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Analyses of physical factors that contribute to the blood carboxyhemoglobin saturation in autopsy cases of house fire fatalities. Leg Med (Tokyo) 2023; 62:102233. [PMID: 36898281 DOI: 10.1016/j.legalmed.2023.102233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Revised: 02/11/2023] [Accepted: 03/01/2023] [Indexed: 03/08/2023]
Abstract
The authors analyzed data from forensic autopsies of 75 patients who died as a result of house fires to clarify the physical factors that affect blood carboxyhemoglobin (COHb) saturation. Blood COHb saturation levels were significantly lower in patients who survived in the hospital. No significant differences were found in the blood COHb saturation levels between patients who died immediately at the scene and those who were pronounced dead at the receiving hospital without heartbeat being restored. The COHb saturation levels were significantly different among the groups of patients classified by the amount of soot. Although age, coronary artery stenosis, and blood alcohol concentration did not significantly affect blood COHb saturation, on comparing patients who died in the same fire, lower COHb saturation was observed in two patients, one with severe coronary artery stenosis and other with severe alcohol intoxication. To accurately interpret blood COHb saturation during forensic autopsy, the heartbeat status (present or absent) at the time of the rescue and the amount of soot in the trachea must be determined. Low levels of COHb saturation may be observed in fatalities with severe coronary atherosclerosis or severe alcohol intoxication.
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Naps MS, Leong SH, Hartwell EE, Rentsch CT, Kranzler HR. Effects of topiramate therapy on serum bicarbonate concentration in a sample of 10,279 veterans. Alcohol Clin Exp Res 2023; 47:438-447. [PMID: 36810985 DOI: 10.1111/acer.15011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 12/20/2022] [Accepted: 01/03/2023] [Indexed: 02/24/2023]
Abstract
BACKGROUND Topiramate, which is increasingly being used to treat alcohol use disorder (AUD), is commonly associated with reduced serum bicarbonate concentrations. However, estimates of the prevalence and magnitude of this effect are from small samples and do not address whether topiramate's effects on acid-base balance differ in the presence of an AUD or by topiramate dosage. METHODS Veterans Health Administration electronic health record (EHR) data were used to identify patients with a minimum of 180 days of topiramate prescription for any indication and a propensity score-matched control group. We differentiated patients into two subgroups based on the presence of a diagnosis of AUD in the EHR. Baseline alcohol consumption was determined using Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) scores in the EHR. Analysis also included a three-level measure representing mean daily dosage. The topiramate-associated changes in serum bicarbonate concentration were estimated in difference-in-differences linear regression models. A serum bicarbonate concentration <17 mEq/L was considered to represent possible clinically significant metabolic acidosis. RESULTS The cohort comprised 4287 topiramate-treated patients and 5992 propensity score-matched controls with a mean follow-up period of 417 days. The mean topiramate-associated reductions in serum bicarbonate concentration were <2 mEq/L in the low (≤88.75), medium (>88.75 and ≤141.70), and high (>141.70) mg/day dosage tertiles, irrespective of AUD history. Concentrations <17 mEq/L occurred in 1.1% of topiramate-treated patients and 0.3% of controls and were not associated with alcohol consumption or an AUD diagnosis. CONCLUSIONS The excess prevalence of metabolic acidosis associated with topiramate treatment does not differ with dosage, alcohol consumption, or the presence of an AUD. Baseline and periodic serum bicarbonate concentration measurements are recommended during topiramate therapy. Patients prescribed topiramate should be educated about the symptoms of metabolic acidosis and urged to report their occurrence promptly to a healthcare provider.
