Acid-base disturbances in acute poisoning and their association with survival

Hamdi, Haleh; Hassanian‐Moghaddam, Hossein; Hamdi, Amir; Zahed, Narges Sadat

doi:10.1016/j.jcrc.2016.05.003

Cited by 14 publications

(6 citation statements)

References 18 publications

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“…[21][22][23] The acid-base status predicts the survival of the poisoned patients. 28 However, various studies on mortality predictor factors have been insufficient for whole pesticides, and these parameters may have been limited to their rapid and adequate use in ED for patients with acute pesticide poisoning. Additionally, in initial emergency room sites, it is not often that we learn about the types of pesticides from initial management start, and there are many cases that different kinds of pesticides are judged or mixed with other types of pesticide poisoning.…”

Section: Discussionmentioning

confidence: 99%

Anion gap and base deficit are predictors of mortality in acute pesticide poisoning

Kim

et al. 2018

Hum Exp Toxicol

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Background: Acute pesticide poisoning has long been a serious problem as a method of suicide worldwide. This poisoning is a highly fatal condition that requires a rapid and precise diagnosis for adequate treatment. However, various studies on mortality predictor factors have been insufficient for whole pesticide treatments. We hypothesized that the initial plasma anion gap (AG) and base deficit (BD) are reliable prognostic factors. Methods: A retrospective study analyzed 561 patients with a diagnosis of acute pesticide poisoning between January 1, 2014 and June 30, 2017. The initial AG and BD values were divided into quartiles according to the number of patients. Survival at 30 days from admission was estimated using the Kaplan–Meier survival analysis. Receiver-operator characteristic (ROC) curves were drawn, and the areas under the curve for AG and BD for mortality were calculated. Results: Fifty-eight (10.3%) of 561 patients died within 30 days. The highest AG quartile (>22 mEq/L) was associated with an increased risk of 30-day hospital mortality. Compared to patients with an AG less than 14.7 mEq/L, these patients had a 4.18-fold higher risk of 30-day hospital mortality and the highest BD quartile (>7.9 mEq/L) was associated with an increased risk of 30-day hospital mortality. Compared to patients with a BD less than 1.4 mEq/L, these patients had 2.23-fold higher risk of 30-day hospital mortality. The areas under the ROC for AG and BD curve were 0.699 and 0.744, respectively. Conclusions: Initial high AG and BD values could predict mortality and require precise intensive care.

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Section: Discussionmentioning

confidence: 99%

Anion gap and base deficit are predictors of mortality in acute pesticide poisoning

Kim

et al. 2018

Hum Exp Toxicol

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“…Blood gas (BG) analyses were interpreted based on arterial or venous route of the samples . Cases with cardiac arrest before hospital admission were excluded from BG analysis.…”

Section: Methodsmentioning

confidence: 99%

Suspected Methadone Toxicity: from Hospital to Autopsy Bed

Gharehdaghi

Takalloo-Bakhtiari

Hassanian‐Moghaddam

et al. 2017

Basic Clin Pharma Tox

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High mortality rates have been reported for methadone in both adults and children. We aimed to determine the pattern of toxicity, possible underlying diseases and treatment challenges in patients referred to our centre with early diagnosis of methadone toxicity and who later died. Medical files of all methadone-poisoned patients who had been admitted to a referral centre of toxicology between March 2011 and March 2016, died during the hospital stay and sent for autopsy to Legal Medicine Organization were retrospectively evaluated. In a total of 94 patients, autopsy findings and laboratory evaluations showed that cause of death was pure methadone toxicity in 57 (60.6%). Other causes of death were ischaemic heart disease in ten, co-ingestions (toxicities including methadone) in eight, brain haemorrhage, multi-organ failure and pneumosepsis (each in four), meningitis/encephalitis in three and head trauma and other toxicities (other than methadone but including an opioid, each in two) patients. Time of cardiopulmonary arrest was significantly different between those with pure methadone toxicity and those who died due to other causes (p = 0.01). Patients who had died due to co-ingestions and other toxicities were younger (p = 0.029) and took more bolus doses of naloxone (p = 0.042). In methadone users, especially in older ages and those with trivial response to naloxone administration, loss of consciousness should not be strictly attributed to methadone toxicity. In such patients, thorough evaluation for other possible causes of loss of consciousness is mandatory.

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“…In the present study, most cases had venous blood gas imbalance, and metabolic acidosis was the commonest disorder, while in studies by Karakoç (2020) and Karahan (2016) in Turkey, arterial blood gas values were normal [ 28 , 31 ]. Acid–base homeostasis is significantly affected by tissue and organ dysfunction, which can reflect poor organ functioning [ 32 ]. However, the different results can be attributed to different demographic characteristics of patients and the type and amount of mushrooms eaten.…”

Section: Discussionmentioning

confidence: 99%

Demographic, clinical, and laboratory findings of mushroom-poisoned patients in Kermanshah province, west of Iran

Janatolmakan

Ganji

Ahmadi-Jouybari

et al. 2022

BMC Pharmacol Toxicol

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Background Mushroom poisoning can cause gastrointestinal, renal, and hepatic symptoms and even death. This descriptive study examined the demographic, clinical, and laboratory findings of patients with fungal poisoning, a type of fungus causing the poisoning, and the incidence and mortality rates of fungal poisoning in Kermanshah province, western Iran, from 2014 to 2018. Methods The medical records of 193 patients with mushroom poisoning from 2014 to 2018 were evaluated. The liver and kidney function tests, electrolytes, abdominal and pelvic ultrasound, chest x-ray, coagulation tests, and coagulation factors (fibrinogen, prothrombin) were assessed. Data were collected from the medical records of patients admitted to the Poisoning Center of Imam Khomeini Hospital in Kermanshah, Iran using a researcher-made checklist. Data were analyzed by SPSS (version 16) using descriptive statistics, including mean, standard deviation, and frequency distribution tables. Trend analysis for proportion was done by chi-square statistics in STATA-14 software (ptrend command). Results Of cases, ‌51.3% were male, 92.6% were city dwellers, 38.3% were aged 21–40 years, and 92.5% were poisoned during the spring. The fungus that caused poisoning was Amanita virosa. The gastrointestinal, nervous, and visual systems were the most common systems involved. The most common gastrointestinal symptoms included nausea and vomiting (72.0%) and abdominal pain (71.0%). Vertigo (11.9%) and headache (9.3%) were the most common neurological symptoms. The most common visual manifestation was blurred vision (7.8%). Of cases, 23.7% had metabolic acidosis. The increased alkaline phosphatase level was the most common liver disorder in 98.7% of the cases. Increased blood urea nitrogen and creatinine levels were also reported in 21.0% and 17.7% of the cases, respectively. The serum lactic dehydrogenase and creatine phosphokinase levels also increased in 99.3% and 30.2% of the patients, respectively. The mortality rate was 1.6% (n = 3). Conclusion The fungal poisoning diagnosis should always be considered in young patients referred to the emergency department with gastrointestinal complaints, a history of consuming wild self-picked mushrooms, and high liver and kidney test values. Since most fungal poisonings occur in the spring, it is necessary to inform the community of the dangers of consuming self-picked wild mushrooms, especially in this season.

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Acid-base disturbances in acute poisoning and their association with survival

Cited by 14 publications

References 18 publications

Anion gap and base deficit are predictors of mortality in acute pesticide poisoning

Anion gap and base deficit are predictors of mortality in acute pesticide poisoning

Suspected Methadone Toxicity: from Hospital to Autopsy Bed

Demographic, clinical, and laboratory findings of mushroom-poisoned patients in Kermanshah province, west of Iran

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