1
|
Yu CH, Huang LC, Su YJ. Poisoning-Induced Acute Kidney Injury: A Review. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:1302. [PMID: 39202583 PMCID: PMC11356116 DOI: 10.3390/medicina60081302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2024] [Revised: 08/06/2024] [Accepted: 08/11/2024] [Indexed: 09/03/2024]
Abstract
Acute kidney injury (AKI) is a debilitating, multi-etiological disease that is commonly seen in clinical practice and in the emergency department. In this review, we introduce the definition, symptoms, and causes of poisoning-related AKI; we also discuss its mechanisms, risk factors, and epidemiology, as well as elaborate on the relevant laboratory tests. Subsequently, we discuss the treatment strategies for toxin- and substance-related AKI caused by Glafenin, antimicrobial agents, lithium, contrast media, snake venom, herbicides, ethylene glycol, synthetic cannabinoids, cocaine, heroin, and amphetamines. Finally, for a comprehensive overview of poisoning-related AKI, we review the management, prevention, and outcomes of this condition.
Collapse
Affiliation(s)
- Ching-Hsiang Yu
- Department of Emergency Medicine, MacKay Memorial Hospital, Taipei 10449, Taiwan;
| | - Lan-Chi Huang
- Department of Emergency Medicine, MacKay Memorial Hospital, Tamshui Branch, New Taipei City 251020, Taiwan;
| | - Yu-Jang Su
- Department of Emergency Medicine, MacKay Memorial Hospital, Taipei 10449, Taiwan;
- Toxicology Division, Department of Emergency Medicine, MacKay Memorial Hospital, Taipei 10449, Taiwan
- Department of Medicine, MacKay Medical College, New Taipei City 25245, Taiwan
- MacKay Junior College of Medicine, Nursing, and Management, Taipei 11260, Taiwan
- Department of Nursing, Yuanpei University of Medical Technology, Hsinchu 300, Taiwan
| |
Collapse
|
2
|
Chen J, Su Y, Lin F, Iqbal M, Mehmood K, Zhang H, Shi D. Effect of paraquat on cytotoxicity involved in oxidative stress and inflammatory reaction: A review of mechanisms and ecological implications. ECOTOXICOLOGY AND ENVIRONMENTAL SAFETY 2021; 224:112711. [PMID: 34455184 DOI: 10.1016/j.ecoenv.2021.112711] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 08/07/2021] [Accepted: 08/24/2021] [Indexed: 06/13/2023]
Abstract
Paraquat (PQ) is a cheap and an effective herbicide, which is widely being used worldwide to remove weeds in cultivated crop fields. However, it can cause soil and water pollution, and pose serious harm to the environment and organisms. Several countries have started to limit or prohibit the use of PQ because of the increasing number of human deaths. Its toxicity can damage the organisms with a multi-target mechanism, which has not been fully understood yet. That is why it is hard to treat as well. The current research on PQ focuses on its targeted organ, the lungs, in which PQ mostly trigger pulmonary fibrosis. While there is a lack of systematic research, there are few studies published discussing its toxic effects at systematic level. This review summarizes the major damages caused by PQ in different organisms and partial mechanisms by which it causes these damages. For this purpose, we consulted several research articles that studied the toxicity of PQ in various tissues. We also listed some drugs that can be used to alleviate the toxicity of PQ. However, at present, the effectiveness of these drugs is still being explored in animal experiments and the study of their mechanism will also help in understanding the poisoning mechanism of PQ, which will ultimately lead to effective treatment in future.
