Journal of The Korean Society of Clinical Toxicology (대한임상독성학회지)

Korean society of Clincal Toxicology (대한임상독성학회)
권호 표지
DOI QR코드

DOI QR Code

A Study of Predicting the Severity Following Glufosinate Ammonium Containing Herbicide Poisoning Experienced in Single Emergency Medical Institution

단일 응급의료기관에서 경험한 글루포시네이트 암모니움 포함 제초제 중독 후 중증도 예측에 관한 연구

  • Lee, Doo Sung (Department of Emergency Medicine, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Choi, Kyoung Ho (Department of Emergency Medicine, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea)
  • 이두성 (가톨릭대학교 의정부성모병원 응급의학과) ;
  • 최경호 (가톨릭대학교 의정부성모병원 응급의학과)
  • Received : 2018.11.12
  • Accepted : 2019.01.01
  • Published : 2019.06.30
Download PDF
⟨ Previous Next ⟩

Abstract

Purpose: Owing to the increased agricultural use of the herbicide glufosinate ammonium (GLA), the incidence of GLA poisoning has recently increased. Therefore, we investigated the possible predictive factors associated with severe complications following GLA poisoning. Methods: A retrospective analysis of medical records was conducted based on 76 patients who had visited our regional emergency medical center with GLA poisoning from 2006 to 2017. Severe complications were defined as respiratory failure requiring intubation, systolic blood pressure less than 90 mmHg, Glasgow Coma Scale (GCS) less than 8, and presence of seizure. Results: Age, ingested amount and ingested amount per weight were significantly greater in the severe group (p<0.001). PSS grade 2 or higher was more common in the severe group (p<0.001), and In addition, the APACHE II score was significantly higher in the severe group (p<0.001), as were the SOFA scores (p=0.002). Serum ammonia levels were significantly higher in the severe group (p=0.007), while MDRD-GFR was smaller in the severe group (p=0.002). The spot urine protein levels were significantly higher in the severe group (p=0.005), as was the urine protein to creatinine ratio (p=0.001). Upon multivariate analysis, the amount ingested per weight and PSS grade 2 or higher were identified as significant predictors. Conclusion: Our study showed that MDRD-GFR was significantly lower in the severe group after GLA poisoning. PSS grade 2 or higher and ingested amount per weight may be useful to evaluate the severity of complications after GLA poisoning.

Keywords

References

  1. Hack R, Ebert E, Ehling G, et al. Glufocinate ammoniumsome aspects of its mode of action in mammals. Food Chem Toxicol 1994;32(5):461-70. https://doi.org/10.1016/0278-6915(94)90043-4
  2. Mao YC, Hung DZ, Wu ML, et al. Acute human glufocinate containing herbicide poisoning. Clin Toxicol (Phila) 2012;50(5):396-402. https://doi.org/10.3109/15563650.2012.676646
  3. Kim YK, Kim KH, Moon HJ, et al. Predicting acute intoxication of glufosinate-containing herbicides: A comparative study of a group with complication versus the others without complication in single institution. J Korean Soc Emerg Med 2016;27(1):52-60.
  4. Inoue Y, Onodera M, Fujita Y, et al.. Factors associated with severe effects following acute glufosinate poisoning. Clin Toxicol (Phila) 2013;51(9):846-9. https://doi.org/10.3109/15563650.2013.841180
  5. Bone RC, Balk RA, Cerra FB, et al. Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM consensus conference committee. american college of chest physicians/ Society of critical care medicine. Chest 1992;101(6):1644-55. https://doi.org/10.1378/chest.101.6.1644
  6. ARDS Definition Task Force, Ranieri VM, Rubenfeld GD, et al. Acute respiratory distress syndrome: the berlin definition. JAMA 2012;307(23):2526-33.
  7. Available at: http://www.who.int/ipcs/poisons/pss.pdf. Accessed October 22, 2018.
  8. Levey AS, Bosch JP, Lewis JB, et al. More accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of diet in renal disease study group. Ann Intern Med 1999;130(6):461-70. https://doi.org/10.7326/0003-4819-130-6-199903160-00002
  9. Persson HE, Sjoberg GK, Haines JA, et al.. Poisoning severity score. Grading of acute poisoning. J Toxicol Clin Toxicol 1998;36(3):205-13. https://doi.org/10.3109/15563659809028940
  10. Casey PB, Dexter EM, Michell J, et al. The prospective value of the IPCS/EC/EAPCCT poisoning severity score in cases of poisoning. J Toxicol Clin Toxicol 1998;36(3):215-7. https://doi.org/10.3109/15563659809028941
  11. Jung SH, Park DY, Park JS, et al. Significance of the poisoning severity score as a prognostic factor in poisoning. J Korean Soc Emerg Med 2005;16(6):660-6.
  12. Wagner DP, Knaus WA, Draper EA. Statistical validation of a severity of illness measure. Am J Public Health 1983;73:878-84. https://doi.org/10.2105/AJPH.73.8.878
  13. Yoo DH, Lee JW, Choi JH, et. al. Utility of the APACHE II score as a neurologic prognostic factor for glufosinate intoxicated patients. J Korean Soc Clin Toxicol 2016;14(2):107-14. https://doi.org/10.22537/jksct.2016.14.2.107
  14. Vincent JL, Moreno R, Takala J, et al. The SOFA score to describe organ dysfunction/failure. On behalf of the working group on sepsis-related problems of the european society of intensive care medicine. Intensive Care Med 1996;22(7):707-10. https://doi.org/10.1007/BF01709751
  15. Moon JM, Chun BJ. Serial ammonia measurement in patients poisoned with glufosinate ammonium herbicide. Hum Exp Toxicol 2016;35(5):554-61. https://doi.org/10.1177/0960327115595688
  16. Lee DK, Youk H, Kim H, et al. Initial serum ammonia as a predictor of neurologic complications in patients with acute glufosinate poisoning. Yonsei Med J 2016;57(1):254-9. https://doi.org/10.3349/ymj.2016.57.1.254
  17. Cha YS, Kim H, Lee Y, et al. The relationship between serum ammonia level and neurologic complications in patients with acute glufosinate ammonium poisoning: A prospective observational study. Hum Exp Toxicol 2018;37(6):571-9. https://doi.org/10.1177/0960327117715902
  18. Schwab SJ, Christensen RL, Dougherty K, et al. Quantitation of proteinuria by the use of protein-to-creatinine ratios in single urine samples. Arch Intern Med 1987;147(5):943-4. https://doi.org/10.1001/archinte.1987.00370050135022
  19. Barnas U, Schmidt A, Haas M, et al. Parameters associated with chronic renal transplant failure. Nephrol Dial Transplant 1997;12(Suppl 2):82-5.
  20. Price CP, Newall RG, Boyd JC. Use of protein:creatinine ratio measurements on random urine samples for prediction of significant proteinuria: a systematic review. Clin Chem 2005;51(9):1577-86. https://doi.org/10.1373/clinchem.2005.049742
  21. Darren MR. Herbicides. In: Robert SH, Mary AH, Neal AL, Lewis SN, Lewis RG, editors. Goldfrank's toxicologic emergency. 10th ed. New York:McGraw Hill; 2015. p.1389-1408.