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A 41-year-old male with no prior comorbidities presented to the emergency department with painful swallowing and reduced urine output 2 days after accidental consumption of 20 ml of 24% w/v of paraquat. On presentation, he was found to be afebrile with a pulse rate of 98 bpm, blood pressure of 130/70 mmHg, respiratory rate of 22/min and an oxygen saturation of 98% on room air. Systemic examination revealed a clear chest and an ulcerated tongue coated with slough (Figure 1A). On routine investigation he was found to have oliguric acute kidney injury that resolved with multiple sessions of hemodialysis. Esophagogastroduodenoscopy revealed a Zargar IIIB esophageal injury for which a feeding jejunostomy was planned. He was managed conservatively as he did not show signs of systemic toxicity. However, on Day 11 of ingestion, the patient started desaturating gradually (from oxygen saturation of 98% up …