The Prevalence of Acid-Base Disorders in Patients with Acute Poisoning in the Intensive Care Unit of Clinical Toxicology Department, Isfahan, Iran

Document Type : Original Article (s)

Authors

1 Professor, Isfahan Clinical Toxicology Research Center AND Department of Clinical Toxicology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

2 Student of Medicine, Student Research Committee. School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

3 Professor, Department of Epidemiology and Biostatistics, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran

Abstract

Background: Acid-base disturbances are common in critically ill patients, and contribute to morbidity and mortality. We evaluated the prevalence of acid-base disturbances in cases with acute poisoning admitted to intensive care unit (ICU).Methods: In this cross-sectional study, patients with acute poisoning hospitalized in ICU of a university hospital affiliated with Isfahan University of Medical Sciences, Isfahan, Iran, from March 2016 to December 2017 were included. The acid-base status of the patients on admission time in emergency room, and its association with demographic factors, as well as clinical manifestations and outcome was recorded. Outcome was defined as survived without complication and complication/death.Findings: The majority of patients had acid-base disorder (89.7%). Most patients had metabolic acidosis (31.3%) on admission time, and most of them were men (71.6%) (P = 0.01). 48 patients (22.4%) were alert, of whom, 93.8% had an acid-base disorder. 60 patients (28.03%) were admitted with stupor and coma, of whom, 89.1% had acid-base disorder. There was a significant relationship between acid-base state with gender and level of consciousness at the time of admission (P < 0.05). There was also a significant correlation between treatment outcome with age, ingested toxic agents, and abnormal electrocardiography (ECG). Among different evaluated variables, age was the determinant factor in outcome prediction (P = 0.01; odds ratio (OR) = 1.02; 95% confidence interval (CI) = 1.004-1.04).Conclusion: Acid-base disorders are common in patients with acute poisoning. The level of consciousness on admission and gender are important associated factors. The status of acid-base on the admission is not the only factor affecting outcomes and prognosis, and should be assessed along with other factors.

Keywords

References

  1. Al-Jaghbeer M, Kellum JA. Acid-base disturbances in intensive care patients: etiology, pathophysiology and treatment. Nephrol Dial Transplant 2015; 30(7): 1104-11.
  2. Adrogue HJ, Madias NE. Management of life-threatening acid-base disorders. First of two parts. N Engl J Med 1998; 338(1): 26-34.
  3. Morgan TJ. The meaning of acid-base abnormalities in the intensive care unit: part III -- effects of fluid administration. Crit Care 2005; 9(2): 204-11.
  4. Bockenkamp B, Vyas H. Understanding and managing acute fluid and electrolyte disturbances. Current Paediatrics 2003; 13(7): 520-8.
  5. Balci AK, Koksal O, Kose A, Armagan E, Ozdemir F, Inal T, et al. General characteristics of patients with electrolyte imbalance admitted to emergency department. World J Emerg Med 2013; 4(2): 113-6.
  6. Hu J, Wang Y, Chen R, Zhang X, Lin J, Teng J, et al. Electrolyte and acid-base disturbances in critically ill patients: a retrospective and propensity-matched study. Int J Clin Exp Med 2017;10(1):992-1003.
  7. Stevens DC, Campbell JP, Carter JE, Watson WA. Acid-base abnormalities associated with cocaine toxicity in emergency department patients. J Toxicol Clin Toxicol 1994; 32(1): 31-9.
  8. Liu JH, Chou CY, Liu YL, Liao PY, Lin PW, Lin HH, et al. Acid-base interpretation can be the predictor of outcome among patients with acute organophosphate poisoning before hospitalization. Am J Emerg Med 2008; 26(1): 24-30.
  9. Paasma R, Hovda KE, Hassanian-Moghaddam H, Brahmi N, Afshari R, Sandvik L, et al. Risk factors related to poor outcome after methanol poisoning and the relation between outcome and antidotes--a multicenter study. Clin Toxicol (Phila) 2012; 50(9): 823-31.
  10. Kerr GW, McGuffie AC, Wilkie S. Tricyclic antidepressant overdose: a review. Emerg Med J 2001; 18(4): 236-41.
  11. Singer RB. The acid-base disturbance in salicylate intoxication. Medicine (Baltimore) 1954; 33(1): 1-13.
  12. Gray TA, Buckley BM, Vale JA. Hyperlactataemia and metabolic acidosis following paracetamol overdose. Q J Med 1987; 65(246): 811-21.
  13. Arefi M, Behnoush B, Lalezari M, Zamani N. The frequency of the causes of acid base disturbances in patients hospitalized in the toxicology ward of Baharloo Hospital in 2009. Iran J Toxicol 2011; 5 (12-13): 410-4. [In Persian].
  14. Hamdi H, Hassanian-Moghaddam H, Hamdi A, Zahed NS. Acid-base disturbances in acute poisoning and their association with survival. J Crit Care 2016; 35: 84-9.
  15. Hovda KE, Bjornaas MA, Skog K, Opdahl A, Drottning P, Ekeberg O, et al. Acute poisonings treated in hospitals in Oslo: a one-year prospective study (I): pattern of poisoning. Clin Toxicol (Phila) 2008; 46(1): 35-41.
  16. Moviat M, van HF, van der Hoeven H. Conventional or physicochemical approach in intensive care unit patients with metabolic acidosis. Crit Care 2003; 7(3): R41-R45.
  17. Maehle K, Haug B, Flaatten H, Nielsen E. Metabolic alkalosis is the most common acid-base disorder in ICU patients. Crit Care 2014; 18(2): 420.
  18. Eizadi-Mood N, Yaraghi A, Alikhasi M, Jabalameli M, Farsaei S, Sabzghabaee AM. Prediction of endotracheal intubation outcome in opioid-poisoned patients: A clinical approach to bispectral monitoring. Can J Respir Ther 2014; 50(3): 83-6.
  19. Mirmoghtadaee P, Eizadi-Mood N, Sabzghabaee AM, Yaraghi A, Hosseinzadeh F, Dorvashi G, et al. Risk factors for endotracheal intubation and mechanical ventilation in patients with opioids intoxication. Pak J Med Sci 2012; 28(2): 279-82.
  20. Eizadi-Mood N, Shariati M, Yaraghi A, Gheshlaghi F, Masoomi G, Siadat ZD. Predictive factors of endotracheal intubation in poisoned patients with organophosphates. J Isfahan Med Sch 2011; 29(150): 1058-69. [In Persian].
  21. Jabal-Ameli M, Eizadi-Mood N, Tavangar-Rad P, Yaraghi A. The relationship between the scores of bispectral index (BIS) and glasgow coma scale (GCS) in poisoned patients with decreased level of consciousness requiring tracheal intubation. J Isfahan Med Sch 2016; 33(364): 2256-62. [In Persian].
  22. Eizadi-Mood N, Saghaei M, Alfred S, Zargarzadeh AH, Huynh C, Gheshlaghi F, et al. Comparative evaluation of Glasgow Coma Score and gag reflex in predicting aspiration pneumonitis in acute poisoning. J Crit Care 2009; 24(3): 470-15.
  23. Eizadi-Mood N, Sabzghabaee AM, Manteghi A, Yaraghi A, Motamedi N. Prevalence of different types of seizures in a poisoning referral center. J Isfahan Med Sch 2016; 34(395): 957-62. [In Persian].
Journal of Isfahan Medical School
Volume 36, Issue 509 - Serial Number 509
November and December 2019
Pages 1554-1559

Files

History

  • Receive Date: 21 June 2018
  • Revise Date: 01 November 2024
  • Accept Date: 06 April 2022

Share

How to cite

Statistics