Paraquat survival..

This is one case that misleaded me...

This middle-aged female had presented to ED 1 week ago. She c/o sorethroat and running nose and others flu-like symptom. I took a look at the mouth and noted some blister and oral ulcer, the throat and tongue was also involved. She had mild fever as well and told me that she was seen in local clinic but in vain. I did a blood test and white count of 16000+ was noted. I admitted her under the impression of flu. 3 days ago I seen her again in ED and showed me a referred letter from a medical center. The cousin who came with her told me that the medical center said that she had no sign of agriculture chemical intoxication and was ok for her to get admitted back in a smaller hospital. I was confused while glancing through the referrel letter(it was not a referral letter - more like a lab result). The medical center ED did a cholinesterese test for her(it was normal).

I asked the whole history again and was irritated by it. Appearently, her oral ulcer has worsen the next day and the attending physician( my senior, nephrologist cum toxicologist cum infectionist ...a Malaysian as well) was suspicious about the history and asked her again"properly". She claimed that she had drunk some Paraquat ! 2 days before she was admitted. Due to her " paraquat" history - she was referred to medical center for further evaluation.
But I don't think the medical center ED buy her story - no urine paraquat test was done. I didn't buy story as well...I has seen lots of paraquat intoxication(mostly in Malaysia) - well, a very very very toxic chemical - there is only 1 survival I seen so far. A Malay Chap who had an arguement with his father about his girl friend. He took a bottle of paraquat and put it in the busket of his Honda cub and rode away. His father chased him from behind and rammed his bike to stopped him. Unfortunately, the bottle spilled and few drops went into his left eye, few drops into his mouths. He was admitted for 3 weeks and lost 1 eye sight with discharge with severe pulmonary fibrosis...This is the only survival.
I had met a few paraquat intoxication here - unlike the Malaysia paraquat which smelled like X%$@...  the paraquat here does not have a strong smell...
Back to the patient - she was then discharged from the medical center after the cholinesterese test was normal, and negative of urine paraquat test.  The oral ulcer has worsen..

D4 oral ulcer	chemical burn all over t

Me and my senior favor a corrosive injury rather than paraquat...

The cause of suicide  - Some misunderstanding with her family... This is one hell of the patient : she has this fulminant hepatitis few months ago complicated with acute respiratory failure intubated and ventilated , acute renal failure,  - she just got back from the gate of Hell/ (or maybe Heaven..) but chose to give it up due to some minor cause....