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Backgrounds: Paraquat is a major cause of fatal poisoning in agro-based countries like India. Being, a veiled offender it is often deluded for its relatively less fatal counterpart i.e organophhosporous compounds. It is a highly lethal herbicide, contributing to a majority of the pesticide poisoning related deaths & Disability Adjusted Life Years (DALY) globally. Methods: A retrospective record review of the patients presenting with paraquat poisoning to the Emergency Medicine Department of a tertiary care center in South India, between August 2014 to August 2016 was done. Demographics, clinical presentation, and laboratory data of patients were analysed to study risk factors associated with morbidity & mortality. Results: 91 case were evaluated, of which 65.9% were male and majority (78.1%) belonged to the age group 20-30 years and 31 (34%) being agriculturists. 85 (93.4%) attempts were suicidal in nature. Most common presenting symptom was vomiting 72 (79.1%), 27% of the patients had hypoxia (pao2<70%) however the initial mean circulatory assessment were within stable limits (HR- 84/min, BP- 124/78mmhg). Investigations revealed average serum creatinine of 2.8mg/dL (+ 3.16) and bicarbonate of 17.6 mg/dL (+ 4.47). Treatment measures included gastric lavage (67%) and haemoperfusion (49.5%) amongst others.47 (51.6%) patients died with the most common cause of death being Multiorgan dysfunction syndrome -MODS (61.7%) and Acute Kidney Injury-AKI (29.7%). To determine predictors of mortality, univariate and multivariate analysis [adjusted odds ratio (95% confidence intervals)] was done which revealed low bicarbonate6.174[1.20-31.59] and hypokalemia4.79 [1.08-21.19] to be significant risk factors. Conclusion: Paraquat poisoning has a high disease burden and concerning mortality ratesespecially in young and middle aged adults. Risk factors for mortality include low bicarbonate, hypokalemia and increased serum creatinine with AKI and MODS being the most common causes of death. [ABSTRACT FROM AUTHOR]