Paraquat poisoning Age 70+ M
Need medical insight regarding my grandfather with suspected paraquat poisoning.
My grandfather is a chronic heavy smoker with baseline chronic phlegm/cough. Possible exposure to paraquat 24% concentrate (unclear exact swallowed amount; some was reportedly spat out). Endoscopy showed Grade 1 superficial ulcerative/erosive changes in upper/mid esophagus, stomach relatively preserved. Initially creatinine was ~1.0 mg/dL, then progressively increased to 1.29 → 2.24 → 3.81 mg/dL with low urine output. Urea ~97. ABGs showed metabolic acidosis (pH ~7.27, HCO3 ~19). Oxygen saturation fluctuating and requiring oxygen support; wet cough and low-grade fever present. Neutrophils ~92%, lymphocytes ~5%. BP relatively stable. Doctors say prognosis is poor and are monitoring urine output with catheter.
Main questions:
Based on this presentation, can recovery still realistically be expected?
Which findings here are most concerning prognostically?
Does superficial esophageal injury with relatively preserved stomach suggest a lower absorbed dose?
Can AKI/metabolic acidosis still reverse if urine output improves?
What measures/treatments generally give the best chance of maximizing recovery at this stage (ICU, dialysis, antioxidants, steroids, hemoperfusion, etc.)?
Looking for toxicology/ICU/nephrology perspectives.