Collapse
Affiliation(s)
- Jiaxin Chen
- College of Veterinary Medicine, South China Agricultural University, Guangzhou 510642, China
| | - Yalin Su
- College of Veterinary Medicine, South China Agricultural University, Guangzhou 510642, China
| | - Fei Lin
- College of Veterinary Medicine, South China Agricultural University, Guangzhou 510642, China
| | - Mujahid Iqbal
- Department of Pathology, Cholistan University of Veterinary and Animal Sciences (CUVAS), Bahawalpur 63100, Pakistan
| | - Khalid Mehmood
- Department of Clinical Medicine and Surgery, Faculty of Veterinary and Animal Sciences, The Islamia University of Bahawalpur, 63100, Pakistan
| | - Hui Zhang
- College of Veterinary Medicine, South China Agricultural University, Guangzhou 510642, China.
| | - Dayou Shi
- College of Veterinary Medicine, South China Agricultural University, Guangzhou 510642, China.
| |
Collapse
|
3
|
Gao Y, Hou L, Wang Y, Zhang Y, Zhang S, Li Y, Jiang Y, Zhu C, Sun T, Duan G, Yuan D. Comparison of Pancreatic Damage in Rats for Two Methods of Paraquat Administration. Front Pharmacol 2021; 12:611433. [PMID: 33967752 PMCID: PMC8099104 DOI: 10.3389/fphar.2021.611433] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 02/01/2021] [Indexed: 01/09/2023] Open
Abstract
It is noted that elevated serum amylase levels suggesting pancreatic damage has an association with prognosis in PQ patients. This study aimed to determine whether PQ can cause pancreatic damage. The two conventional models (intragastric infusion (iG) and intraperitoneal injection (iP)) may exhibit different effects on the pancreas depending on whether or not they pass through the digestive tract. In this study, the rats were divided into four groups: the intragastric infusion group (PQ-iG, n = 45), intraperitoneal injection group (PQ-iP, n = 53), normal control group 1 (NC-iG, n = 6) and normal control group 2 (NC-iP, n = 6). Pancreatic damage was compared between groups using serum amylase activity assay, hematoxylin and eosin (H&E) staining, TUNEL assay, and transmission electron microscopy (TEM). Serum amylase levels in group PQ-iG were significantly higher than in group PQ-iP (p < 0.05). Examination of the H&E sections showed damage to the pancreas. Both experimental groups were displayed inflammatory infiltration within 9 h of PQ treatment. After 9 h, patchy necrosis was observed in group PQ-iP, when inflammatory infiltration was still the dominant pathology. Necrosis appeared and gradually worsened in group PQ-iG, in which necrosis was the dominant pathology. The TUNEL assay showed significantly higher numbers of apoptotic cells in the pancreas of PQ-groups than in the control NC- groups (p < 0.05). TEM showed expansive endoplasmic reticulum lumens and mitochondria swelling in the pancreas of the PQ-groups. It is concluded that both methods of modeling could cause pancreatic damage and the type and degree of damage would change over time. Note that pancreatic damage in group PQ-iG was more severe than that in group PQ-iP. Therefore, clinical practitioners should pay close attention to pancreatic damage caused by PQ, especially when the route of PQ administration was oral.
Collapse
Affiliation(s)
- Yanxia Gao
- Emergency Department, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Linlin Hou
- Emergency Department, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yibo Wang
- Emergency Department, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yan Zhang
- Emergency Department, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Shoutao Zhang
- Henan Key Laboratory of Bioactive Macromolecules, School of Life Sciences, Zhengzhou, China
| | - Yi Li
- Emergency Department, Chinese Academy of Medical Sciences, Peking Union Medical College Hospital, Beijing, China
| | - Yanan Jiang
- Department of Pathophysiology, School of Basic Medical Sciences, Zhengzhou University, Zhengzhou, China
| | - Changju Zhu
- Emergency Department, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Tongwen Sun
- Emergency Department, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Guoyu Duan
- Emergency Department, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Ding Yuan
- Emergency Department, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| |
Collapse
|
4
|
Huang C, Bai L, Xue X, Peng L, Jiang J, Zhang X. Hyperamylasemia as an early predictor of mortality in patients with acute paraquat poisoning. J Int Med Res 2020; 48:300060520910037. [PMID: 32223576 PMCID: PMC7133085 DOI: 10.1177/0300060520910037] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 01/27/2020] [Indexed: 12/12/2022] Open
Abstract
Objective This study aimed to evaluate the relationship between elevated serum amylase levels and the prognosis of paraquat poisoning. Methods Patients were categorized into the elevated and non-elevated serum amylase groups according to serum amylase levels. Demographics, mortality, risk factors of elevated serum amylase levels, and injury to the pancreas were analyzed. Results A total of 457 patients were enrolled in this study and the overall mortality rate was 51.9%. Patients in the elevated group had worse indices than those in the non-elevated group. Kaplan–Meier survival analysis showed that the mortality rate in the elevated group was significantly higher than that in the non-elevated group (hazard ratio: 10.65, 95% confidence interval [CI]: 7.55–15.02). Multivariate Cox proportional hazards analysis showed that elevated serum amylase levels were related to mortality (hazard ratio: 2.066, 95% CI: 1.239–3.444). The receiver operating characteristic curve showed that the area under the curve was 0.724 (95% CI: 0.666–0.783) for serum amylase levels with 70.4% sensitivity and 74.0% specificity. Conclusion Elevated serum amylase levels are observed in PQ poisoning. This elevation might be one of the most accurate early prognostic factors for predicting severity and mortality.
