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1.
Medicine (Baltimore) ; 99(31): e21351, 2020 Jul 31.
Artigo em Inglês | MEDLINE | ID: mdl-32756123

RESUMO

Paraquat (PQ) poisoning is associated with high mortality rate. Therefore, an accurate method for predicting the survival of patients with PQ poisoning is required. This study evaluated the value of serum anion gap (AG) at admission in predicting the survival of such patients.Cases of patients with PQ poisoning admitted to Cangzhou Central Hospital between May 2012 and March 2019 were retrospectively analyzed. The patients were classified into survival and nonsurvival groups on the basis of their 90-day prognosis. Correlation analysis, Cox regression analysis, and receiver operating characteristic and Kaplan-Meier curve analyses were performed to assess the value of AG in predicting the 90-day survival of patients with PQ poisoning.Only 44 of the 108 patients with PQ poisoning survived; thus, the 90-day survival was 40.74%. AG levels at admission were significantly higher in nonsurvivors (26.53 ±â€Š4.93 mmol/L) than in survivors (20.88 ±â€Š2.74 mmol/L) (P < .001) and negatively correlated with 90-day survival (r = -0.557; P < .001). Cox regression analysis revealed that AG at admission is an independent prognostic marker of the 90-day survival of patients with PQ poisoning. AG level at admission had an area under the receiver operating characteristic curve of 0.836 (95% confidence interval: 0.763-0.909) and an optimal cut-off value of 25.5 mmol/L (59.4% sensitivity and 95.5% specificity).AG level at admission may serve as a candidate marker for predicting the survival of patients with PQ poisoning.


Assuntos
Desequilíbrio Ácido-Base/sangue , Herbicidas/envenenamento , Paraquat/envenenamento , Envenenamento/mortalidade , Adulto , Biomarcadores/sangue , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Envenenamento/diagnóstico , Valor Preditivo dos Testes , Modelos de Riscos Proporcionais , Estudos Retrospectivos
2.
Artigo em Chinês | MEDLINE | ID: mdl-32536077

RESUMO

The glufosinate poisoning can cause damage to the respiratory system and nervous system. In severe cases, respiratory failure and toxic encephalopathy are life-threatening. It should be paid attention to and supportive treatment.In this paper, 15 cases of acute oral glyphosate poisoning diagnosed by toxicant test in the Poisoning Treatment Center of the Army from March to August 2018 were analyzed, and the clinical characteristics and treatment effect of acute glyphosate poisoning were summarized, so as to improve the understanding, diagnosis and treatment level of the disease.


Assuntos
Aminobutiratos , Herbicidas , Síndromes Neurotóxicas , Envenenamento , Insuficiência Respiratória , Aminobutiratos/envenenamento , Herbicidas/envenenamento , Humanos , Envenenamento/terapia
3.
Artigo em Chinês | MEDLINE | ID: mdl-32447895

RESUMO

Objective: To report a case of acute glufosinate-ammonium poisoning cause respiratory cardiac arrest and grass amine poisoning cases of successful rescue. Methods: The clinical data of a case of acute glufosinate-ammonium poisoning admitted to a third-class a hospital in April 2018 were analyzed and summarized. Results: The patient was poisoned by oral administration of a large amount of glufosinate-ammonium. Respiratory and cardiac arrest occurred during treatment and resuscitation was successful Later, the nervous system showed impaired function, The patients were treated with complete gastrointestinal cleansing, hemoperfusion, and the protection of important organs. Conclusion: For a large number of patients with oral glufosinate-ammonium poisoning, we should pay close attention to the damage of nervous system while taking active and conventional detoxification treatment.


