A novel low-metabolism strategy combined with multimodal detoxification for successful management of high-dose diquat–paraquat mixed poisoning: A comprehensive therapeutic analysis

Combined diquat and paraquat poisoning is a rare but clinically significant form of poisoning, associated with severe oxidative stress and multiorgan failure. Historical case series have reported high case fatality, particularly following high-dose exposure. The absence of specific antidotes and standardized treatment protocols for mixed poisoning necessitate innovative therapeutic approaches. We present the case of an adolescent girl in her early teens who ingested 100 mL of a commercially obtained but illegally formulated diquat–paraquat mixture (200 g/L). A novel low-metabolism strategy was implemented, comprising low-concentration oxygen therapy (fraction of inspired oxygen (21%–30%), targeted sedation/analgesia, β-blockade, temperature management, and multimodal detoxification). Plasma toxin levels decreased by >97% within 20 h. Despite complications including anuria, cerebral edema, and respiratory failure, the patient achieved complete recovery after 49 days. Low-metabolism strategy reduced cellular oxygen consumption, mitigated oxidative damage, and enabled effective elimination of toxins. Dynamic monitoring guided tailored organ support. The integration of low-metabolism strategy timely and multimodal detoxification may represent a promising, albeit resource-intensive, approach for severe bipyridinium herbicide poisoning. This strategy warrants further validation in controlled studies and offers a potential framework for cases with severe poisoning.