Case Report: A Case of Successful Rescue of Compartment Syndrome after Diquat Poisoning

Case Report: A Case of Successful Rescue of Compartment Syndrome after Diquat Poisoning | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Short Report Case Report: A Case of Successful Rescue of Compartment Syndrome after Diquat Poisoning Xisheng Zheng, Feng Yongli, Zhang Chaoyuan, Zhang Tai'an, Sun Xiuqin, and 7 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7410383/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 16 You are reading this latest preprint version Abstract A retrospective analysis was conducted on the clinical data of one patient with compartment syndrome caused by paraquat dichloride poisoning who was successfully treated in Nanyang Central Hospital in May 2025. After the patient took paraquat dichloride by himself, he received treatment such as gastric lavage and catharsis in a local hospital. Due to the critical condition, he was transferred to Nanyang Central Hospital, where he was diagnosed with acute renal failure and rhabdomyolysis. Treatments including hemoperfusion and continuous veno-venous hemofiltration (CVVH) were given. Compartment syndrome was diagnosed in a timely manner, and decompressive fasciotomy was performed. Eventually, the patient was successfully cured and discharged. So far, this is the first successfully treated case of paraquat dichloride poisoning complicated with rhabdomyolysis and compartment syndrome, which will enrich the experience in the treatment of paraquat dichloride poisoning, help detect the complications of paraquat dichloride poisoning at an early stage, and attract high attention from doctors. Diquat poisoning Rhabdomyolysis Osteofascial compartment syndrome Figures Figure 1 Figure 2 Figure 3 Figure 4 Introduction Diquat (1,1’-ethylene-2,2’-bipyridilium) is a nonselective bipyridyl herbicide, related structurally to paraquat[ 1 ].The national poison data system of the United States revealed 2,128 cases of diquat poisoning between 1998 and 2013[ 2 ].Diquat, like paraquat, is a potent redox cycler and its toxic effects depend on its ability to undergo a single electron addition to form a free radical. This occurs in the presence of NADPH and cytochrome P450 reductase[ 3 ].The diquat radical formed in this step is highly unstable and transfers an electron to molecular oxygen to form a superoxide anion radical, a highly reactive species.The superoxide anion radicals produced from the redox cycling of diquat react with each other forming hydrogen peroxide and molecular oxygen.In the presence of iron, the superoxide anion radical reacts with hydrogen peroxide generating the even more potent hydroxyl radical. The hydroxyl radical can attack the lipid chains of biological membranes initiating lipid peroxidation which causes membrane damage and ultimately cell death[ 4 ].Acute diquat poisoning damaged the kidney, liver, and central nervous systems,and subsequent multiple-organ failure syndromes were the main cause of death[ 5 ]. Diquat poisoning caused acute kidney injury (AKI) as much as 73.3%, which was higher than other types of pesticide poisoning[ 6 – 8 ]. In cases of severe diquat poisoning, complications such as respiratory failure, heart failure, arrhythmia, epilepsy, and even intracerebral hemorrhage may be induced [ 9 – 10 ]. Rhabdomyolysis is rarely reported in diquat poisoning [ 11 – 12 ]. The first reported patient with diquat poisoning-induced compartment syndrome eventually failed to be rescued and died of respiratory failure [ 13 ]. Case description Patient: Male, 22 years old, admitted to our hospital with the main complaint of "sore throat for more than 1 day after oral ingestion of 'diquat'". The patient took 20ml of 25% diquat orally one day ago, and a small amount of diquat was vomited onto his lower limbs, followed by sore throat. He went to the emergency department of the local county hospital 2 hours later, and anuria occurred there. A complete blood count was performed:WBC12.81×10^9/L, N84.7%, HGB 161g/L, PLT 272×10^9/L, CRP0.16mg/L;血生化: UA533umol/L, CK 99U/L, CKMB 18U/L, AST 3.3 U/L, Cr 76 umol/L, BUN6.09mmol/L, Ca2.66mmol/L。Toxicant monitoring showed: blood diquat concentration: 78.571ug/ml, urine diquat concentration: 0.472ug/ml. Acute pesticide poisoning, liver function damage, and renal failure were considered. After admission, treatments such as gastric lavage, fluid replacement, two sessions of HA330 hemoperfusion, and continuous hemodialysis were immediately given. Two hours after admission, the patient developed muscle pain and numbness in both lower limbs, and a re-examination was conducted on the second day༚WBC16.7×10^9/L, N87.6%, HGB 144g/L, PLT 254×10^9/L, CRP6.24mg/L༛血生化༚TBIL 36.1umol/L, DBIL 9.1umol/L, ALT20.5U/L, AST 110 U/L, CK 5680.9U/L, CKMB 63.8U/L, Cr 186.2 umol/L, BUN5.94mmol/L, Ca2.29mmol/L, Myoglobin > 1200 ng/ml, troponin < 0.01 ng/ml, LDH 250.6 U/L. Due to the critical condition, the patient was transferred to the ICU of our hospital. On admission examination:T 36.6℃, P 78次/分, R 17次/分, BP 101 /62mmHg, H 175cm, W 70.0kg, BMI22.9(kg/m2), SPO2༈air༉100%, The patient was conscious and pushed into the ward. Physical examination: pharynx was red with scattered ulcers, and the patient complained of eye pain; no other abnormalities were found.Test report of lymphocyte immune analysis (relative count + absolute count) on May 15, 2025:Percentage of helper/inducer T lymphocytes: 29.38% (↓),Absolute count of lymphocytes: 322.00 cells/µl (↓),Absolute count of total T lymphocytes: 183.00 cells/µl (↓),Absolute count of helper/inducer T lymphocytes: 94.00 cells/µl (↓),Absolute count of suppressor/cytotoxic T lymphocytes: 84.00 cells/µl (↓),Absolute count of B lymphocytes: 71.00 cells/µl (↓),Absolute count of NK lymphocytes: 67.00 cells/µl (↓)Immediately, the local areas of the lower limbs exposed to vomited diquat were thoroughly rinsed with clean water. Treatments including catharsis, enema, activated charcoal adsorption of toxins, fluid replacement, urine alkalinization, and blood purification were administered. Antioxidant and free radical scavenging therapies with reduced glutathione, vitamin C, and acetylcysteine, as well as anti-inflammatory treatment with methylprednisolone sodium succinate were given. Meanwhile, analgesia and sedation, nutritional support, acid suppression to prevent gastrointestinal bleeding, myocardial nutrition, liver function protection, renal support, and stabilization of the internal environment were provided. On the 4th day after the onset, the patient's lower limbs swelling and pain worsened, with numbness below the middle segment of the lower legs. The circumference of both lower legs increased by 2 cm compared with the previous day. Color Doppler ultrasound showed no thrombus in the arteries and veins of the lower limbs; The skin shows a mottled red and white appearance, with weakened pulsations in the bilateral dorsalis pedis arteries, and the skin temperature of both feet and toes decreased(Fig. 1 ). It was considered as diquat poisoning complicated with rhabdomyolysis and bilateral lower leg compartment syndrome. Emergency bilateral lower leg fasciotomy for decompression with VSD (vacuum sealing drainage) negative pressure suction was performed(Fig. 2 ). On the 