Initial Serum Ammonia as a Predictor of Neurologic Complications in Patients with Acute Glufosinate Poisoning

Abstract

PurposeGlufosinate poisoning can cause neurologic complications that may be difficult to treat due to delayed manifestation. Studies assessing possible predictors of complications are lacking. Although serum ammonia level is a potential predictor of severe neurotoxicity, it has only been assessed via case reports. Therefore, we investigated factors that predict neurologic complications in acute glufosinate-poisoned patients.Materials and MethodsWe conducted a retrospective review of 45 consecutive glufosinate-poisoning cases that were diagnosed in the emergency department (ED) of Wonju Severance Christian Hospital between May 2007 and July 2014. Patients with a Glasgow Coma Scale (GCS) score of <8, seizure, and/or amnesia were defined to a neurologic complication group.ResultsThe neurologic complication group (29 patients, 64.4%) comprised patients with GCS<8 (27 patients, 60.0%), seizure (23 patients, 51.1%), and amnesia (5 patients, 11.1%). Non-neurologic complications included respiratory failure (14 patients, 31.1%), intubation and ventilator care (23 patients, 51.1%), shock (2 patients, 4.4%), pneumonia (16 patients, 35.6%), acute kidney injury (10 patients, 22.2%), and death (4 patients, 8.9%). Complications of GCS<8, seizure, respiratory failure, and intubation and ventilator care appeared during latent periods within 11 hrs, 34 hrs, 14 hrs, and 48 hrs, respectively. Initial serum ammonia was a predictor of neurologic complications [odds ratio 1.039, 95% confidence interval (1.001-1.078), p=0.046 and area under the curve 0.742].ConclusionNeurologic complications developed in 64.4% of patients with acute glufosinate poisoning. The most common complication was GCS<8. Initial serum ammonia level, which can be readily assessed in the ED, was a predictor of neurologic complications.

Seizures in patients with acute pesticide intoxication, with a focus on glufosinate ammonium

“…3 Although glufosinate ammonium herbicides are considered safe when used properly, 4 many clinical toxicologists have reported that the ingestion of a large amount of glufosinate ammonium can cause convulsions. 5 –8…”

The relationship between serum ammonia level and neurologic complications in patients with acute glufosinate ammonium poisoning: A prospective observational study

“…In this study, 72.0% of the patients were placed in the neurologic complication group. Some differences in the incidence of neurologic complications in previous studies exist 3,5,12,13 that may have occurred due to the definition of complication group and the severity of poisoned patients. However, similarities in the results of recent human studies (including our prospective study) indicate that acute glufosinate ammonium poisoning causes serious complications much more often than previously reported.…”

“…All patients with hyperammonemia upon ED arrival received a lactulose enema to lower the ammonia level, as high levels have been suggested to cause neurologic complications. 12 All glufosinate ammonium–poisoned patients were admitted to the intensive care unit (ICU) for close observation for more than 1 day.…”

“…However, existing reports regarding the serum ammonia level as a probable predictor of neurologic complications are limited to case reports or retrospective studies. 1,3,12 –14 We also reported that the initial serum ammonia level, which is performed at the emergency department (ED), may predict neurologic complications. 12…”

Review article: Emergency endotracheal intubation in non‐traumatic brain pathologies: A systematic review and meta‐analysis

“…The seven studies that were not suitable for prevalence‐of‐intubation pooling had cohorts that consisted entirely of those that were intubated, making a calculation of prevalence impossible . A comprehensive listing of the 46 articles with a description of study characteristics, prevalence‐bias assessment, and intubation prevalence are shown in Table S1 …”