Hemoperfusion is considered the best option.

 dear manisha

have you ever used this option ? was it useful ?

In one patient I used hemoperfusion, adding hemofiltration. The treatment was successful

Best

Maurizio Salvadori

Certainly hemoperfusion. To protect lungs, consider to continue hemoperfusion sessions for 2-4 more days after urine paraquat stops been detected, because the poison bound in tissues keeps releasing.

See: Survival of a paraquat-poisoned patient, despite late (4 days) referral and initiation of conventional haemoperfusion treatment

Nephrol. Dial. Transplant. (1993) 8 (6): 570-571

Medical management of paraquat ingestion

Indika B Gawarammana1,2,3 and Nicholas A Buckley1,3,4

Abstract

Poisoning by paraquat herbicide is a major medical problem in parts of Asia while sporadic cases occur elsewhere. The very high case fatality of paraquat is due to inherent toxicity and lack of effective treatments. We conducted a systematic search for human studies that report toxicokinetics, mechanisms, clinical features, prognosis and treatment. Paraquat is rapidly but incompletely absorbed and then largely eliminated unchanged in urine within 12–24 h. Clinical features are largely due to intracellular effects. Paraquat generates reactive oxygen species which cause cellular damage via lipid peroxidation, activation of NF-κB, mitochondrial damage and apoptosis in many organs. Kinetics of distribution into these target tissues can be described by a two-compartment model. Paraquat is actively taken up against a concentration gradient into lung tissue leading to pneumonitis and lung fibrosis. Paraquat also causes renal and liver injury. Plasma paraquat concentrations, urine and plasma dithionite tests and clinical features provide a good guide to prognosis. Activated charcoal and Fuller's earth are routinely given to minimize further absorption. Gastric lavage should not be performed. Elimination methods such as haemodialysis and haemoperfusion are unlikely to change the clinical course. Immunosuppression with dexamethasone, cyclophosphamide and methylprednisolone is widely practised, but evidence for efficacy is very weak. Antioxidants such as acetylcysteine and salicylate might be beneficial through free radical scavenging, anti-inflammatory and NF-κB inhibitory actions. However, there are no published human trials. The case fatality is very high in all centres despite large variations in treatment.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3243009/

thanks