Assuntos
Aminobutiratos/envenenamento , Parada Cardíaca/induzido quimicamente , Herbicidas/envenenamento , Parada Cardíaca/terapia , Hemoperfusão , Humanos , Desintoxicação por Sorção
5.
Toxicology ; 433-434: 152407, 2020 03 30.
Artigo em Inglês | MEDLINE | ID: mdl-32061663

RESUMO

Paraquat (PQ) is a fast-acting and effective herbicide that is used throughout the world to eliminate weeds. Over the past years, PQ was considered one of the most popular poisoning substances for suicide, and PQ poisoning accounts for about one-third of suicides around the world. Poisoning with PQ may cause multiorgan failure, pulmonary fibrosis, and ultimately death. Exposure to PQ results in the accumulation of PQ in the lungs, causing severe damage and, eventually, fibrosis. Until now, no effective antidote has been found to treat poisoning with PQ. In general, the toxicity of PQ is due to the formation of high energy oxygen free radicals and the peroxidation of unsaturated lipids in the cell. Ferroptosis is the result of the loss of glutathione peroxidase 4 (GPX4) activity that transforms iron-dependent lipid hydroperoxides to lipid alcohols, which are inert in the biological environment. Impaired iron metabolism and lipid peroxidation are increasingly known as the driving agents of ferroptosis. The contribution of ferroptosis to the development of cell death during poisoning with PQ has not yet been addressed. There is growing evidence about the relationship between PQ poisoning and ferroptosis. This raises the possibility of using ferroptosis inhibitors for the treatment of PQ poisoning. In this hypothesis-driven review article, we elaborated how ferroptosis inhibitors might circumvent the toxicity induced by PQ and may be potentially useful for the treatment of PQ toxicity.


Assuntos
Antídotos/farmacologia , Ferroptose/efeitos dos fármacos , Paraquat/envenenamento , Animais , Morte Celular/efeitos dos fármacos , Radicais Livres/metabolismo , Herbicidas/envenenamento , Humanos , Peroxidação de Lipídeos/efeitos dos fármacos , Insuficiência de Múltiplos Órgãos/induzido quimicamente , Insuficiência de Múltiplos Órgãos/prevenção & controle , Suicídio/estatística & dados numéricos
6.
Medicine (Baltimore) ; 99(1): e18136, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31895766

RESUMO

RATIONALE: Despite the fact that treatment of paraquat poisoning in pregnant women and their fetuses is challenging and raises ethical issues, it is rarely reported in the literature. We report the case of a pregnant woman who took paraquat intentionally. PATIENT CONCERNS: A 36-year-old woman at 38 weeks gestational age, in an apparent suicide attempt, drank 1 mouthful (about 20 ml) of paraquat solution. Ten hours later, her urine dithionate test showed light blue color with a plasma paraquat concentration of 0.547 µg/ml. Six hours after admission, a male infant, whose plasma paraquat concentration was 0.761 µg/ml, together with 0.673 µg/ml in the amniotic fluid measured by high-performance liquid chromatography, was delivered but the woman's lung, liver, and kidney function declined rapidly. DIAGNOSIS: INTERVENTIONS:: Because of placenta previa and multiple organ failure, emergency cesarean section, and panhysterectomy were performed for the pregnant woman. Intravenous injection of antibiotic to prevent infection and dexamethasone 30 mg once a day were administered. Mechanical ventilation was performed for the infant and meropenem and penicillin injection was administered. OUTCOMES: The infant died 33 hours after birth while the mother died on the 3rd day after ingestion. LESSONS: Paraquat can enter the fetus through the placenta and the amniotic fluid via fluid exchange. The pathological changes of fetal organs may relate to gestational age, and the prognosis was very poor in both the mother and the fetus.