5th day after the onset, the distending pain in the patient's lower limbs was relieved compared with before, but eye pain still persisted. Re-examination showed that the blood diquat concentration was 0.364ug/mll, and the urine diquat concentration was 8.615ug/ml. On the 7th day after the onset, the pain in both lower limbs and eyes was relieved. Re-examination showed that the blood diquat concentration was 0.025 µg/ml, and the urine diquat concentration was 0.143 µg/ml. The re-examined blood toxin concentrations during the patient's hospitalization are shown in Table 1 below: Table 1 Diquat concentrations in blood and urine during hospitalization Time 5.13(D1) 5.15(D3) 5.17(D5) 5.19(D7) 5.22(D10) Blood diquat concentration(ug/ml) 78.571 2.573 0.364 0.025 0.015 Urine diquat concentration(ug/ml) 0.472 4.308 8.615 0.143 0.756 On the 13th day after the onset, the patient's urine output was 3080 ml/day. On the 35th day after the onset, the blood creatinine (Cr) was 96 µmol/L and blood urea nitrogen (BUN) was 6.30 mmol/L, both of which returned to normal. Subsequently, the incisions on both lower limbs healed, and the patient was discharged. The patient was followed up 10 days after discharge, and he recovered well with only a slight limp in the left lower limb(Fig. 3 ). Discussion Current literature reports that acute diquat poisoning can damage the kidneys, liver, and central nervous system, and subsequent multiple organ failure syndrome is the main cause of death [ 5 ]. The incidence of acute kidney injury (AKI) caused by diquat poisoning is as high as 73.3%, which is higher than that of other types of pesticide poisoning [ 6 – 8 ]. In cases of severe diquat poisoning, complications such as respiratory failure, heart failure, arrhythmia, epilepsy, and even cerebral hemorrhage may be induced [ 9 – 10 ]. Rhabdomyolysis is rarely reported in diquat poisoning [ 11 , 12 ].Diquat can cross the placenta [ 13 ]. Shang Ruikai et al. reported another patient who ingested diquat, developed a pontine hematoma and subsequently suffered a miscarriage [ 14 ]. In 2025, the first reported case of compartment syndrome caused by diquat poisoning resulted in rescue failure, with the patient dying of respiratory failure [ 15 ]. Acute compartment syndrome (ACS), as one of the severe complications after fractures, affects 30.4% of patients with tibial shaft and proximal fractures, and is particularly common in patients with comminuted fractures or tibial plateau fractures [ 16 – 18 ]. For patients with rhabdomyolysis caused by diquat poisoning, fluid replacement, urine alkalinization, and promotion of urination can be applied, and renal dialysis can be used as an auxiliary treatment for patients with renal failure [ 19 ]. It is necessary to observe the affected limbs and detect tissue edema in a timely manner. If conditions permit, intermuscular pressure monitoring should be performed. Once compartment syndrome is diagnosed or suspected, decompressive fasciotomy of the affected limb should be performed immediately, while preventing infection at the incision site. Early rehabilitation exercises should be carried out to preserve limb function as much as possible. According to literature reports, 29.4% of rhabdomyolysis cases present with varying degrees of infiltration of CD3, CD4 and/or CD8 positive lymphocytes [ 20 ]. The most common triggers of rhabdomyolysis in adults are trauma and drugs. In the pathological analysis of the skeletal muscle of the affected limb in this case, lymphocytes and scattered eosinophils were found in the muscle tissue(Fig. 4 ), which provides more active schemes and ideas for further precise treatment of diquat poisoning. In acute compartment syndrome, 69% of cases are triggered by fractures, 23% by non-fracture soft tissue trauma, and 9% by non-traumatic causes [ 21 ]. Those caused by poisoning are relatively rare. A study found that among 187 patients with compartment syndrome, only 6 cases were caused by venomous snake bites [ 22 ]. Carbon monoxide poisoning [ 23 ] and paraquat poisoning [ 24 ] can also lead to compartment syndrome, while those caused by rodenticide poisoning are even rarer [ 25 – 27 ]. Studies have shown that rhabdomyolysis and non-traumatic compartment syndrome may occur due to cocaine use [ 28 ]. Compartment syndrome is a rare complication of snake bites. Among 219 cases of viper bites in Switzerland, the incidence of compartment syndrome was reported to be 1.4% [ 29 ]; among 147 cases in Greece, the incidence was 1.36% [ 30 ]. The clinical manifestations of acute compartment syndrome are usually described by the "five Ps": pallor, disproportionate pain, pulselessness, paresthesia, and paralysis [ 31 ]. For patients with acute compartment syndrome, the preferred treatment is timely surgical fasciotomy. The prolongation of the time to surgical intervention is associated with an increase in tissue necrosis rate, amputation rate, and mortality. Patients diagnosed with non-traumatic compartment syndrome (FDECS) tend to have poor clinical outcomes [ 32 ]. In summary, the clinical manifestations of diquat poisoning are relatively complex, and cases complicated with rhabdomyolysis and compartment syndrome are particularly rare. The successful treatment of this case suggests that close observation, active continuous renal replacement therapy (CRRT), and timely decompressive fasciotomy are effective treatment measures. Declarations Ethical Approval and Consent to Participate This study has obtained ethical approval from the Human Research Ethics Committee of Nanyang Central Hospital. Before the start of the study, we explained in detail to the patients the purpose, methods, potential risks and benefits of the study, and obtained their written consent to participate. The informed consent form used is comprehensive in content and written in plain language, fully safeguarding the patients' right to information. During the process of obtaining consent, we ensured that patients had sufficient time to consider, patiently answered their questions, and the patients' family members signed the informed consent form after fully understanding and of their own free will. Consent to Publish The patients have signed a special consent form for publication, agreeing to the use of their case - related information for academic publication. The publication consent form clearly states the purpose of publication, the possible scope of content involved, and the protection measures for patients' privacy. The patients are fully aware that their case information may be presented on academic journals and other platforms, and understand the important significance of this for the dissemination and development of medical knowledge, on the basis of which they voluntarily gave their consent to publish. Availability of Supporting Data The supporting data involved in this study, including patients' clinical examination data, laboratory test results, etc., can be provided to interested researchers on the premise of complying with ethics and privacy protection. For access to relevant data, please contact the corresponding author, Zheng Xisheng, via email: [email protected] . The provision of data will strictly abide by relevant data sharing policies and regulations to ensure that patients' privacy