Multi-organ Toxicity Including New-Onset Diabetes Mellitus Following Acute Paraquat Poisoning: A Case Report

Background

Paraquat is a highly toxic herbicide capable of causing severe multisystem injury. Although pulmonary, renal, and hepatic toxicity is well recognised, haematological, pancreatic, and endocrine manifestations are less frequently described. Case Presentation: A 39-year-old woman, not previously known to have diabetes mellitus or hypertension, presented approximately 4 hours after intentional ingestion of approximately 25 mL of paraquat. Initial investigations showed acute kidney injury, transaminitis, and pancytopenia. Despite supportive management, including haemodialysis for worsening renal dysfunction, renal and hepatic abnormalities progressed during the early hospital course. Pancytopenia also worsened, and serum amylase and lipase became markedly elevated. On the seventh hospital day, the patient developed polyuria, fatigue, and excessive thirst. Random blood glucose was 312 mg/dL and fasting blood glucose was 172 mg/dL. C-peptide was low, GAD and ICA antibodies were negative, and urine ketones were negative. New-onset diabetes mellitus was diagnosed, and subcutaneous insulin was initiated with a good glycaemic response. Renal function subsequently showed partial recovery, liver enzymes declined, and blood counts improved. At 3-month follow-up, the patient remained insulin-dependent with stable renal and liver function.