Initial Serum Ammonia as a Predictor of Neurologic Complications in Patients with Acute Glufosinate Poisoning.
10.3349/ymj.2016.57.1.254
- Author:
Dong Keon LEE
1
;
Hyun YOUK
;
Hyun KIM
;
Oh Hyun KIM
;
Jin GO
;
Tae Hoon KIM
;
Kyoungchul CHA
;
Kang Hyun LEE
;
Sung Oh HWANG
;
Yong Sung CHA
Author Information
1. Department of Emergency Medicine, Wonju College of Medicine, Yonsei University, Wonju, Korea. zza96@hanmail.net
- Publication Type:Original Article ; Observational Study
- Keywords:
Glufosinate;
herbicide;
poisoning;
complication;
predictor
- MeSH:
Adult;
Aged;
Aged, 80 and over;
Aminobutyrates/blood/*poisoning;
Ammonia/*blood;
*Emergency Service, Hospital;
Female;
Glasgow Coma Scale;
Humans;
Male;
Middle Aged;
Nausea/etiology;
Neurotoxicity Syndromes/blood/immunology/*physiopathology;
Respiratory Insufficiency/etiology;
Retrospective Studies;
Seizures/etiology;
Severity of Illness Index;
Vomiting/etiology
- From:Yonsei Medical Journal
2016;57(1):254-259
- CountryRepublic of Korea
- Language:English
-
Abstract:
PURPOSE: Glufosinate 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 METHODS: We 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. RESULTS: The 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]. CONCLUSION: Neurologic 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.