is not violated. Conflicts of Interest All authors declare that there are no conflicts of interest in the process of this study, the writing and publication of the article. The authors have not received any commercial funding, consulting fees or other interests that may affect the objectivity and fairness of the research results. An independent and objective scientific attitude was maintained during the research and paper writing process. Funding Support This study received no funding support. Author Contributions Zheng Xisheng was responsible for the conception and design of the study, collecting patients' clinical data, and writing the first draft of the paper. Feng Yongli, Zhang Chaoyuan, Zhang Taian, Sun Xiuqin, Jia Mingya, Li Changli, Xiao Jing, Ma Jing, Zhou Xiaochao, Wei Chao, and Bai Bin participated in the analysis and interpretation of data, and provided professional suggestions and revision opinions on the clinical part of the paper. Zhang Chaoyuan and Feng Yongli assisted in the ethics - related work in the study, ensuring that the study complied with ethical norms, and standardized and proofread the overall format of the paper. All authors have reviewed and approved the final version of the paper and agree to be responsible for all contents of the paper. Acknowledgements The authors sincerely thank the Human Research Ethics Committee of Nanyang Central Hospital for their rigorous work and professional guidance during the ethical approval process, which ensured the compliant conduct of the study. We thank the patients and their families for their active cooperation and trust during the study, which provided valuable case resources for medical research. At the same time, we also thank Nanyang Central Hospital, the unit where the research team is located, for providing administrative support and resource guarantee during the study, which enabled the study to be carried out smoothly. In addition, we express our sincere thanks to Zuo Fangtian, Zhao Congyuan, Yuan Jianghan, Hou Jun, Li Zhen, and Lyu Boyi for their assistance in data collection and analysis. References Jones GM, Vale JA. Mechanisms of toxicity, clinical features, and management of diquat poisoning: a review. J Toxicol Clin Toxicol. 2000;38(2):123-8. doi: 10.1081/clt-100100926. PMID: 10778908. Fortenberry GZ, Beckman J, Schwartz A, Prado JB, Graham LS, Higgins S, Lackovic M, Mulay P, Bojes H, Waltz J, Mitchell Y, Leinenkugel K, Oriel MS, Evans E, Calvert GM. Magnitude and characteristics of acute paraquat- and diquat-related illnesses in the US: 1998-2013. Environ Res. 2016 Apr;146:191-9. doi: 10.1016/j.envres.2016.01.003. Epub 2016 Jan 11. PMID: 26775000; PMCID: PMC4920265. Rawlings JM, Wyatt I, Heylings JR. Evidence for redox recycling of diquat in rat small intestine. Biochem Pharmacol 1994;47:1271–1274. Niesink JM, de Vries J, Hollinger MA. Toxicology: Principles and Applications. Boca Raton: CRC Press, 1996. Xing J, Chu Z, Han D, Jiang X, Zang X, Liu Y, et al. Lethal diquat poisoning manifesting as central pontine myelinolysis and acute kidney injury: a case report and literature review. J Int Med Res. (2020) 48:300060520943824. doi: 10.1177/0300060520943824 Ronco C, Bellomo R, Kellum JA. Acute kidney injury. Lancet. (2019) 394:1949–64.doi: 10.1016/S0140-6736(19)32563-2 Granata A, Distefano G, Pesce F, Battaglia Y, Suavo Bulzis P, Venturini M, et al.Performing an ultrasound-guided percutaneous needle kidney biopsy: an up-to-date procedural review. Diagnostics (Basel). (2021) 11:2186. doi: 10.3390/diagnostics11122186 Guck D, Hernandez R, Moore S, Van de Louw A, Haouzi P. Rapid glomerulotubular nephritis as an initial presentation of a lethal diquat ingestion. Case Rep Nephrol. (2021)2021:4723092. doi: 10.1155/2021/4723092 Magalhaes N, Carvalho F, DinisOliveira R. Human and experimental toxicology of diquat poisoning: toxicokinetics, mechanisms of toxicity, clinical features, and treatment[J]. Hum Exp Toxicol, 2018,37:1131-1160. Xing J, Chu Z, Han D, et al. Lethal diquat poisoning manifesting as central pontine myelinolysis and acute kidney injury: a case report and literature review[J].J Int Med Res, 2020, 48(7):1-6 Feng D, Fu L, Du X, Yao L. Acute diquat poisoning causes rhabdomyolysis. Am J Med Sci. (2022) 364:472–80. doi: 10.1016/j.amjms.2022.04.032 Yu G, Wang J, Jian T, Shi L, Zhao L, Li Y. Case series: diquat poisoning with acute kidney failure, myocardial damage, and rhabdomyolysis. Front Public Health. (2022)10:991587. doi: 10.3389/fpubh.2022.991587 Yu G, Cui S, Jian T, et al. Diquat poisoning in a pregnant woman resulting in a miscarriage and maternal death. Clin Toxicol. 2021; 59(12):1275–1277. doi:10.1080/15563650.2021.1905164. Shang RK, Tian QX, Jian XD, Liu HY, Liu YR, Li QL. A pregnant woman with diquat poisoning leading to miscarriage and pontine haematoma. Clin Toxicol (Phila). 2025 Apr;63(4):296-297. doi: 10.1080/15563650.2025.2454972. Epub 2025 Feb 3. PMID: 39895619. Luo Weidong, Zhang Jun, Shu Tingting. A case of compartment syndrome caused by diquat poisoning[J]. Chinese Journal of Emergency Resuscitation and Disaster Medicine, 2025, 20(02): 276-277. Acklin YP, Potocnik P, Sommer C (2012) Compartment syndrome in dislocation and non-dislocation type proximal tibia fractures: analysis of 356 consecutive cases. Arch Orthop Trauma Surg 132:227–231 Ziran BH, Becher SJ (2013) Radiographic predictors of compartment syndrome in tibial plateau fractures. J Orthop Trauma 27:612–615 Guo J, Yin Y, Jin L, Zhang R, Hou Z, Zhang Y (2019) Acute compartment syndrome: cause, diagnosis, and new viewpoint. Medicine (Baltimore) 98(27):e16260 Yang BF, Li D, Liu CL, Luo Y, Shi J, Guo XQ, Fan HJ, Lv Q. Advances in rhabdomyolysis: A review of pathogenesis, diagnosis, and treatment. Chin J Traumatol. 2025 Feb 27:S1008-1275(25)00010-0. doi: 10.1016/j.cjtee.2024.10.005. Epub ahead of print. PMID: 40082140. Zhao Yawen, Wang Danqing, Deng Jianwen, Yu Meng, Zheng Yiming, Leng Yinglin, Zhang Wei, Wang Chaoxia, Yuan Yun. Value of muscle biopsy in etiological diagnosis of rhabdomyolysis[J]. Chinese Journal of Internal Medicine, 2019, 58(12): 899-904. DOI: 10.3760/cma.j.issn.0578-1426.2019.12.006. McQueen MM, Gaston P, Court-Brown CM. Acute compartment syndrome. Who is at risk? J Bone Joint Surg Br. 2000 Mar;82(2):200-3. PMID: 10755426. Jiang Xiannian. Implementation and Effect Evaluation of Standardized Treatment for Compartment Syndrome [D]. Nanning: Guangxi Medical University, 2018. Zou Lihua, Li Meixiao, Li Hui, Chen Xiaodan. A case of compartment syndrome caused by carbon monoxide poisoning[J]. The Journal of Practical Medicine, 2013, 29(6): 1033. DOI: 10.3969/j.issn.1006-5725.2013.06.076. Zhang Qin. Analysis of 1 case of compartment syndrome caused by paraquat poisoning[J]. World Latest Medicine Information Abstracts (Serial Electronic Journal),2016,16(61):281-281.DOI:10.3969/j.issn.1671-3141.2016.61.191. Sungur M, Güven M. Rhabdomyolysis due to carbon monoxide poisoning. Clin Nephrol 2001;55:336–7. Sefer S, Degoricija V, Bilic´ B, et al. Acute carbon monoxide poisoning as the cause of rhabdomyolysis and acute renal failure. Acta Med Croatica 1999;53:199–202. Abdul-Ghaffar NU, Farghaly MM, Swamy AS. Acute renal failure,compartment syndrome, and systemic capillary leak syndrome complicating carbon monoxide poisoning. J Toxicol Clin Toxicol 1996;34:713–9. Iftikhar MH, Dar AY, Haw A. Cocaine-induced rhabdomyolysis and compartment syndrome. BMJ Case Rep. 2022 May 19;15(5):e249413. doi: 10.1136/bcr-2022-249413. PMID: 35589265; PMCID: PMC9121409. Fuchs J, Gessner T, Kupferschmidt H, Weiler S. Indigenous venomous snakebites in Switzerland: analysis of reports to the National Poisons Information Centre over 22 years. Swiss Med Wkly. 2021;151:w30085. Frangides CY, Koulouras V, Kouni SN, Tzortzatos GV, Nikolaou A, Pneumaticos J, Pierrakeas C, Niarchos C, Kounis NG, Koutsojannis CM. Snake venom poisoning in Greece. Experiences with 147 cases. Eur J Intern Med. 2006;17:24–7. von Keudell AG, Weaver MJ, Appleton PT, Bae DS, Dyer GSM, Heng M, Jupiter JB, Vrahas MS. Diagnosis and treatment of acute extremity compartment syndrome. Lancet. Erratum in: Lancet. 