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Affiliation(s)
- Michelle S Naps
- Mental Illness Research, Education and Clinical Center, Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania, USA.,School of Engineering and Applied Sciences, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Shirley H Leong
- Mental Illness Research, Education and Clinical Center, Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania, USA
| | - Emily E Hartwell
- Mental Illness Research, Education and Clinical Center, Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania, USA.,Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Christopher T Rentsch
- VA Connecticut Healthcare System, US Department of Veterans Affairs, West Haven, Connecticut, USA.,Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA.,Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Henry R Kranzler
- Mental Illness Research, Education and Clinical Center, Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania, USA.,Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
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Purnell BS, Thompson S, Bowman T, Bhasin J, George S, Rust B, Murugan M, Fedele D, Boison D. The role of adenosine in alcohol-induced respiratory suppression. Neuropharmacology 2023; 222:109296. [PMID: 36377091 PMCID: PMC10208026 DOI: 10.1016/j.neuropharm.2022.109296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 09/26/2022] [Accepted: 10/17/2022] [Indexed: 11/13/2022]
Abstract
Alcohol-related poisoning is the foremost cause of death resulting from excessive acute alcohol consumption. Respiratory failure is crucial to the pathophysiology of fatal alcohol poisoning. Alcohol increases accumulation of extracellular adenosine. Adenosine suppresses breathing. The goal of this investigation was to test the hypothesis that adenosine signaling contributes to alcohol-induced respiratory suppression. In the first experiment, the breathing of mice was monitored following an injection of the non-selective adenosine receptor antagonist caffeine (40 mg/kg), alcohol (5 g/kg), or alcohol and caffeine combined. Caffeine reduced alcohol-induced respiratory suppression suggesting that adenosine contributes to the effects of alcohol on breathing. The second experiment utilized the same experimental design, but with the blood brain barrier impermeant non-selective adenosine receptor antagonist 8-sulfophenyltheophylline (8-SPT, 60 mg/kg) instead of caffeine. 8-SPT did not reduce alcohol-induced respiratory suppression suggesting that adenosine is contributing to alcohol-induced respiratory suppression in the central nervous system. The third and fourth experiments used the same experimental design as the first, but with the selective A1 receptor antagonist DPCPX (1 mg/kg) and the selective A2A receptor antagonist istradefylline (3.3 mg/kg). Istradefylline, but not DPCPX, reduced alcohol-induced respiratory suppression indicating an A2A receptor mediated effect. In the fifth experiment, alcohol-induced respiratory suppression was evaluated in Adk+/- mice which have impaired adenosine metabolism. Alcohol-induced respiratory suppression was exacerbated in Adk+/- mice. These findings indicate that adenosinergic signaling contributes to alcohol-induced respiratory suppression. Improving our understanding of how alcohol affects breathing may lead to better treatment strategies and better outcomes for patients with severe alcohol poisoning.
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Affiliation(s)
- Benton S Purnell
- Department of Neurosurgery, Robert Wood Johnson Medical School, Rutgers University, Piscataway, NJ, USA; Brain Health Institute, Rutgers University, Piscataway, NJ, USA
| | - Sydney Thompson
- Department of Neurosurgery, Robert Wood Johnson Medical School, Rutgers University, Piscataway, NJ, USA; Brain Health Institute, Rutgers University, Piscataway, NJ, USA
| | - Tenise Bowman
- Department of Neurosurgery, Robert Wood Johnson Medical School, Rutgers University, Piscataway, NJ, USA; Brain Health Institute, Rutgers University, Piscataway, NJ, USA
| | - Jayant Bhasin
- Department of Neurosurgery, Robert Wood Johnson Medical School, Rutgers University, Piscataway, NJ, USA; Brain Health Institute, Rutgers University, Piscataway, NJ, USA
| | - Steven George
- Department of Neurosurgery, Robert Wood Johnson Medical School, Rutgers University, Piscataway, NJ, USA; Brain Health Institute, Rutgers University, Piscataway, NJ, USA
| | - Brian Rust
- Department of Neurosurgery, Robert Wood Johnson Medical School, Rutgers University, Piscataway, NJ, USA.
| | - Madhuvika Murugan
- Department of Neurosurgery, Robert Wood Johnson Medical School, Rutgers University, Piscataway, NJ, USA; Brain Health Institute, Rutgers University, Piscataway, NJ, USA
| | - Denise Fedele
- Department of Neurosurgery, Robert Wood Johnson Medical School, Rutgers University, Piscataway, NJ, USA; Brain Health Institute, Rutgers University, Piscataway, NJ, USA
| | - Detlev Boison
- Department of Neurosurgery, Robert Wood Johnson Medical School, Rutgers University, Piscataway, NJ, USA; Brain Health Institute, Rutgers University, Piscataway, NJ, USA.
