Clinical Profile and Predictors of Intensive Care Admission in Neonicotinoid Poisoning in a Tertiary Care Hospital in South India.

Background and objectives: Neonicotinoids are a newer class of pesticides that are believed to cause predominantly mild toxicity in humans. This study aimed to describe the clinical features of neonicotinoid poisoning and identify predictors of severe toxicity. Materials and methods: This retrospective study included all patients with neonicotinoid poisoning admitted to a Tertiary Care Center in India over an 18-year period. Clinical and laboratory features were compared against outcomes to identify predictors of the need for intensive care admission. Results: Twenty-eight patients were included in the study of which 28.6% had severe disease requiring ICU admission. A higher respiratory rate, blood lactate level, SOFA, and qSOFA scores as well as a lower Glasgow coma score at presentation predicted ICU admission. First-generation compounds and imidacloprid consumption were associated with longer ICU stays and a longer duration of invasive ventilation. Conclusion: Neonicotinoid compounds can cause significant toxicity with oral ingestion. Imidacloprid and other first-generation compounds were associated with more severe toxicity requiring intensive care. Simple clinical parameters assessed at presentation can be used to predict severe disease and the need for ICU care. Larger, prospective studies are required to confirm these findings. How to cite this article: Sanga L, Jacob A, Jayakaran JAJ, Iyadurai R. Clinical Profile and Predictors of Intensive Care Admission in Neonicotinoid Poisoning in a Tertiary Care Hospital in South India. Indian J Crit Care Med 2024;28(1):66-69.

Adrenaline is effective in reversing the inadequate heart rate response in atropine treated organophosphorus and carbamate poisoning.

BACKGROUND: In acute organophosphorus (OP) or carbamate poisoning, some patients require high dose atropine to counteract the effects on heart rate (HR) and blood pressure (BP). This study describes the factors associated with high dose atropine therapy and the use of adrenaline to reverse the inadequate HR response to atropine. METHODS: Consecutive patients admitted to the intensive care unit (ICU) were prospectively recruited. Demographic data, treatment and outcomes of patients who failed to achieve target HR (100/min) or systolic BP >90 mm Hg with either a cumulative atropine dose of 100-mg within 6-h following admission or an infusion of 30 mg/h for at least 3-h were compared with patients who achieved the targets. Factors associated with high dose atropine therapy were explored using logistic regression analysis and expressed as odds ratio (OR) with 95% confidence intervals (CIs). RESULTS: Of the 181 patients admitted with OP or carbamate poisoning, 155 patients fulfilled inclusion criteria. The mean (SD) age was 35.7 (15.8) years; admission APACHE-II score was 14.6 (7.5). Heart rate and/or BP target was not achieved in 13.6%. In these patients, target HR was achieved after adding adrenaline infusion at 2-4 µg/min. Ventilation duration (11.6 ± 6.3 vs. 8.4 ± 6.9 days, p = 0.05) and ICU stay (12.3 ± 5.8 vs. 8.9 ± 5.8 days, p = 0.01) were longer in patients requiring high dose atropine when compared with others. On multivariate logistic regression analysis, shorter time to presentation to hospital (p = 0.04) was associated with need for high dose atropine. Overall mortality was 9% and similar in both groups (p = 0.41). CONCLUSIONS: High dose atropine therapy is required in a subset of patients with OP and carbamate poisoning and was associated with longer ventilation duration and ICU stay. Adrenaline infusion improved hemodynamics in these patients.

Heat-related illness-Clinical profile and predictors of outcome from a healthcare center in South India.

BACKGROUND: Heat-related illness is a common medical emergency. There is failure of thermoregulatory mechanisms of the body resulting in multiple organ dysfunction syndrome which if not identified and treated urgently can result in high mortality rate and permanent neurological damage. This study provides description of clinical profile patients presenting with heat-related illness and identifies clinical and laboratory variables resulting in poor outcome. METHODS: This retrospective study was done identifying adult patients admitted with a diagnosis of heat-related illness from April to August 2019 in tertiary care center. Their clinical profile, laboratory investigations and outcome were extracted from medical records and variables associated with poor outcome were analyzed for statistical significance. RESULTS: Mean age of the patients in the study was 61 years with mean heat index of the localities being 39.6-degree C. 66% of patients had multiple organ dysfunction with central nervous system dysfunction (77%) followed by respiratory distress syndrome (61%) as the most common organ derangement. Evaporative cooling measures were incorporated in management of all patients, followed by cold saline infusion in 60%. Higher J-ERATO score at admission was found to be a predictor for underlying multiple organ dysfunction syndrome (P value < 0.029). The mortality rate associated with heat-related illness in this study was 11.1%. CONCLUSIONS: Multiple organ dysfunction is seen in majority of the patients and calculation of simple admission J-ERATO score helps in predicting the same. Declining mortality rate observed in our study as compared to the earlier studies could be attributed to increased awareness, prompt diagnosis and initiation of rapid cooling measures.