2015 Nov 7;386(10006):1824. doi: 10.1016/S0140-6736(15)00768-0. PMID: 26460664. Smith RDJ, Mortensen SJ, Zhang D, Smith MR, Weaver MJ, von Keudell AG. Found Down Extremity Compartment Syndrome Secondary to Substance Use: An Observational Multicenter Study. JB JS Open Access. 2021 Oct 6;6(4):e21.00038. doi: 10.2106/JBJS.OA.21.00038. PMID: 34646972; PMCID: PMC8500555. Additional Declarations No competing interests reported. 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Hospital","correspondingAuthor":false,"prefix":"","firstName":"Wei","middleName":"","lastName":"Chao","suffix":""},{"id":516895394,"identity":"079430b1-0b5d-45f3-a49a-d40737f37434","order_by":11,"name":"Bai Bin","email":"","orcid":"","institution":"Nanyang Central Hospital","correspondingAuthor":false,"prefix":"","firstName":"Bai","middleName":"","lastName":"Bin","suffix":""}],"badges":[],"createdAt":"2025-08-19 16:08:11","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7410383/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7410383/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":91959585,"identity":"2fef1bf5-3dfc-4240-bf33-11e0777b6cf1","added_by":"auto","created_at":"2025-09-23 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07:39:39","extension":"png","order_by":10,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":180299,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage4.png","url":"https://assets-eu.researchsquare.com/files/rs-7410383/v1/9e5815673d1969c8480af780.png"},{"id":91959589,"identity":"e921e279-f81e-4224-b44a-57d981daf10d","added_by":"auto","created_at":"2025-09-23 07:39:39","extension":"xml","order_by":11,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":72144,"visible":true,"origin":"","legend":"","description":"","filename":"1a424f83f51b40609befb058922a23501structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-7410383/v1/56f5125df17629293605d816.xml"},{"id":91960654,"identity":"98bb5557-1800-4b74-b148-c183626f1067","added_by":"auto","created_at":"2025-09-23 07:47:39","extension":"html","order_by":12,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":81289,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7410383/v1/ed05c8c76ecbce4c2ff31aa5.html"},{"id":91962600,"identity":"1e20ad47-06f0-4bd6-b0fb-5dc418877ec1","added_by":"auto","created_at":"2025-09-23 07:55:39","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":331352,"visible":true,"origin":"","legend":"\u003cp\u003eThe skin of the patient's lower extremities showed alternating red and white mottling.\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-7410383/v1/7350644e9efbb1902eab0005.png"},{"id":91959582,"identity":"cf19f8e4-d8f5-4330-b500-9cdf5cfc948d","added_by":"auto","created_at":"2025-09-23 07:39:39","extension":"jpeg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":55099,"visible":true,"origin":"","legend":"\u003cp\u003eEmergency fasciotomy for decompression with VSD (Vacuum Sealing Drainage) negative pressure suction was performed on both lower extremities.\u003c/p\u003e","description":"","filename":"floatimage2.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7410383/v1/606bc746f2019f7033b0655f.jpeg"},{"id":91960652,"identity":"f96bacff-b27a-43f8-90a5-bd6957e9bd32","added_by":"auto","created_at":"2025-09-23 07:47:39","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":271716,"visible":true,"origin":"","legend":"\u003cp\u003eFollow-up after discharge showed that the wounds on the patient's lower extremities healed well.\u003c/p\u003e","description":"","filename":"floatimage3.png","url":"https://assets-eu.researchsquare.com/files/rs-7410383/v1/7b0fb2c56b16ae02d862469f.png"},{"id":91959586,"identity":"e3657e5d-c297-4d97-9ec2-7045442f1f4f","added_by":"auto","created_at":"2025-09-23 07:39:39","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":341495,"visible":true,"origin":"","legend":"\u003cp\u003eLower extremity muscle biopsy: (Calf muscle) Lymphocytes and scattered eosinophils were observed between muscle tissues; hemorrhage, inflammatory necrosis and suppurative inflammation were present in some areas; in addition, irregular, structureless substances with light red staining (considered as gelatin sponge) were seen.\u003c/p\u003e","description":"","filename":"4.png","url":"https://assets-eu.researchsquare.com/files/rs-7410383/v1/2a39d49c6919d35424f28be9.png"},{"id":91962603,"identity":"9bc24f28-ce1a-412f-9d58-57bae26275d8","added_by":"auto","created_at":"2025-09-23 07:55:44","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1482997,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7410383/v1/ac500f15-28a5-4ca2-bba9-27724f218250.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Case Report: A Case of Successful Rescue of Compartment Syndrome after Diquat Poisoning","fulltext":[{"header":"Introduction","content":"\u003cp\u003eDiquat (1,1’-ethylene-2,2’-bipyridilium) is a nonselective bipyridyl herbicide, related structurally to paraquat[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e].The national poison data system of the United States revealed 2,128 cases of diquat poisoning between 1998 and 2013[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].Diquat, like paraquat, is a potent redox cycler and its toxic effects depend on its ability to undergo a single electron addition to form a free radical. This occurs in the presence of NADPH and cytochrome P450 reductase[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].The diquat radical formed in this step is highly unstable and transfers an electron to molecular oxygen to form a superoxide anion radical, a highly reactive species.The superoxide anion radicals produced from the redox cycling of diquat react with each other forming hydrogen peroxide and molecular oxygen.In the presence of iron, the superoxide anion radical reacts with hydrogen peroxide generating the even more potent hydroxyl radical. The hydroxyl radical can attack the lipid chains of biological membranes initiating lipid peroxidation which causes membrane damage and ultimately cell death[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].Acute diquat poisoning damaged the kidney, liver, and central nervous systems,and subsequent multiple-organ failure syndromes were the main cause of death[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Diquat poisoning caused acute kidney injury (AKI) as much as 73.3%, which was higher than other types of pesticide poisoning[\u003cspan