Collapse
Affiliation(s)
- Changbao Huang
- Department of Emergency Medicine, Yijishan Hospital, Wannan Medical College, Wuhu, Anhui, P.R. China
| | - Lina Bai
- Department of Emergency Medicine, the 5th Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Xiang Xue
- Department of Emergency Medicine, Yijishan Hospital, Wannan Medical College, Wuhu, Anhui, P.R. China
| | - Liangfei Peng
- Department of Emergency Medicine, Yijishan Hospital, Wannan Medical College, Wuhu, Anhui, P.R. China
| | - Jinghan Jiang
- Department of Emergency Medicine, Yijishan Hospital, Wannan Medical College, Wuhu, Anhui, P.R. China
| | - Xigang Zhang
- Department of Emergency Medicine, the 5th Medical Center of Chinese PLA General Hospital, Beijing, China
| |
Collapse
|
5
|
Shadnia S, Ebadollahi-Natanzi A, Ahmadzadeh S, Karami-Mohajeri S, Pourshojaei Y, Rahimi HR. Delayed death following paraquat poisoning: three case reports and a literature review. Toxicol Res (Camb) 2018; 7:745-753. [PMID: 30310653 PMCID: PMC6116805 DOI: 10.1039/c8tx00120k] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 06/12/2018] [Indexed: 12/12/2022] Open
Abstract
Paraquat (PQ) poisoning is principally reported in developing countries. However, most fatalities occur elsewhere due to the induction of multi-organ failure. PQ poisoning can hardly be managed by clinical practice, and no specific antidote has come into existence yet. Here three cases, including 17-, 20-, and 23-year-old men, who were poisoned with PQ, have been reported. Furthermore, the literature regarding biological mechanisms, clinical manifestation, and treatment of PQ-induced toxicity was reviewed. Patients who, either intentionally or accidentally, ingested PQ earlier were initially found to be stable at the emergency department (ED). Therefore, they were discharged from the hospital under a follow-up. However, after several days, the patients were referred to the hospital for the second time and despite cardiovascular resuscitation (CPR) efforts, they suddenly expired. The delayed death following exposure to PQ was reported for inducing gradual progressive pulmonary fibrosis, metabolic acidosis, neurotoxicity, renal failure, and liver injury in poisoned patients. Therefore, PQ-intoxicated patients should be supervised for up to several weeks, and kept in the hospital for a longer period of time. Clinical manifestations and laboratory findings are beneficial markers that act as useful predictors of PQ poisoning.