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Simultaneous fatal poisoning of two victims with 4F-MDMB-BINACA and ethanol. Forensic Toxicol 2023; 41:151-157. [PMID: 36652056 PMCID: PMC9849308 DOI: 10.1007/s11419-022-00632-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 06/06/2022] [Indexed: 01/22/2023]
Abstract
PURPOSE Methyl-2-(1-(4-fluorobutyl)-1H-indazole-3-carboxamido)-3,3-dimethylbutanoate (4F-MDMB-BINACA) is a newly emerging synthetic cannabinoid receptor agonists (SCRA) first described in 2018 in both Europe and the United States. Two fatal cases are reported caused by simultaneous consumption of 4F-MDMB-BINACA and ethanol. METHODS The victims were brothers who were both found deceased after consuming 4F-MDMB-BINACA and ethanol. Post-mortem toxicological analyses of blood and urine were carried out by supercritical fluid chromatography tandem mass spectrometry (SFC-MS/MS) and headspace gas chromatography with flame ionization detection (HS-GC-FID). RESULTS The concentration of 4F-MDMB-BINACA in the postmortem blood was 2.50 and 2.34 ng/mL, and blood alcohol concentration was 2.11 and 2.49 g/L, respectively. CONCLUSION According to the reported cases and reviews of the scientific literature, concurrent ethanol consumption should amplify the toxicity of SCRAs. The threshold SCRA concentration for fatal overdose can be estimated ng/mL level (0.37-4.1 ng/mL according to the reported cases) in cases in which 1.5-2.5 g/L of ethanol is present in the blood.
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Getachew B, Csoka AB, Tizabi Y. Dihydromyricetin Protects Against Ethanol-Induced Toxicity in SH-SY5Y Cell Line: Role of GABA A Receptor. Neurotox Res 2022; 40:892-899. [PMID: 35386023 DOI: 10.1007/s12640-022-00503-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 03/07/2022] [Accepted: 03/29/2022] [Indexed: 11/26/2022]
Abstract
Toxicity induced by binge alcohol drinking, particularly in adolescent and young adults, is of major medical and social consequence. Recently, we reported that butyrate, a short chain fatty acid, can protect against ethanol (ETOH)-induced toxicity in an in vitro model. In this study, we sought to evaluate the potential effectiveness of dihydromyricetin (DHM), a natural bioactive flavonoid, alone or in combination with butyrate in the same model. Exposure of SH-SY5Y cells for 24 h to 500 mM ETOH resulted in approximately 40% reduction in cell viability, which was completely prevented by 0.1 μM DHM. Combinations of DHM and butyrate provided synergistic protection against alcohol toxicity. Whereas butyrate effect was shown to be mediated primarily through fatty acid receptor 3 activation, DHM protection appears to be mediated primarily via benzodiazepine receptor site of GABAA receptor. This is based on the finding that DHM's effect could be completely prevented by pretreatment with flumazenil, a selective antagonist at this site, but not by bicuculline, a selective antagonist at the actual GABAA receptor binding site. These findings suggest potential utility of DHM alone or in combination with butyrate against ETOH-induced toxicity.
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Affiliation(s)
- Bruk Getachew
- Department of Pharmacology, Howard University College of Medicine, 520 W Street NW, Washington, DC, USA
| | - Antonei B Csoka
- Department of Anatomy, Howard University College of Medicine, 520 W Street NW, Washington, DC, USA
| | - Yousef Tizabi
- Department of Pharmacology, Howard University College of Medicine, 520 W Street NW, Washington, DC, USA.