additionalcitationids=\"CR7\" citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e–\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. In cases of severe diquat poisoning, complications such as respiratory failure, heart failure, arrhythmia, epilepsy, and even intracerebral hemorrhage may be induced [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e–\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Rhabdomyolysis is rarely reported in diquat poisoning [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e–\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. The first reported patient with diquat poisoning-induced compartment syndrome eventually failed to be rescued and died of respiratory failure [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e"},{"header":"Case description","content":"\u003cp\u003ePatient: Male, 22 years old, admitted to our hospital with the main complaint of \"sore throat for more than 1 day after oral ingestion of 'diquat'\". The patient took 20ml of 25% diquat orally one day ago, and a small amount of diquat was vomited onto his lower limbs, followed by sore throat. He went to the emergency department of the local county hospital 2 hours later, and anuria occurred there. A complete blood count was performed:WBC12.81×10^9/L, N84.7%, HGB 161g/L, PLT 272×10^9/L, CRP0.16mg/L;血生化: UA533umol/L, CK 99U/L, CKMB 18U/L, AST 3.3 U/L, Cr 76 umol/L, BUN6.09mmol/L, Ca2.66mmol/L。Toxicant monitoring showed: blood diquat concentration: 78.571ug/ml, urine diquat concentration: 0.472ug/ml. Acute pesticide poisoning, liver function damage, and renal failure were considered. After admission, treatments such as gastric lavage, fluid replacement, two sessions of HA330 hemoperfusion, and continuous hemodialysis were immediately given. Two hours after admission, the patient developed muscle pain and numbness in both lower limbs, and a re-examination was conducted on the second day༚WBC16.7×10^9/L, N87.6%, HGB 144g/L, PLT 254×10^9/L, CRP6.24mg/L༛血生化༚TBIL 36.1umol/L, DBIL 9.1umol/L, ALT20.5U/L, AST 110 U/L, CK 5680.9U/L, CKMB 63.8U/L, Cr 186.2 umol/L, BUN5.94mmol/L, Ca2.29mmol/L, Myoglobin \u0026gt; 1200 ng/ml, troponin \u0026lt; 0.01 ng/ml, LDH 250.6 U/L. Due to the critical condition, the patient was transferred to the ICU of our hospital.\u003c/p\u003e\u003cp\u003eOn admission examination:T 36.6℃, P 78次/分, R 17次/分, BP 101 /62mmHg, H 175cm, W 70.0kg, BMI22.9(kg/m2), SPO2༈air༉100%, The patient was conscious and pushed into the ward. Physical examination: pharynx was red with scattered ulcers, and the patient complained of eye pain; no other abnormalities were found.Test report of lymphocyte immune analysis (relative count + absolute count) on May 15, 2025:Percentage of helper/inducer T lymphocytes: 29.38% (↓),Absolute count of lymphocytes: 322.00 cells/µl (↓),Absolute count of total T lymphocytes: 183.00 cells/µl (↓),Absolute count of helper/inducer T lymphocytes: 94.00 cells/µl (↓),Absolute count of suppressor/cytotoxic T lymphocytes: 84.00 cells/µl (↓),Absolute count of B lymphocytes: 71.00 cells/µl (↓),Absolute count of NK lymphocytes: 67.00 cells/µl (↓)Immediately, the local areas of the lower limbs exposed to vomited diquat were thoroughly rinsed with clean water. Treatments including catharsis, enema, activated charcoal adsorption of toxins, fluid replacement, urine alkalinization, and blood purification were administered. Antioxidant and free radical scavenging therapies with reduced glutathione, vitamin C, and acetylcysteine, as well as anti-inflammatory treatment with methylprednisolone sodium succinate were given. Meanwhile, analgesia and sedation, nutritional support, acid suppression to prevent gastrointestinal bleeding, myocardial nutrition, liver function protection, renal support, and stabilization of the internal environment were provided.\u003c/p\u003e\u003cp\u003eOn the 4th day after the onset, the patient's lower limbs swelling and pain worsened, with numbness below the middle segment of the lower legs. The circumference of both lower legs increased by 2 cm compared with the previous day. Color Doppler ultrasound showed no thrombus in the arteries and veins of the lower limbs; The skin shows a mottled red and white appearance, with weakened pulsations in the bilateral dorsalis pedis arteries, and the skin temperature of both feet and toes decreased(Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eIt was considered as diquat poisoning complicated with rhabdomyolysis and bilateral lower leg compartment syndrome. Emergency bilateral lower leg fasciotomy for decompression with VSD (vacuum sealing drainage) negative pressure suction was performed(Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eOn the 5th day after the onset, the distending pain in the patient's lower limbs was relieved compared with before, but eye pain still persisted. Re-examination showed that the blood diquat concentration was 0.364ug/mll, and the urine diquat concentration was 8.615ug/ml.\u003c/p\u003e\u003cp\u003eOn the 7th day after the onset, the pain in both lower limbs and eyes was relieved. Re-examination showed that the blood diquat concentration was 0.025 µg/ml, and the urine diquat concentration was 0.143 µg/ml. The re-examined blood toxin concentrations during the patient's hospitalization are shown in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e below:\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eDiquat concentrations in blood and urine during hospitalization\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003c/colgroup\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTime\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5.13(D1)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5.15(D3)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e5.17(D5)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003e5.19(D7)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003e5.22(D10)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBlood diquat concentration(ug/ml)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e78.571\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2.573\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.364\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.025\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.015\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUrine diquat concentration(ug/ml)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.472\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e4.308\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e8.615\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.143\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.756\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/table\u003e\u003c/div\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eOn the 13th day after the onset, the patient's urine output was 3080 ml/day. On the 35th day after the onset, the blood creatinine (Cr) was 96 µmol/L and blood urea nitrogen (BUN) was 6.30 mmol/L, both of which returned to normal. Subsequently, the incisions on both lower limbs healed, and the patient was discharged. The patient was followed up 10 days after discharge, and he recovered well with only a slight limp in the left lower limb(Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eCurrent