Collapse
Affiliation(s)
- Shahin Shadnia
- Toxicology Research Center , Excellence Center of Clinical Toxicology , Department of Clinical Toxicology , Loghman Hakim Hospital , School of Medicine , Shahid Beheshti University of Medical Sciences , Tehran , Iran
| | - Alireza Ebadollahi-Natanzi
- Medicinal Plants Department , Imam Khomeini Higher Education Center , Agricultural Research , Education and Extension Organization (AREEO) , Karaj , Iran
| | - Saeid Ahmadzadeh
- Pharmaceutics Research Center , Institute of Neuropharmacology , Kerman University of Medical Sciences , Kerman , Iran . ;
| | - Somayyeh Karami-Mohajeri
- Department of Toxicology & Pharmacology , Faculty of Pharmacy , Kerman University of Medical Sciences , Kerman , Iran
| | - Yaghoub Pourshojaei
- Department of Medicinal Chemistry , Faculty of Pharmacy , Kerman University of Medical Sciences , Kerman , Iran
| | - Hamid Reza Rahimi
- Pharmaceutics Research Center , Institute of Neuropharmacology , Kerman University of Medical Sciences , Kerman , Iran . ;
- Department of Toxicology & Pharmacology , Faculty of Pharmacy , Kerman University of Medical Sciences , Kerman , Iran
| |
Collapse
|
6
|
Huang J, Xuan D, Li X, Ma L, Zhou Y, Zou H. The value of APACHE II in predicting mortality after paraquat poisoning in Chinese and Korean population: A systematic review and meta-analysis. Medicine (Baltimore) 2017; 96:e6838. [PMID: 28746171 PMCID: PMC5627797 DOI: 10.1097/md.0000000000006838] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The Acute Physiology and Chronic Health Evaluation II (APACHE II) score is used to determine disease severity and predict outcomes in critically ill patients. However, the prognostic significance of APACHE after acute paraquat (PQ) poisoning remains unclear. The meta-analysis was aimed to study the value of APACHE II in predicting mortality in PQ-exposed Chinese and Korean patients. METHODS Databases that included PubMed, Embase, Cochrane Library, and the Chinese National Knowledge Infrastructure were searched through August 2016. Studies using APACHE II to predict mortality in PQ-poisoned patients were selected. The odds ratio and weighted mean difference (WMD) were used to pool binary and continuous data. Additionally, we aggregated sensitivity, specificity, and other measures of accuracy. Statistical analyses were made using the Stata V.13.0 software. RESULTS This study included 29 studies, and 25 studies evaluated APACHE II scores on admission. Pooled data showed that survivors had significantly lower total scores than nonsurvivors (WMD = -7.29, and I = 98.2%, both P <.05). The pooled sensitivity of an APACHE II score ≥5 for predicting mortality was 75% and the pooled specificity was 86%. The positive likelihood ratio (PLR) was 5.3 and the negative likelihood ratio (NLR) was 0.29. The pooled sensitivity of an APACHE II score ≥10 for predicting mortality was 88% and the pooled specificity was 84%. The pooled PLR and NLR was 5.5 and 0.15, respectively. CONCLUSION This study showed PQ-poisoned nonsurvivors had significantly higher APACHE II score than did survivors. APACHE II scores satisfactorily predicted mortality.
Collapse
Affiliation(s)
- Jianshu Huang
- Department of Occupational Medicine, Huashan Hospital
- Department of Occupational Medicine, Jinshan Hospital, Fudan University, Shanghai, China
| | - Dandan Xuan
- Department of Occupational Medicine, Huashan Hospital
| | - Xiuju Li
- Department of Occupational Medicine, Jinshan Hospital, Fudan University, Shanghai, China
| | - Li Ma
- Department of Occupational Medicine, Jinshan Hospital, Fudan University, Shanghai, China
| | - Yuanling Zhou
- Department of Occupational Medicine, Jinshan Hospital, Fudan University, Shanghai, China
| | - Hejian Zou
- Department of Occupational Medicine, Huashan Hospital
| |
Collapse
|
7
|
Dong H, Peng X, Qiu Z. A rare case of epilepsy and acute pancreatitis induced by severe paraquat poisoning. ANNALS OF TRANSLATIONAL MEDICINE 2017; 5:163. [PMID: 28480199 DOI: 10.21037/atm.2017.03.106] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Paraquat can lead to injury of multiple organs. As there is no specific treatment for paraquat poisoning, it represents a serious clinical problem. Antioxidants are required to treat oxidative stress in paraquat poisoning and paraquat-induced injury. In this study, we report on successful treatment of a rare case of epilepsy and acute pancreatitis caused by paraquat poisoning. A 29-year-old woman at our hospital presented with a 13-day history of nausea and vomiting after ingesting 20 mL of paraquat (20% W/V). After therapies, the symptoms were controlled. The patient remained asymptomatic during 1 year of follow-up.
