Acute paraquat poisoning seems to be very complex because many possible mechanisms of paraquat cytotoxicity have been reported. Some may not be the cause of paraquat poisoning but the result or an accompanying phenomenon of paraquat action. The mechanism critical for cell damage is still unknown. Paraquat poisoning is probably a combination of several paraquat actions. Arguing which mechanism is more critical may not be important, and these clarified mechanisms should be connected and utilized in the development of treatment for paraquat poisoning. Many people still die of pulmonary fibrosis after paraquat exposure. The next target of study will be to verify the mechanism of pulmonary fibrosis by paraquat on the basis of the outcome of studies such as this review.