational Disease Prevention and Treatment Hospital (Guangzhou Twelfth People\u2019s Hospital)","place":["Guangzhou, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yuqiang","family":"Lin","sequence":"additional","affiliation":[{"name":"Department of Occupational Diseases and Poisoning, Guangzhou Occupational Disease Prevention and Treatment Hospital (Guangzhou Twelfth People\u2019s Hospital)","place":["Guangzhou, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yifan","family":"Ye","sequence":"additional","affiliation":[{"name":"Department of Occupational Diseases and Poisoning, Guangzhou Occupational Disease Prevention and Treatment Hospital (Guangzhou Twelfth People\u2019s Hospital)","place":["Guangzhou, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Meiwen","family":"Xie","sequence":"additional","affiliation":[{"name":"Department of Occupational Diseases and Poisoning, Guangzhou Occupational Disease Prevention and Treatment Hospital (Guangzhou Twelfth People\u2019s Hospital)","place":["Guangzhou, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zhiqian","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Occupational Diseases and Poisoning, Guangzhou Occupational Disease Prevention and Treatment Hospital (Guangzhou Twelfth People\u2019s Hospital)","place":["Guangzhou, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zhi","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Occupational Diseases and Poisoning, Guangzhou Occupational Disease Prevention and Treatment Hospital (Guangzhou Twelfth People\u2019s Hospital)","place":["Guangzhou, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,5,8]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"191","DOI":"10.1016\/j.envres.2016.01.003","article-title":"Magnitude and characteristics of acute paraquat- and diquat- related illnesses in the US: 1998-2013","volume":"146","author":"Fortenberry","year":"2016","journal-title":"Environ Res"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"1131","DOI":"10.1177\/0960327118765330","article-title":"Human and experimental toxicology of diquat poisoning: Toxicokinetics, mechanisms of toxicity, clinical features, and treatment","volume":"37","author":"Magalh\u00e3es","year":"2018","journal-title":"Hum Exp Toxicol"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"123","DOI":"10.1081\/clt-100100926","article-title":"Mechanisms of toxicity, clinical features, and management of diquat poisoning: a review","volume":"38","author":"Jones","year":"2000","journal-title":"J Toxicol Clin Toxicol"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"120","DOI":"10.1080\/19440049.2018.1547424","article-title":"High throughput residue analysis of paraquat and diquat involving hydrophilic interaction liquid chromatographic separation and mass spectrometric determination","volume":"36","author":"Oulkar","year":"2019","journal-title":"Food Addit Contam Part A Chem Anal Control Expo Risk Assess"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"e9621","DOI":"10.1097\/MD.0000000000009621","article-title":"Clinical features and prognosis of paraquat poisoning in French Guiana: A review of 62 cases","volume":"97","author":"Elenga","year":"2018","journal-title":"Medicine (Baltimore)"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"e21351","DOI":"10.1097\/MD.0000000000021351","article-title":"Serum anion gap at admission as a predictor of the survival of patients with paraquat poisoning: A retrospective analysis","volume":"99","author":"Yong","year":"2020","journal-title":"Medicine (Baltimore)"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"123","DOI":"10.1186\/s40545-023-00635-z","article-title":"Predicting mortality in paraquat poisoning through clinical findings, with a focus on pulmonary and cardiovascular system disorders","volume":"16","author":"Preechaya","year":"2023","journal-title":"J Pharm Policy Pract"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"427","DOI":"10.1080\/1354750X.2024.2410238","article-title":"Association between toxicity-index of diquat and in-hospital mortality in patients with acute diquat poisoning: a retrospective cohort study","volume":"29","author":"Zhang","year":"2024","journal-title":"Biomarkers"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"55","DOI":"10.1080\/10408444.2024.2433242","article-title":"Construction of a risk prediction model of diquat poisoning based on clinical indicators","volume":"55","author":"Qian","year":"2024","journal-title":"Crit Rev Toxicol"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"9272","DOI":"10.1007\/s12035-024-04172-x","article-title":"Imaging findings and toxicological mechanisms of nervous system injury caused by diquat","volume":"61","author":"Yanguang","year":"2024","journal-title":"Mol Neurobiol"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"030006052094382","DOI":"10.1177\/0300060520943824","article-title":"Lethal diquat poisoning manifesting as central pontine myelinolysis and acute kidney injury: A case report and literature review","volume":"48","author":"Xing","year":"2020","journal-title":"J Int Med Res"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"472","DOI":"10.1016\/j.amjms.2022.04.032","article-title":"Acute diquat poisoning causes rhabdomyolysis","volume":"364","author":"Feng","year":"2022","journal-title":"Am J Med Sci"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"417","DOI":"10.1177\/0748233720933522","article-title":"Investigation of simple, objective, and effective indicators for predicting acute paraquat poisoning outcomes","volume":"36","author":"Su","year":"2020","journal-title":"Toxicol Ind Health"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"3000605211043243","DOI":"10.1177\/03000605211043243","article-title":"Alveolar-arterial partial pressure difference as an early predictor for patients with acute paraquat poisoning","volume":"49","author":"Chen","year":"2021","journal-title":"J Int Med Res"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"6621894","DOI":"10.1155\/2021\/6621894","article-title":"Development and validation of a radiomics nomogram for prognosis prediction of patients with acute paraquat poisoning: A retrospective cohort study","volume":"2021","author":"Lu","year":"2021","journal-title":"Biomed Res Int"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"2","DOI":"10.4103\/jrms.JRMS_478_18","article-title":"Does hemoperfusion in combination with other treatments