Collapse
Affiliation(s)
- Hongxia Dong
- Department of Gastroenterology and Poisoning, Beijing 307 Hospital, Beijing 100071, China
| | - Xiaobo Peng
- Department of Gastroenterology and Poisoning, Beijing 307 Hospital, Beijing 100071, China
| | - Zewu Qiu
- Department of Gastroenterology and Poisoning, Beijing 307 Hospital, Beijing 100071, China
| |
Collapse
|
8
|
Liu S, Wang Q, Zhou R, Li C, Hu D, Xue W, Wu T, Mohan C, Peng A. Hyperamylasemia as an Early Predictor of Mortality in Patients with Acute Paraquat Poisoning. Med Sci Monit 2016; 22:1342-8. [PMID: 27101346 PMCID: PMC4844273 DOI: 10.12659/msm.897930] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Background Paraquat (PQ) is a non-selective and fast-acting contact herbicide which has been widely used in developing countries. Hyperamylasemia was reported in patients with PQ poisoning. This study investigated the predictive value and clinical characteristics of hyperamylasemia in patients with PQ poisoning. Material/Methods This study included 87 patients with acute PQ poisoning admitted from July 2012 to May 2015. Data were collected from medical records. Receiver operating characteristic (ROC) analysis was conducted to analyze the discriminatory potential of serum amylase with respect to 90-day mortality. Results Of 87 patients, 29 patients had elevated serum amylase. We found that serum amylase was significantly higher among patients with AKI than those with non-AKI (p<0.001), and was an independent predictor of mortality (hazard ratio [HR]=3.644; 95% [CI], 1.684–7.881; p=0.001). The area under the ROC curve for the serum amylase (area under curve [AUC]=0.796; 95% [CI], 0.690–0.903) had a better discriminatory potential than plasma PQ concentration (0.698;0.570–0.825) or urinary PQ concentration (0.647;0.514–0.781) in predicting 90-day mortality. Conclusions Hyperamylasemia is a valuable early predictor of 90-day mortality in PQ poisoning.
Collapse
Affiliation(s)
- Shuai Liu
- Department of Nephrology & Rheumatology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China (mainland)
| | - Qiang Wang
- Department of Nephrology & Rheumatology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China (mainland)
| | - Rong Zhou
- Department of Nephrology, Shanghai Yangpu Hospital, Tongji University School of Medicine, Shanghai, China (mainland)
| | - Changbin Li
- Department of Nephrology & Rheumatology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China (mainland)
| | - Dayong Hu
- Department of Nephrology & Rheumatology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China (mainland)
| | - Wen Xue
- Department of Nephrology & Rheumatology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China (mainland)
| | - Tianfu Wu
- Department of Nephrology, Shanghai Yangpu Hospital, Tongji University School of Medicine, Shanghai, China (mainland)
| | - Chandra Mohan
- Department of Nephrology & Rheumatology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China (mainland)
| | - Ai Peng
- Department of Nephrology & Rheumatology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China (mainland)
| |
Collapse
|
9
|
Sun IO, Shin SH, Yoon HJ, Lee KY. Predicting the probability of survival in acute paraquat poisoning. Kidney Res Clin Pract 2016; 35:102-6. [PMID: 27366665 PMCID: PMC4919560 DOI: 10.1016/j.krcp.2016.01.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Revised: 01/24/2016] [Accepted: 01/31/2016] [Indexed: 10/24/2022] Open
Abstract
