Journal of The Korean Society of Clinical Toxicology (대한임상독성학회지)

Korean society of Clincal Toxicology (대한임상독성학회)
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General Characteristics for Poisoning-Induced Transient or Sustained Hyperammonemia

급성 약물중독에 합병된 일과성 혹은 지속성 고암모니아혈증의 특성

  • Lee, Soo Hyung (Department of Emergency Medicine, CHA Gumi Medical Center, CHA University) ;
  • Park, Hong In (Department of Emergency Medicine, CHA Gumi Medical Center, CHA University) ;
  • Choe, Michael Sung Pil (Department of Emergency Medicine, CHA Gumi Medical Center, CHA University) ;
  • Je, Dong Wook (Department of Emergency Medicine, CHA Gumi Medical Center, CHA University) ;
  • Nho, Woo Young (Department of Emergency Medicine, CHA Gumi Medical Center, CHA University) ;
  • Kim, Seong Hun (Department of Emergency Medicine, CHA Gumi Medical Center, CHA University) ;
  • Lee, Mi Jin (Department of Emergency Medicine, School of Medicine, Kyungpook National University) ;
  • Ahn, Jae Yun (Department of Emergency Medicine, School of Medicine, Kyungpook National University) ;
  • Moon, Sung Bae (Department of Emergency Medicine, School of Medicine, Kyungpook National University) ;
  • Lee, Dong Eun (Department of Emergency Medicine, School of Medicine, Kyungpook National University) ;
  • Park, Jung Bae (Department of Emergency Medicine, School of Medicine, Kyungpook National University)
  • 이수형 (차의과대학교 구미차병원 응급의학과) ;
  • 박홍인 (차의과대학교 구미차병원 응급의학과) ;
  • 최마이클승필 (차의과대학교 구미차병원 응급의학과) ;
  • 제동욱 (차의과대학교 구미차병원 응급의학과) ;
  • 노우영 (차의과대학교 구미차병원 응급의학과) ;
  • 김성훈 (차의과대학교 구미차병원 응급의학과) ;
  • 이미진 (경북대학교 의학전문대학교 응급의학교실) ;
  • 안재윤 (경북대학교 의학전문대학교 응급의학교실) ;
  • 문성배 (경북대학교 의학전문대학교 응급의학교실) ;
  • 이동언 (경북대학교 의학전문대학교 응급의학교실) ;
  • 박정배 (경북대학교 의학전문대학교 응급의학교실)
  • Received : 2016.09.27
  • Accepted : 2016.10.21
  • Published : 2016.12.31
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Abstract

Purpose: In patients with altered mentality caused by drugs or unknown causes, ammonia is checked to facilitate differential diagnosis or diagnose hepatic coma. This helps early prevention and treatment of brain damage due to hyperammonemia. This study was conducted to evaluate clinical characteristics of intoxicated adult patients with hyperammonemia. Methods: We evaluated 95 patients with hyperammonemia among intoxicated patients above the age of 15 who visited our ED from January 2013 to December 2015. We analyzed the demographic characteristics and type of poisoning substance, reason for ingestion, toxicological characteristics such as elapsed time from ingestion to hospital visit, lab, clinical progression and complications. Data were evaluated using the student's t test or Mann-Whitney U test for continuous variables, and Chi-square test and Fisher's exact test for frequency analysis of categorical variables. Results: When compared to healthy individuals, patients with hyperammonemia showed statistical significance on their SOFA score (p=0.016) and poison severity score (p<0.001). Additionally, patients with hyperammonemia showed significantly different initial serum AST level (p=0.012) and maximum serum AST level during the hospital stay (p=0.026) when compared to healthy individuals. Moreover, individuals with sustained hyperammonemia compared to transient hyperammonemia showed clinically significant SOFA scores (p<0.001), poison severity scores (p=0.007), mortality rates in the ICU (p=0.021), as well as different duration of hospital stay (p=0.037), serum creatinine level (p=0.002), erythrocyte sedimentation rate (p=0.025), and serum myoglobin (p=0.015). Conclusion: Most poisoning-induced hyperammonemia cases were transient and recovered without special treatment. Therefore, hyperammonemia is almost non-specific among poisoning patients.