literature reports that acute diquat poisoning can damage the kidneys, liver, and central nervous system, and subsequent multiple organ failure syndrome is the main cause of death [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. The incidence of acute kidney injury (AKI) caused by diquat poisoning is as high as 73.3%, which is higher than that of other types of pesticide poisoning [\u003cspan additionalcitationids=\"CR7\" citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. In cases of severe diquat poisoning, complications such as respiratory failure, heart failure, arrhythmia, epilepsy, and even cerebral hemorrhage may be induced [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Rhabdomyolysis is rarely reported in diquat poisoning [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e].Diquat can cross the placenta [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Shang Ruikai et al. reported another patient who ingested diquat, developed a pontine hematoma and subsequently suffered a miscarriage [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. In 2025, the first reported case of compartment syndrome caused by diquat poisoning resulted in rescue failure, with the patient dying of respiratory failure [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Acute compartment syndrome (ACS), as one of the severe complications after fractures, affects 30.4% of patients with tibial shaft and proximal fractures, and is particularly common in patients with comminuted fractures or tibial plateau fractures [\u003cspan additionalcitationids=\"CR17\" citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eFor patients with rhabdomyolysis caused by diquat poisoning, fluid replacement, urine alkalinization, and promotion of urination can be applied, and renal dialysis can be used as an auxiliary treatment for patients with renal failure [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. It is necessary to observe the affected limbs and detect tissue edema in a timely manner. If conditions permit, intermuscular pressure monitoring should be performed. Once compartment syndrome is diagnosed or suspected, decompressive fasciotomy of the affected limb should be performed immediately, while preventing infection at the incision site. Early rehabilitation exercises should be carried out to preserve limb function as much as possible. According to literature reports, 29.4% of rhabdomyolysis cases present with varying degrees of infiltration of CD3, CD4 and/or CD8 positive lymphocytes [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. The most common triggers of rhabdomyolysis in adults are trauma and drugs. In the pathological analysis of the skeletal muscle of the affected limb in this case, lymphocytes and scattered eosinophils were found in the muscle tissue(Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e), which provides more active schemes and ideas for further precise treatment of diquat poisoning.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eIn acute compartment syndrome, 69% of cases are triggered by fractures, 23% by non-fracture soft tissue trauma, and 9% by non-traumatic causes [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Those caused by poisoning are relatively rare. A study found that among 187 patients with compartment syndrome, only 6 cases were caused by venomous snake bites [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Carbon monoxide poisoning [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e] and paraquat poisoning [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e] can also lead to compartment syndrome, while those caused by rodenticide poisoning are even rarer [\u003cspan additionalcitationids=\"CR26\" citationid=\"CR26\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. Studies have shown that rhabdomyolysis and non-traumatic compartment syndrome may occur due to cocaine use [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. Compartment syndrome is a rare complication of snake bites. Among 219 cases of viper bites in Switzerland, the incidence of compartment syndrome was reported to be 1.4% [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e29\u003c/span\u003e]; among 147 cases in Greece, the incidence was 1.36% [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e30\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe clinical manifestations of acute compartment syndrome are usually described by the \"five Ps\": pallor, disproportionate pain, pulselessness, paresthesia, and paralysis [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. For patients with acute compartment syndrome, the preferred treatment is timely surgical fasciotomy. The prolongation of the time to surgical intervention is associated with an increase in tissue necrosis rate, amputation rate, and mortality. Patients diagnosed with non-traumatic compartment syndrome (FDECS) tend to have poor clinical outcomes [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e32\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eIn summary, the clinical manifestations of diquat poisoning are relatively complex, and cases complicated with rhabdomyolysis and compartment syndrome are particularly rare. The successful treatment of this case suggests that close observation, active continuous renal replacement therapy (CRRT), and timely decompressive fasciotomy are effective treatment measures.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch3\u003eEthical Approval and Consent to Participate\u003c/h3\u003e\n\u003cp\u003eThis study has obtained ethical approval from the Human Research Ethics Committee of Nanyang Central Hospital. Before the start of the study, we explained in detail to the patients the purpose, methods, potential risks and benefits of the study, and obtained their written consent to participate. The informed consent form used is comprehensive in content and written in plain language, fully safeguarding the patients\u0026apos; right to information. During the process of obtaining consent, we ensured that patients had sufficient time to consider, patiently answered their questions, and the patients\u0026apos; family members signed the informed consent form after fully understanding and of their own free will.\u003c/p\u003e\n\u003ch3\u003eConsent to Publish\u003c/h3\u003e\n\u003cp\u003eThe patients have signed a special consent form for publication, agreeing to the use of their case - related information for academic publication. The publication consent form clearly states the purpose of publication, the possible scope of content involved, and the protection measures for patients\u0026apos; privacy. The patients are fully aware that their case information may be presented on academic journals and other platforms, and understand the important significance of this for the dissemination and development of medical knowledge, on the basis of which they voluntarily gave their consent to publish.\u003c/p\u003e\n\u003ch3\u003eAvailability of Supporting Data\u003c/h3\u003e\n\u003cp\u003eThe supporting data involved in this study, including patients\u0026apos; clinical examination data, laboratory test results, etc., can be provided to interested researchers on the premise of complying with ethics and privacy protection. For access to relevant data, please contact the corresponding author, Zheng Xisheng, via email: [email protected]. The provision of data will strictly abide by relevant data sharing policies and regulations to ensure that patients\u0026apos; privacy is not violated.