BACKGROUND Paraquat (PQ) concentration-time data have been used to predict prognosis for 3 decades. The aim of this study was to find a more accurate method to predict the probability of survival. METHODS This study included 788 patients with PQ poisoning who were diagnosed using plasma PQ concentration between January 2005 and August 2012. We divided these patients into 2 groups (survivors vs. nonsurvivors), compared their clinical characteristics, and analyzed the predictors of survival. RESULTS The mean age of the included patients was 57 years (range, 14-95 years). When we compared clinical characteristics between survivors (n = 149, 19%) and nonsurvivors (n = 639, 81%), survivors were younger (47 ± 14 years vs. 59 ± 16 years) and had lower plasma PQ concentrations (1.44 ± 8.77 μg/mL vs. 80.33 ± 123.15 μg/mL) than nonsurvivors. On admission, serum creatinine was lower in survivors than in nonsurvivors (0.95 ± 0.91 mg/dL vs. 1.88 ± 1.27 mg/dL). In multivariate logistic regression analysis, age and logarithmically converted serum creatinine [ln(Cr)], [ln(time)], and [ln(PQ)] were assessed as prognostic factors to predict survival in PQ poisoning. The predicted probability of survival using significant prognostic factors was exp (logit)/[1 + exp(logit)], where logit = -1.347 + [0.212 × sex (male = 1, female = 0)] + (0.032 × age) + [1.551 × ln(Cr)] + [0.391 × ln(hours since ingestion)] + [1.076 × ln(plasma PQ μg/mL)]. With this equation, the sensitivity and specificity were 86.5% and 98.7%, respectively. CONCLUSION Age, ln(Cr), ln(time), and ln(PQ) were important prognostic factors in PQ poisoning, and our equation can be helpful to predict the survival in acute PQ poisoning patients.
Collapse
Affiliation(s)
- In O Sun
- Division of Nephrology & Toxicology, Department of Internal Medicine, Presbyterian Medical Center, Jeonju, Korea
| | - Sung Hye Shin
- Department of Biochemistry, Christian Medical Research Center, Jeonju, Korea
| | - Hyun Ju Yoon
- Division of Nephrology & Toxicology, Department of Internal Medicine, Presbyterian Medical Center, Jeonju, Korea
| | - Kwang Young Lee
- Division of Nephrology & Toxicology, Department of Internal Medicine, Presbyterian Medical Center, Jeonju, Korea; Department of Biochemistry, Christian Medical Research Center, Jeonju, Korea
| |
Collapse
|
10
|
Abnormal pancreatic enzymes and their prognostic role after acute paraquat poisoning. Sci Rep 2015; 5:17299. [PMID: 26603772 PMCID: PMC4658566 DOI: 10.1038/srep17299] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Accepted: 10/26/2015] [Indexed: 02/07/2023] Open
Abstract
Ingestion of paraquat causes multi-organ failure. Prognosis is best estimated through
measurement of blood paraquat concentrations but this facility is not available in
most hospitals. We studied the prognostic significance of abnormal pancreatic
enzymes for survival. Patients with acute paraquat poisoning were recruited. An
extensive series of blood tests including serum amylase were serially checked.
Patients were sorted according to their serum amylase activity (normal
[<220 U/L], mildly elevated [220 to 660 U/L],
elevated [>660 U/L]), and survival compared between groups. 177
patients were enrolled to the study, of whom 67 died and 110 survived. 122 (70.62%),
27 (15.25%) and 25 (14.13%) patients were in the normal, mildly elevated and
elevated amylase activity groups, respectively. The case fatality in the elevated
group was 100% compared to 17% in the normal group
(P < 0.001). We found four independent factors for
paraquat death prediction: amylase, PaCO2, leukocyte number, and
neutrophil percentage. Models using pancreatic enzyme activity showed good
prediction power. We have found that abnormal pancreatic enzymes are useful
prognostic marker of death after acute paraquat poisoning. Including serum amylase
activity into a prognostic model provides a good prognostication.
Collapse
|