Keywords

References

  1. Persson HE, Sjoberg GK, Haines JA, Pronczuk de Garbino J. Poisoning severity score. Grading of acute poisoning. J Toxicol Clin Toxicol 1998;36:205-13. https://doi.org/10.3109/15563659809028940
  2. Clay AS, Hainline BE. Hyperammonemia in the ICU. Chest 2007;132:1368-78. https://doi.org/10.1378/chest.06-2940
  3. Weng TI, Shih FF, Chen WJ. Unusual causes of hyperammonemia in the ED. Am J Emerg Med 2004;22:105-7. https://doi.org/10.1016/j.ajem.2003.12.011
  4. Chalasani N, Fontana RJ, Bonkovsky HL, Watkins PB, Davern T, Serrano J, et al. Causes, clinical features, and outcomes from a prospective study of drug-induced liver injury in the United States. Gastroenterology 2008;135:1924-34, 34 e1-4. https://doi.org/10.1053/j.gastro.2008.09.011
  5. Park HY, Lee PH, Shin DH, Kim GW. Anterograde amnesia with hippocampal lesions following glufosinate intoxication. Neurology 2006;67:914-5.
  6. Watanabe T, Sano T. Neurological effects of glufosinate poisoning with a brief review. Hum Exp Toxicol 1998;17:35-9. https://doi.org/10.1177/096032719801700106
  7. Lluis M, Nogue S, Miro O. Severe acute poisoning due to a glufosinate containing preparation without mitochondrial involvement. Hum Exp Toxicol 2008;27:519-24. https://doi.org/10.1177/0960327108092291
  8. Bosoi CR, Rose CF. Identifying the direct effects of ammonia on the brain. Metab Brain Dis 2009;24:95-102. https://doi.org/10.1007/s11011-008-9112-7
  9. Kim JH, Yu I, Kim YD, Na SJ, Lee KO, Yoon B. Encephalopathy after glufosinate ammonium intoxication. J Korean Neurol Assoc 2014;32:113-6.
  10. Mao YC, Wang JD, Hung DZ, Deng JF, Yang CC. Hyperammonemia following glufosinate-containing herbicide poisoning: a potential marker of severe neurotoxicity. Clin Toxicol (Phila) 2011;49:48-52. https://doi.org/10.3109/15563650.2010.539184
  11. Chen YJ, Wu ML, Deng JF, Yang CC. The epidemiology of glyphosate-surfactant herbicide poisoning in Taiwan, 1986-2007: a poison center study. Clin Toxicol (Phila) 2009;47:670-7. https://doi.org/10.1080/15563650903140399
  12. Roberts DM, Buckley NA, Mohamed F, Eddleston M, Goldstein DA, Mehrsheikh A, et al. A prospective observational study of the clinical toxicology of glyphosatecontaining herbicides in adults with acute self-poisoning. Clin Toxicol (Phila) 2010;48:129-36. https://doi.org/10.3109/15563650903476491
  13. Lee HL, Kan CD, Tsai CL, Liou MJ, Guo HR. Comparative effects of the formulation of glyphosate-surfactant herbicides on hemodynamics in swine. Clin Toxicol (Phila) 2009;47:651-8. https://doi.org/10.1080/15563650903158862
  14. Kim DK, Kim YH, Lee JH, Hwang SY, Cho KW, Kang MJ, et al. The factors associated with the hypotension development in acute glyphosate-surfactant herbicide poisoning. J Korean Soc Emerg Med 2015;26:248-55.
  15. Verrotti A, Trotta D, Morgese G, Chiarelli F. Valproateinduced hyperammonemic encephalopathy. Metab Brain Dis 2002;17:367-73. https://doi.org/10.1023/A:1021918104127
  16. Gomceli YB, Kutlu G, Cavdar L, Sanivar F, Inan LE. Different clinical manifestations of hyperammonemic encephalopathy. Epilepsy Behav 2007;10:583-7. https://doi.org/10.1016/j.yebeh.2007.02.013
  17. Choi YH, Kim JH, Ko W, Kim HI, Kim WJ. Differential diagnostic value of transient increase of plasma ammonia level in seizure and syncope. J Korean Neurol Assoc 2012;30:279-83.