Homicidal paraquat poisoning: Poisoned while drinking

The incidence of paraquat poisoning has significantly decreased with the addition of odorizer and emetics to the liquid concentrate. Paraquat poisonings are usually attributed to suicidal and accidental or occupational exposure. Here, we report an unusual fatal case of homicidal paraquat poisoning. An intoxicated, a 37-year-old man consumed a mixture of white wine and paraquat prepared by his wife. This resulted in intermittent vomiting, which he attributed to being intoxicated. The man was admitted to the hospital for treatment 3 days later. Due to the lack of knowledge of paraquat exposure, the man did not receive effective treatment and died of respiratory failure 22 days later. High-performance liquid chromatography-tandem mass spectrometry (HPLC-MS/MS) was applied to detect paraquat in 16 postmortem specimens: kidney (1.31 ug/g), urine (0.91 ug/ml), liver (0.62 ug/g), lung (0.39 ug/g), muscle (0.35 ug/g), bile (0.32 ug/ml), heart (0.28 ug/g), brain (0.22 ug/g), pancreas (0.22 ug/g), spleen (0.18 ug/g), cardiac blood (0.15 ug/ml), cerebrospinal fluid (0.14 ug/ml), pericardial effusion (0.12 ug/ml), pleural effusion (0.09 ug/ml), peripheral blood (0.08 ug/ml), and vitreous humor (0.06 ug/ml). The highest concentration of paraquat was detected in the kidney followed by the urine in all tissues and body fluids. At present, although the cases of paraquat poisoning have decreased, the high mortality rate resulting from its irreversible lung damage and respiratory failure makes paraquat poisoning, especially occult paraquat poisoning, still needs to be carefully identified in forensic practice and clinical diagnosis.