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Pediatric Acute Alcohol Intoxication Admitted to the ICU: A Review of 102 Cases in France. Crit Care Med 2021; 49:e833-e839. [PMID: 33870912 DOI: 10.1097/ccm.0000000000005032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To describe the profile and clinical outcomes of children (<18 yr) admitted to intensive care for acute alcohol intoxication, with special attention to complications and to the subgroup that required intubation. DESIGN Retrospective observational study. SETTING Seven pediatric and three adult ICUs in France. PATIENTS Children 1-17 yr admitted to intensive care for acute alcohol intoxication between January 1, 2010, and December 30, 2017. INTERVENTIONS The study was observational and patients received standard care. MEASUREMENTS AND MAIN RESULTS We included 102 patients, with 71 males (69.6%) and 31 females (30.4%). Mean age was not different between males and females (14.0 ± 3.0 yr [range, 2-17 yr] and 14.2 ± 1.3 yr [range, 11-17 yr]; p = 0.67); six children were younger than 10 years. Mean blood alcohol concentration was not significantly different in males and females (2.42 ± 0.86 and 2.20 ± 0.54 g/L, respectively; p = 0.51). Of the 102 patients, 58 (57%) required intubation. Factors significantly associated with requiring intubation were lower Glasgow Coma Scale score (p = 0.002), lower body temperature (p = 0.045), and higher blood alcohol concentration (p = 0.012); vascular filling, and electrolyte disturbances were not associated with needing intubation. Mean intubation time was 9.7 ± 5.2 hours. Among the 59 patients with Glasgow Coma Scale score less than 8, 12 did not require intubation. The most common metabolic disturbance was a high lactate level (48%), followed by hypokalemia (27.4%); 59 (58.2%) patients had hyperglycemia and three had hypoglycemia. CONCLUSIONS Male adolescents make up the majority of pediatric patients admitted to intensive care for acute alcohol intoxication. A need for intubation was associated with a worse Glasgow Coma Scale, lower body temperature, and higher blood alcohol concentration. Intubation was usually required for less than 12 hours. Other acute medical complications reported in adults with acute alcohol intoxication, such as electrolyte disturbances and aspiration pneumonia, were rare in our pediatric patients.
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Mehrifar Y, Zamanian Z, Pirami H. Authors' Reply. THE INTERNATIONAL JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL MEDICINE 2019; 10:152-154. [PMID: 31325298 PMCID: PMC6708402 DOI: 10.15171/ijoem.2019.1679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Accepted: 05/01/2019] [Indexed: 11/09/2022]
Affiliation(s)
- Younes Mehrifar
- Student Research Committee, School of Health Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Zahra Zamanian
- Department of Occupational Health, School of Public Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hamideh Pirami
- Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran.
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Wang H, Xu H, Li W, Li B, Shi Q, Ma K, Xiao B, Chen L. Forensic appraisal of death due to acute alcohol poisoning: three case reports and a literature review. Forensic Sci Res 2019; 5:341-347. [PMID: 33457053 PMCID: PMC7781983 DOI: 10.1080/20961790.2019.1572259] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Accepted: 01/17/2019] [Indexed: 11/18/2022] Open
Abstract
Death due to acute alcohol poisoning lacks specific anatomical characteristics, compared with other deaths due to drug poisoning. We report three forensic cases of death from acute alcohol poisoning due to inhibition of the respiratory centre and eventual asphyxia. Blood alcohol concentrations in the three fatalities were 5.28, 3.33 and 3.78 mg/mL, respectively. Lethal doses and blood alcohol concentrations showed differences between individuals. Detailed auxiliary tests besides autopsy were undertaken. These cases show that forensic scientists should exclude other causes of death, combine the autopsy with auxiliary tests, and then make an appraisal.
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Affiliation(s)
- Hui Wang
- Department of Forensic Medicine, School of Basic Medical Sciences, Fudan University, Shanghai, China
| | - Hongmei Xu
- Department of Forensic Medicine, School of Basic Medical Sciences, Fudan University, Shanghai, China
| | - Wencan Li
- Institute of Criminal Scientific Technology, Shanghai Public Security Bureau, Pudong Branch, Shanghai, China
| | - Beixu Li
- Department of Forensic Medicine, School of Basic Medical Sciences, Fudan University, Shanghai, China
| | - Qun Shi
- Forensic Laboratory, Criminal Science and Technology Institute, Shanghai Public Security Bureau, Shanghai, China
| | - Kaijun Ma
- Forensic Laboratory, Criminal Science and Technology Institute, Shanghai Public Security Bureau, Shanghai, China
| | - Bi Xiao
- Forensic Laboratory, Criminal Science and Technology Institute, Shanghai Public Security Bureau, Shanghai, China
| | - Long Chen
- Department of Forensic Medicine, School of Basic Medical Sciences, Fudan University, Shanghai, China
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Morimoto K, Tsutsui Y, Ogura S, Sunda K. Are Wireless Electronic Stethoscopes Useful for Respiratory Rate Monitoring During Intravenous Sedation? J Oral Maxillofac Surg 2018; 76:70.e1-70.e5. [DOI: 10.1016/j.joms.2017.08.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Revised: 07/31/2017] [Accepted: 08/09/2017] [Indexed: 10/19/2022]
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Pianca TG, Sordi AO, Hartmann TC, von Diemen L. Identification and initial management of intoxication by alcohol and other drugs in the pediatric emergency room. J Pediatr (Rio J) 2017; 93 Suppl 1:46-52. [PMID: 28886402 DOI: 10.1016/j.jped.2017.06.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 05/19/2017] [Accepted: 06/12/2017] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE To review the screening, diagnosis, evaluation, and treatment of intoxication by alcohol and other drugs in children and adolescents in the emergency scenario. DATA SOURCE This was a narrative literature review. DATA SUMMARY The detection of this problem in the emergency room can be a challenge, especially when its assessment is not standardized. The intentional and episodic use of large amounts of psychoactive substances by adolescents is a usual occurrence, and unintentional intoxication is more common in children younger than 12 years. The clinical picture in adolescents and children differs from that in adults and some particularities are important in the emergency scenario. After management of the acute condition, interventions targeting the adolescent at risk may be effective. CONCLUSION The diagnosis and treatment of intoxication by alcohol and other drugs in adolescents and children in the emergency scenario requires a systematic evaluation of the use of these drugs. There are few specific treatments for intoxication, and the management comprehends support measures and management of related clinical complications.
