The development of guidelines for any new treatment regimen stems from well-designed and controlled clinical trials. However, conducting a well-controlled clinical trial in patients with paraquat poisoning is quite difficult given the high mortality rate (80-90%) and ethical issues. Based on our clinical experience and previous reports, we suggest the following as essential elements of an effective treatment strategy 1. the treatable subgroup is those patients who can abort the progression of lung injury with intensive treatment; 2. early initiation of treatment is the most important factor; 3. renal protection is the cornerstone of early treatment.