\u003c/p\u003e\n\u003ch3\u003eConflicts of Interest\u003c/h3\u003e\n\u003cp\u003eAll authors declare that there are no conflicts of interest in the process of this study, the writing and publication of the article. The authors have not received any commercial funding, consulting fees or other interests that may affect the objectivity and fairness of the research results. An independent and objective scientific attitude was maintained during the research and paper writing process.\u003c/p\u003e\n\u003ch3\u003eFunding Support\u003c/h3\u003e\n\u003cp\u003eThis study received no funding support.\u003c/p\u003e\n\u003ch3\u003eAuthor Contributions\u003c/h3\u003e\n\u003cp\u003eZheng Xisheng was responsible for the conception and design of the study, collecting patients\u0026apos; clinical data, and writing the first draft of the paper. Feng Yongli, Zhang Chaoyuan, Zhang Taian, Sun Xiuqin, Jia Mingya, Li Changli, Xiao Jing, Ma Jing, Zhou Xiaochao, Wei Chao, and Bai Bin participated in the analysis and interpretation of data, and provided professional suggestions and revision opinions on the clinical part of the paper. Zhang Chaoyuan and Feng Yongli assisted in the ethics - related work in the study, ensuring that the study complied with ethical norms, and standardized and proofread the overall format of the paper. All authors have reviewed and approved the final version of the paper and agree to be responsible for all contents of the paper.\u003c/p\u003e\n\u003ch3\u003eAcknowledgements\u003c/h3\u003e\n\u003cp\u003eThe authors sincerely thank the Human Research Ethics Committee of Nanyang Central Hospital for their rigorous work and professional guidance during the ethical approval process, which ensured the compliant conduct of the study. We thank the patients and their families for their active cooperation and trust during the study, which provided valuable case resources for medical research. At the same time, we also thank Nanyang Central Hospital, the unit where the research team is located, for providing administrative support and resource guarantee during the study, which enabled the study to be carried out smoothly. In addition, we express our sincere thanks to Zuo Fangtian, Zhao Congyuan, Yuan Jianghan, Hou Jun, Li Zhen, and Lyu Boyi for their assistance in data collection and analysis.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eJones GM, Vale JA. Mechanisms of toxicity, clinical features, and management of diquat poisoning: a review. J Toxicol Clin Toxicol. 2000;38(2):123-8. doi: 10.1081/clt-100100926. PMID: 10778908.\u003c/li\u003e\n \u003cli\u003eFortenberry GZ, Beckman J, Schwartz A, Prado JB, Graham LS, Higgins S, Lackovic M, Mulay P, Bojes H, Waltz J, Mitchell Y, Leinenkugel K, Oriel MS, Evans E, Calvert GM. Magnitude and characteristics of acute paraquat- and diquat-related illnesses in the US: 1998-2013. Environ Res. 2016 Apr;146:191-9. doi: 10.1016/j.envres.2016.01.003. Epub 2016 Jan 11. PMID: 26775000; PMCID: PMC4920265.\u003c/li\u003e\n \u003cli\u003eRawlings JM, Wyatt I, Heylings JR. Evidence for redox recycling of diquat in rat small intestine. Biochem Pharmacol 1994;47:1271\u0026ndash;1274.\u003c/li\u003e\n \u003cli\u003eNiesink JM, de Vries J, Hollinger MA. Toxicology: Principles and Applications. Boca Raton: CRC Press, 1996.\u003c/li\u003e\n \u003cli\u003eXing J, Chu Z, Han D, Jiang X, Zang X, Liu Y, et al. Lethal diquat poisoning manifesting as central pontine myelinolysis and acute kidney injury: a case report and literature review. J Int Med Res. (2020) 48:300060520943824. doi: 10.1177/0300060520943824\u003c/li\u003e\n \u003cli\u003eRonco C, Bellomo R, Kellum JA. Acute kidney injury. Lancet. (2019) 394:1949\u0026ndash;64.doi: 10.1016/S0140-6736(19)32563-2\u003c/li\u003e\n \u003cli\u003eGranata A, Distefano G, Pesce F, Battaglia Y, Suavo Bulzis P, Venturini M, et al.Performing an ultrasound-guided percutaneous needle kidney biopsy: an up-to-date procedural review. Diagnostics (Basel). (2021) 11:2186. doi: 10.3390/diagnostics11122186\u003c/li\u003e\n \u003cli\u003eGuck D, Hernandez R, Moore S, Van de Louw A, Haouzi P. Rapid glomerulotubular nephritis as an initial presentation of a lethal diquat ingestion. Case Rep Nephrol. (2021)2021:4723092. doi: 10.1155/2021/4723092\u003c/li\u003e\n \u003cli\u003eMagalhaes N, Carvalho F, DinisOliveira R. Human and experimental toxicology of diquat poisoning: toxicokinetics, mechanisms of toxicity, clinical features, and treatment[J]. Hum Exp Toxicol, 2018,37:1131-1160.\u003c/li\u003e\n \u003cli\u003eXing J, Chu Z, Han D, et al. Lethal diquat poisoning manifesting as central pontine myelinolysis and acute kidney injury: a case report and literature review[J].J Int Med Res, 2020, 48(7):1-6\u003c/li\u003e\n \u003cli\u003eFeng D, Fu L, Du X, Yao L. Acute diquat poisoning causes rhabdomyolysis. Am J Med Sci. (2022) 364:472\u0026ndash;80. doi: 10.1016/j.amjms.2022.04.032\u003c/li\u003e\n \u003cli\u003eYu G, Wang J, Jian T, Shi L, Zhao L, Li Y. Case series: diquat poisoning with acute kidney failure, myocardial damage, and rhabdomyolysis. Front Public Health. (2022)10:991587. doi: 10.3389/fpubh.2022.991587\u003c/li\u003e\n \u003cli\u003eYu G, Cui S, Jian T, et \u0026nbsp;al. Diquat poisoning in a pregnant woman\u0026nbsp; resulting in a miscarriage and maternal death. Clin Toxicol. 2021; 59(12):1275\u0026ndash;1277. doi:10.1080/15563650.2021.1905164.\u003c/li\u003e\n \u003cli\u003eShang RK, Tian QX, Jian XD, Liu HY, Liu YR, Li QL. A pregnant woman with diquat poisoning leading to miscarriage and pontine haematoma. Clin Toxicol (Phila). 2025 Apr;63(4):296-297. doi: 10.1080/15563650.2025.2454972. Epub 2025 Feb 3. PMID: 39895619.\u003c/li\u003e\n \u003cli\u003eLuo Weidong, Zhang Jun, Shu Tingting. A case of compartment syndrome caused by diquat poisoning[J]. Chinese Journal of Emergency Resuscitation and Disaster Medicine, 2025, 20(02): 276-277.\u003c/li\u003e\n \u003cli\u003eAcklin YP, Potocnik P, Sommer C (2012) Compartment syndrome in dislocation and non-dislocation type proximal tibia fractures: analysis of 356 consecutive cases. Arch Orthop Trauma Surg 132:227\u0026ndash;231\u003c/li\u003e\n \u003cli\u003eZiran BH, Becher SJ (2013) Radiographic predictors of compartment syndrome in tibial plateau fractures. J Orthop Trauma 27:612\u0026ndash;615\u003c/li\u003e\n \u003cli\u003eGuo J, Yin Y, Jin L, Zhang R, Hou Z, Zhang Y (2019) Acute compartment syndrome: cause, diagnosis, and new viewpoint. Medicine (Baltimore) 98(27):e16260\u003c/li\u003e\n \u003cli\u003eYang BF, Li D, Liu CL, Luo Y, Shi J, Guo XQ, Fan HJ, Lv Q. Advances in rhabdomyolysis: A review of pathogenesis, diagnosis, and treatment. Chin J Traumatol. 2025 Feb 27:S1008-1275(25)00010-0. doi: 10.1016/j.cjtee.2024.10.005. Epub ahead of print. PMID: 40082140.\u003c/li\u003e\n \u003cli\u003eZhao Yawen, Wang Danqing, Deng Jianwen, Yu Meng, Zheng Yiming, Leng Yinglin, Zhang Wei, Wang Chaoxia, Yuan Yun. Value of muscle biopsy in etiological diagnosis of rhabdomyolysis[J]. Chinese Journal of Internal Medicine, 2019, 58(12): 899-904. DOI: 10.3760/cma.j.issn.0578-1426.2019.12.006.