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Affiliation(s)
- Thiago Gatti Pianca
- Hospital de Clínicas de Porto Alegre, Serviço de Psiquiatria da Infância e Adolescência, Porto Alegre, RS, Brazil
| | - Anne Orgle Sordi
- Hospital de Clínicas de Porto Alegre, Serviço de Psiquiatria de Adição, Porto Alegre, RS, Brazil
| | - Thiago Casarin Hartmann
- Hospital de Clínicas de Porto Alegre, Serviço de Psiquiatria de Adição, Porto Alegre, RS, Brazil; Centro de Saúde Instituto de Aposentadorias e Pensões dos Industriários, Serviço de Emergência Psiquiátrica, Porto Alegre, RS, Brazil
| | - Lisia von Diemen
- Universidade Federal do Rio Grande do Sul, Departamento de Psiquiatria e Medicina Legal, Porto Alegre, RS, Brazil.
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Identification and initial management of intoxication by alcohol and other drugs in the pediatric emergency room. JORNAL DE PEDIATRIA (VERSÃO EM PORTUGUÊS) 2017. [DOI: 10.1016/j.jpedp.2017.09.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Malejko K, Graf H, Gahr M. Survival of Very High Blood Alcohol Concentration Without Consequential Damage in a Patient Without a Previous Substance Use Disorder. J Forensic Sci 2016; 61:1155-1157. [PMID: 27364303 DOI: 10.1111/1556-4029.13082] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Revised: 09/10/2015] [Accepted: 09/20/2015] [Indexed: 11/29/2022]
Abstract
Intoxications with alcohol may lead to death depending on (maximum) blood alcohol concentration (BAC) and accompanying factors such as liver function, tolerance, and comedication. Death may occur due to ethanol-induced respiratory depression and/or aspiration of gastric content (due to an impaired gag reflex); thus, securing of the airway and ventilation is occasionally necessary. A case of a 58-year-old female patient with depression who demonstrated a very high BAC of 8.68 gm/L (0.868%) following ingestion of large amounts of alcohol with suicidal intent is presented. Intubation and ventilation were life-saving, and the patient did not develop any physical or consequential damage. As the patient had not regularly used alcohol or any other psychotropic agent, tolerance could be ruled out. This case emphasizes the necessity of rapid securing of the airway in patients with alcohol intoxication and respiratory depression and, furthermore, illustrates the large interindividual differences regarding ethanol susceptibility.