reduce the mortality of patients with paraquat poisoning more than hemoperfusion alone: A systematic review with meta-analysis","volume":"24","author":"Isfahani","year":"2019","journal-title":"J Res Med Sci"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"2621498","DOI":"10.1080\/07853890.2026.2621498","article-title":"Extracorporeal therapies in the management of paraquat poisoning: A comprehensive review of current evidence","volume":"58","author":"Yang","year":"2026","journal-title":"Ann Med"},{"key":"ref18","doi-asserted-by":"publisher","DOI":"10.4103\/ajts.AJTS_103_20","article-title":"Effectiveness of therapeutic plasma exchange on the outcome of patients with acute non-neurological diseases","author":"Hariharan","year":"2023","journal-title":"Asian J Transfus Sci"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"232","DOI":"10.5847\/wjem.j.1920-8642.2021.03.013","article-title":"Performance of extracorporeal membrane oxygenation in patients with fatal paraquat poisoning: grasp for straws?","volume":"12","author":"Feng","year":"2021","journal-title":"World J Emerg Med"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"1027","DOI":"10.1007\/s12055-024-01893-5","article-title":"Extracorporeal membrane oxygenation as a bridge to lung transplantation following paraquat poisoning","volume":"41","author":"Kantimathinathan","year":"2025","journal-title":"Indian J Thorac Cardiovasc Surg"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"116923","DOI":"10.1016\/j.jpba.2025.116923","article-title":"Rapid diagnosis of diquat and paraquat poisoning: A dual approach using colloidal gold immunochromatographic assay and hydrophilic interaction liquid chromatography","volume":"263","author":"Han","year":"2025","journal-title":"J Pharm Biomed Anal"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1155\/2020\/7359582","article-title":"Separation and determination of paraquat and diquat in human plasma and urine by magnetic dispersive solid phase extraction coupled with high-performance liquid chromatography","volume":"2020","author":"Sha","year":"2020","journal-title":"J Anal Methods Chem"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"4723092","DOI":"10.1155\/2021\/4723092","article-title":"Rapid Glomerulotubular nephritis as an initial presentation of a lethal diquat ingestion","volume":"2021","author":"Guck","year":"2021","journal-title":"Case Rep Nephrol"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"678","DOI":"10.1080\/15376516.2022.2063095","article-title":"Identification of differentially expressed genes and pathways in diquat and paraquat poisoning using bioinformatics analysis","volume":"32","author":"Miao","year":"2022","journal-title":"Toxicol Mech Methods"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"25","DOI":"10.1007\/s00216-010-4633-4","article-title":"Monolithic spin column extraction and GC-MS for the simultaneous assay of diquat, paraquat, and fenitrothion in human serum and urine","volume":"400","author":"Saito","year":"2011","journal-title":"Anal Bioanal Chem"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"e14414","DOI":"10.1097\/MD.0000000000014414","article-title":"Successful extracorporeal membrane oxygenation support for severe acute diquat and glyphosate poisoning: A case report","volume":"98","author":"Wang","year":"2019","journal-title":"Medicine"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"2058","DOI":"10.17305\/bb.2025.11891","article-title":"Lymphocyte subsets predict mortality in acute paraquat poisoning","volume":"25","author":"Qian","year":"2025","journal-title":"Biomol Biomed"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"1354","DOI":"10.3390\/antiox13111354","article-title":"The link between paraquat and demyelination: A review of current evidence","volume":"13","author":"Renata","year":"2024","journal-title":"Antioxidants (Basel)"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"117713","DOI":"10.1016\/j.ecoenv.2025.117713","article-title":"Triiodothyronine activates THR\u03b2 to promote PGC1\u03b1 expression alleviating PQ-induced pulmonary fibrosis","volume":"289","author":"Chen","year":"2025","journal-title":"Ecotoxicol Environ Saf"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"35","DOI":"10.4196\/kjpp.2016.20.1.35","article-title":"Toxicokinetics of paraquat in Korean patients with acute poisoning","volume":"20","author":"Kim","year":"2016","journal-title":"Korean J Physiol Pharmacol"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"310","DOI":"10.1186\/s12967-024-05094-x","article-title":"Exosomes from senescent epithelial cells activate pulmonary fibroblasts via the miR-217-5p\/Sirt1 axis in paraquat-induced pulmonary fibrosis","volume":"22","author":"Zhang","year":"2024","journal-title":"J Transl Med"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"5117","DOI":"10.1097\/MS9.0000000000001166","article-title":"Acute paraquat poisoning complicated by acute kidney injury and lung fibrosis: a case report from Nepal","volume":"85","author":"Yadav","year":"2023","journal-title":"Ann Med Surg (Lond)"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"301","DOI":"10.1038\/s41420-024-02078-0","article-title":"Emerging roles of ferroptosis in pulmonary fibrosis: current perspectives, opportunities and challenges","volume":"10","author":"Hu","year":"2024","journal-title":"Cell Death Discov"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1155\/2020\/7103105","article-title":"Paraquat exposure induces pulmonary cell mitophagy by enhancing the PINK1\/parkin Signaling","volume":"2020","author":"Liu","year":"2020","journal-title":"Biomed Res Int"},{"key":"ref35","doi-asserted-by":"publisher","first-page":"2709","DOI":"10.1038\/s41598-018-21073-x","article-title":"Hypoxia induces pulmonary fibroblast proliferation through NFAT signaling","volume":"8","author":"Senavirathna","year":"2018","journal-title":"Sci Rep"}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1796823\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,8]],"date-time":"2026-05-08T05:55:10Z","timestamp":1778219710000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1796823\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,8]]},"references-count":35,"alternative-id":["10.3389\/fmed.2026.1796823"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2026.1796823","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,8]]},"article-number":"1796823"}}