\u003c/li\u003e\n \u003cli\u003eMcQueen MM, Gaston P, Court-Brown CM. Acute compartment syndrome. Who is at risk? J Bone Joint Surg Br. 2000 Mar;82(2):200-3. PMID: 10755426.\u003c/li\u003e\n \u003cli\u003eJiang Xiannian. Implementation and Effect Evaluation of Standardized Treatment for Compartment Syndrome [D]. Nanning: Guangxi Medical University, 2018.\u003c/li\u003e\n \u003cli\u003eZou Lihua, Li Meixiao, Li Hui, Chen Xiaodan. A case of compartment syndrome caused by carbon monoxide poisoning[J]. The Journal of Practical Medicine, 2013, 29(6): 1033. DOI: 10.3969/j.issn.1006-5725.2013.06.076.\u003c/li\u003e\n \u003cli\u003eZhang Qin. Analysis of 1 case of compartment syndrome caused by paraquat poisoning[J]. World Latest Medicine Information Abstracts (Serial Electronic Journal),2016,16(61):281-281.DOI:10.3969/j.issn.1671-3141.2016.61.191.\u003c/li\u003e\n \u003cli\u003eSungur M, G\u0026uuml;ven M. Rhabdomyolysis due to carbon monoxide poisoning. Clin Nephrol 2001;55:336\u0026ndash;7.\u003c/li\u003e\n \u003cli\u003eSefer S, Degoricija V, Bilic\u0026acute; B, et al. Acute carbon monoxide poisoning as the cause of rhabdomyolysis and acute renal failure. Acta Med Croatica 1999;53:199\u0026ndash;202.\u003c/li\u003e\n \u003cli\u003eAbdul-Ghaffar NU, Farghaly MM, Swamy AS. Acute renal failure,compartment syndrome, and systemic capillary leak syndrome complicating carbon monoxide poisoning. J Toxicol Clin Toxicol 1996;34:713\u0026ndash;9.\u003c/li\u003e\n \u003cli\u003eIftikhar MH, Dar AY, Haw A. Cocaine-induced rhabdomyolysis and compartment syndrome. BMJ Case Rep. 2022 May 19;15(5):e249413. doi: 10.1136/bcr-2022-249413. PMID: 35589265; PMCID: PMC9121409.\u003c/li\u003e\n \u003cli\u003eFuchs J, Gessner T, Kupferschmidt H, Weiler S. Indigenous venomous snakebites in Switzerland: analysis of reports to the National Poisons Information Centre over 22 years. Swiss Med Wkly. 2021;151:w30085.\u003c/li\u003e\n \u003cli\u003eFrangides CY, Koulouras V, Kouni SN, Tzortzatos GV, Nikolaou A, Pneumaticos J, Pierrakeas C, Niarchos C, Kounis NG, Koutsojannis CM. Snake venom poisoning in Greece. Experiences with 147 cases. Eur J Intern Med. 2006;17:24\u0026ndash;7.\u003c/li\u003e\n \u003cli\u003evon Keudell AG, Weaver MJ, Appleton PT, Bae DS, Dyer GSM, Heng M, Jupiter JB, Vrahas MS. Diagnosis and treatment of acute extremity compartment syndrome. Lancet. Erratum in: Lancet. 2015 Nov 7;386(10006):1824. doi: 10.1016/S0140-6736(15)00768-0. PMID: 26460664.\u003c/li\u003e\n \u003cli\u003eSmith RDJ, Mortensen SJ, Zhang D, Smith MR, Weaver MJ, von Keudell AG. Found Down Extremity Compartment Syndrome Secondary to Substance Use: An Observational Multicenter Study. JB JS Open Access. 2021 Oct 6;6(4):e21.00038. doi: 10.2106/JBJS.OA.21.00038. PMID: 34646972; PMCID: PMC8500555.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"international-journal-of-emergency-medicine","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ijem","sideBox":"Learn more about [International Journal of Emergency Medicine](https://intjem.biomedcentral.com/)","snPcode":"12245","submissionUrl":"https://submission.nature.com/new-submission/12245/3","title":"International Journal of Emergency Medicine","twitterHandle":"@IntJEmergMed","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Diquat poisoning, Rhabdomyolysis, Osteofascial compartment syndrome","lastPublishedDoi":"10.21203/rs.3.rs-7410383/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7410383/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eA retrospective analysis was conducted on the clinical data of one patient with compartment syndrome caused by paraquat dichloride poisoning who was successfully treated in Nanyang Central Hospital in May 2025. After the patient took paraquat dichloride by himself, he received treatment such as gastric lavage and catharsis in a local hospital. Due to the critical condition, he was transferred to Nanyang Central Hospital, where he was diagnosed with acute renal failure and rhabdomyolysis. Treatments including hemoperfusion and continuous veno-venous hemofiltration (CVVH) were given. Compartment syndrome was diagnosed in a timely manner, and decompressive fasciotomy was performed. Eventually, the patient was successfully cured and discharged. So far, this is the first successfully treated case of paraquat dichloride poisoning complicated with rhabdomyolysis and compartment syndrome, which will enrich the experience in the treatment of paraquat dichloride poisoning, help detect the complications of paraquat dichloride poisoning at an early stage, and attract high attention from doctors.\u003c/p\u003e","manuscriptTitle":"Case Report: A Case of Successful Rescue of Compartment Syndrome after Diquat Poisoning","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-23 07:39:34","doi":"10.21203/rs.3.rs-7410383/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-10-09T15:50:55+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-07T19:09:49+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-07T02:05:51+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-05T09:16:23+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-05T01:34:29+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"62923110259143019864412400758792686573","date":"2025-10-05T00:49:33+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"13142864454427791147590162339656029590","date":"2025-10-01T13:28:31+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-09-30T13:25:26+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"83817824089210186632778650627351337466","date":"2025-09-30T12:39:41+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"277229079718092474864542426933317832545","date":"2025-09-29T15:29:35+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"57995785404176541202445440383996090228","date":"2025-09-29T13:37:29+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"303768757493165252161232473272591959368","date":"2025-09-17T10:02:56+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-09-14T22:55:38+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-08-28T13:06:22+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-08-28T13:01:53+00:00","index":"","fulltext":""},{"type":"submitted","content":"International Journal of Emergency Medicine","date":"2025-08-19T15:55:01+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"international-journal-of-emergency-medicine","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ijem","sideBox":"Learn more about [International Journal of Emergency Medicine](https://intjem.biomedcentral.com/)","snPcode":"12245","submissionUrl":"https://submission.nature.com/new-submission/12245/3","title":"International Journal of Emergency Medicine","twitterHandle":"@IntJEmergMed","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"f81c256c-6ad7-41d1-b049-cbc3865327fd","owner":[],"postedDate":"September 23rd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-11-14T19:38:38+00:00","versionOfRecord":[],"versionCreatedAt":"2025-09-23 07:39:34","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7410383","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7410383","identity":"rs-7410383","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}