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

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.

• Authors: Dong Keon Lee, Hyun Youk, Hyun Kim, Oh Hyun Kim, Jin Go, Tae Hoon Kim, Kyoungchul Cha, Kang Hyun Lee, Sung Oh Hwang, Yong Sung Cha
• Journal: Yonsei medical journal (Yonsei Med J) Vol. 57 Issue 1 Pg. 254-9 (Jan 2016) ISSN: 1976-2437 [Electronic] Korea (South)
• PMID: 26632409 (Publication Type: Journal Article, Observational Study)

Chemical References

• Aminobutyrates
• phosphinothricin
• Ammonia

Topics

• 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)