Don't count on being “saved” as a safety net: after swallowing pesticide or breathing in gas, the emergency room can save a life, but not the lungs or the brain
- Top value
- Evidence B
- Buys life
- Free
- Takes minutes
- No willpower
In plain words
Paraquat has no antidote, and more than 40% of people who swallow it can't be saved. It inflames the lungs, which slowly stiffen, and the kidneys and liver are hurt as well. Among people saved from carbon monoxide poisoning, nearly half have a brain that is not what it was 6 weeks later, and even with hyperbaric oxygen, a quarter still do.
- Cost
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Free. Just know this first.
- What you get
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A systematic review of paraquat poisoning: the fatality rate is extremely high because the poison is itself very toxic and there is no effective treatment. It is actively pulled into lung tissue against its concentration gradient (technically, active uptake against a concentration gradient), resulting in pneumonitis and pulmonary fibrosis, and it also injures the kidneys and the liver. The review states that stomach pumping should not be done. Hemodialysis and hemoperfusion are unlikely to change the clinical course. The evidence for steroids and immunosuppressants is very weak. The review adds a line: “fatality is high at all centers, despite widely varying treatment.” 10 tertiary hospitals in Bangladesh admitted 1420 cases from 2013 to 2024, of which 257 could be analyzed: the fatality rate was 43.2%. Common presentations were swelling of the lower legs from acute kidney failure in 71.2%, vomiting in 65.8% and abdominal pain in 58.0%. The trial of acute carbon monoxide poisoning was double-blind and randomized, with 76 people in each of two groups. Neither doctors nor patients knew which group they were in. At 6 weeks, the number left with cognitive sequelae was 19/76 (25.0%) in the hyperbaric oxygen group and 35/76 (46.1%) in the normal-pressure oxygen group (P=0.007). After adjusting for other factors, OR 0.45 (95% CI 0.22 to 0.92, the plausible range of this figure in parentheses). Another study followed 73 consecutive cases: 30% had cognitive sequelae and 12% showed white matter hyperintensities. China revoked the registration and production license of paraquat aqueous solutions from July 1, 2014 and stopped production. From July 1, 2016, aqueous solutions were no longer sold or used in China. From September 26, 2020, soluble granule formulations were banned from sale and use within China. The document states that “suicides by taking paraquat occurring from time to time” was the direct reason for stricter oversight.
- Notes
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Why grade B: the subjects of these studies are poisoning patients, not a single population of suicide attempters, and the carbon monoxide trial also included people poisoned by accident. So the percentages of lasting damage above can't be taken directly as “the chance of consequences for someone who attempts suicide.” What can be said for certain is that no method leaves no lasting damage. For handling carbon monoxide at the scene, see §13.19. If someone swallowed pesticide or medicine by mistake, don't induce vomiting; take the bottle and go to the hospital, see §13.20. For not stocking pesticide and sleeping pills at home, see §1.25. This book does not compare the lethality of different methods and does not describe any specific way of doing it.
- Evidence grade
- B : Supported by research but without a precise number, or based on small or single studies.
- Sources
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- Gawarammana IB, Buckley NA (2011). Medical management of paraquat ingestion. British Journal of Clinical Pharmacology, 72(5), 745-757. https://doi.org/10.1111/j.1365-2125.2011.04026.x
- Chowdhury FR 等 (2026). Clinical and Laboratory Profile of Paraquat Poisoning: A Toxicological Crisis in Bangladesh. American Journal of Tropical Medicine and Hygiene, 115, 176-182. https://doi.org/10.4269/ajtmh.25-0719
- Weaver LK, Hopkins RO, Chan KJ, et al. (2002). Hyperbaric oxygen for acute carbon monoxide poisoning. New England Journal of Medicine, 347(14), 1057-1067. https://doi.org/10.1056/NEJMoa013121
- Parkinson RB, Hopkins RO, Cleavinger HB, et al. (2002). White matter hyperintensities and neuropsychological outcome following carbon monoxide poisoning. Neurology, 58(10), 1525-1532. https://doi.org/10.1212/wnl.58.10.1525
- 农业农村部办公厅 (2018). 关于切实加强百草枯监督管理的通知（农办农〔2018〕17 号）. https://www.gov.cn/zhengce/zhengceku/2018-12/31/content_5442594.htm
Mentioned in
- If you are depressed or thinking about suicide, call 12356 (China's national mental-health hotline), and don't keep a stock of sleeping pills or pesticide at home
- When a suicidal thought comes up, tell one person near you first, and hand over those next few dozen minutes
- Don't gamble on “a few days lying down and I'll be fine” after a fall from a height: most people who reach a trauma ICU survive, but the cost is counted in years
- Don't treat death as a way to clear a debt: life insurance doesn't pay out within two years, work injury is not recognized, and debts still come out of the estate first
Translated from the Chinese original. Original book, section 1, tip 33. This section is about health and medicines. It is general information, not a substitute for a doctor’s diagnosis or prescription. Content may be out of date and rules differ by place. When you actually deal with an agency, a doctor or a court, follow what local officials, doctors and lawyers tell you. Disclaimer