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Affiliation(s)
- Kathrin Malejko
- Department of Psychiatry and Psychotherapy III, Ulm University, Leimgrubenweg 12-14, 89075, Ulm, Germany
| | - Heiko Graf
- Department of Psychiatry and Psychotherapy III, Ulm University, Leimgrubenweg 12-14, 89075, Ulm, Germany
| | - Maximilian Gahr
- Department of Psychiatry and Psychotherapy III, Ulm University, Leimgrubenweg 12-14, 89075, Ulm, Germany
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Viglino D, Bourez D, Collomb-Muret R, Schwebel C, Tazarourte K, Dumanoir P, Paquier C, Danel V, Debaty G, Maignan M. Noninvasive End Tidal CO2 Is Unhelpful in the Prediction of Complications in Deliberate Drug Poisoning. Ann Emerg Med 2016; 68:62-70.e1. [PMID: 26810758 DOI: 10.1016/j.annemergmed.2015.11.037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Revised: 11/19/2015] [Accepted: 11/25/2015] [Indexed: 12/26/2022]
Abstract
STUDY OBJECTIVE We study the performance of capnometry in the detection of early complications after deliberate drug poisoning. METHODS This was a prospective cohort study of self-poisoned adult patients who presented at an emergency department (ED) between April 20, 2012, and May 6, 2014. Patients who ingested at least 1 neurologic or respiratory depressant drug were included. The primary outcome was the predictive value of an end tidal CO2 (etco2) measurement greater than or equal to 50 mm Hg for the detection of early complications defined a priori by hypoxia requiring oxygen greater than or equal to 3 L/min, bradypnea less than or equal to 10 breaths/min, or ICU admission after intubation or antidote administration because of unresponsiveness to pain or respiratory arrest. Consciousness scales and clinical data were recorded at admission and every 30 minutes. Noninvasive etco2 was continuously measured for 2 hours after inclusion unless the patient was admitted to the ICU. Patients and physicians were blinded to etco2 values. RESULTS Two hundred one patients were included, 35 of whom exhibited at least 1 complication. An etco2 measurement greater than or equal to 50 mm Hg predicted the onset of a complication, with a sensitivity of 46% (95% confidence interval [CI] 29% to 63%) and a specificity of 80% (95% CI 73% to 86%), leading to a positive predictive value of 33% (95% CI 20% to 48%) and a negative predictive value of 88% (95% CI 81% to 92%). etco2 was less able to predict complications than the Glasgow Coma Scale score at inclusion. CONCLUSION Capnometry in isolation does not provide adequate prediction of early complications in self-poisoned patients referred to the ED. A dynamic minute-by-minute assessment of etco2 could be more predictive.
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Affiliation(s)
- Damien Viglino
- University Grenoble Alps-Emergency Department and Mobile Intensive Care Unit, CHU Michallon, Grenoble, France; INSERM U1042, HP2 Laboratory, University Grenoble Alps, Grenoble, France
| | - Delphine Bourez
- University Grenoble Alps-Emergency Department and Mobile Intensive Care Unit, CHU Michallon, Grenoble, France
| | - Roselyne Collomb-Muret
- University Grenoble Alps-Emergency Department and Mobile Intensive Care Unit, CHU Michallon, Grenoble, France
| | - Carole Schwebel
- University Grenoble Alps-Medical Intensive Care Unit, CHU Michallon, Grenoble, France
| | | | - Perrine Dumanoir
- University Grenoble Alps-Emergency Department and Mobile Intensive Care Unit, CHU Michallon, Grenoble, France
| | - Carole Paquier
- University Grenoble Alps-Emergency Department and Mobile Intensive Care Unit, CHU Michallon, Grenoble, France
| | - Vincent Danel
- University Grenoble Alps-Emergency Department and Mobile Intensive Care Unit, CHU Michallon, Grenoble, France
| | - Guillaume Debaty
- University Grenoble Alps-Emergency Department and Mobile Intensive Care Unit, CHU Michallon, Grenoble, France; CNRS UMR 5525, TIMC-IMAG Laboratory, Team PRETA, University Grenoble Alps, Grenoble, France
| | - Maxime Maignan
- University Grenoble Alps-Emergency Department and Mobile Intensive Care Unit, CHU Michallon, Grenoble, France; CNRS UMR 5525, TIMC-IMAG Laboratory, Team PRETA, University Grenoble Alps, Grenoble, France.
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Acoustic method respiratory rate monitoring is useful in patients under intravenous anesthesia. J Clin Monit Comput 2016; 31:59-65. [DOI: 10.1007/s10877-015-9822-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Accepted: 12/29/2015] [Indexed: 11/27/2022]
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A Synthetic Multifunctional Mammalian pH Sensor and CO2 Transgene-Control Device. Mol Cell 2014; 55:397-408. [DOI: 10.1016/j.molcel.2014.06.007] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Revised: 03/07/2014] [Accepted: 05/15/2014] [Indexed: 11/16/2022]
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