Assuntos
Feto/efeitos dos fármacos , Herbicidas/envenenamento , Paraquat/envenenamento , Morte Perinatal , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Masculino , Morte Materna , Gravidez , Tentativa de Suicídio
7.
Clin Toxicol (Phila) ; 58(3): 201-203, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31169038

RESUMO

Context: During the re-approval process of glyphosate in Europe, it was mentioned that glyphosate-based products (GBF) were more toxic than glyphosate alone. This phenomenon was attributed to the surfactants and among them, polyethoxylated tallowamine (POEA) has been suspected to significantly contribute to the toxicity of glyphosate products. In animal data acute oral toxicity of POEA has been suggested to be greater than glyphosate toxicity in animal studies. There are no data, however, comparing the clinical signs and severity of acute human poisoning with tallowamine-containing GBF (TA) and non-tallowamine-containing GBF (NTA). The aim of this study was to compare the severity of oral poisoning between TA and NTA cases, reported to the French Poison Control Centres (PCC) over 7 years.Methods: This is a retrospective study of cases of oral exposure to GBF reported to French PCCs between January 1st, 2008 and December 12th, 2014. The formulation of every GBF was reviewed using the PCC national database of products and compositions, to identify cases involving TA, NTA, or GBF with unknown co-formulants.Results: Between 2008 and 2014, 1362 cases of GBF ingestion were registered in the PCC national database of poisoning cases. Among them, 429 were symptomatic acute cases of ingestion of GBF. There were 235 exposures to TA, 105 to NTA, and 89 to unknown GBF. There were more severe cases in the TA group than in the NTA group (p = 0.037).Discussion: The present study shows that POEA rather than other co-formulants leads to more severe symptoms in those patients ingesting GBF. The acute toxicity of POEA might be explained by its irritating properties; in experimental studies, it caused skin irritation and severe eye and mucous membranes irritation.Conclusion: In this study, severe respiratory symptoms were also more frequently reported in the TA group. The surfactant properties of POEA are likely to cause aspiration pneumonitis which is a plausible explanation for the respiratory failure complicating severe GBF poisoning cases.


Assuntos
Glicina/análogos & derivados , Herbicidas/envenenamento , Tensoativos/envenenamento , Adulto , Sinergismo Farmacológico , Feminino , França/epidemiologia , Glicina/administração & dosagem , Glicina/envenenamento , Herbicidas/administração & dosagem , Humanos , Masculino , Pessoa de Meia-Idade , Centros de Controle de Intoxicações/estatística & dados numéricos , Estudos Retrospectivos , Índice de Gravidade de Doença , Tensoativos/administração & dosagem
8.
Pestic Biochem Physiol ; 160: 146-153, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31519249

RESUMO

Paraquat (PQ) is widely used as a herbicide around the world. PQ intoxication causes liver disease mainly in mammals. N-acetyl cysteine (NAC) is a medication that has positive effects in reducing the liver intoxication caused by PQ. Here, after formulating a NAC noisome nanoparticle (NACNP), we compared the niosomes and NAC on liver toxicity caused by PQ. Thirty male rats were divided into 5 groups and were treated intraperitoneally with PQ and NAC and NACNP for 24 h. PQ group received 35 mg/kg/day of PQ, while NAC and NACNP groups were administered with 25 mg/kg/day of NAC and NACNP, respectively. In addition, 6 rats receiving saline solution were considered as control group. Serum and liver tissue samples were collected from all rats. Alanine (AST) and aspartate (ALT) aminotransferase levels, and oxidative stress biomarkers including total antioxidant capacity (TAC), lipid peroxidation (LPO), and total thiol groups (TTG) levels were determined. Histological samples were also analyzed using hematoxylin and eosin staining slides. PQ administration resulted in hepatic injury as evidenced by increases in serum AST and ALT levels (p < .001). NACNP decreased LPO, TAC, and TTG levels compered to PQ group in liver tissue. Treatment of animals with NACNP was significantly more effective than free NAC in reducing PQ-induced hepatotoxicity (p < .05). Histological evaluation showed that PQ caused tissue inflammation, which was reduced by NAC treatment. This reduction was stronger for NACNP. Given these results, the use of NACNP, compared to NAC, was more protective against the development of the PQ-induced liver toxicity.


Assuntos
Acetilcisteína/farmacologia , Herbicidas/envenenamento , Fígado/efeitos dos fármacos , Nanopartículas/química , Paraquat/envenenamento , Acetilcisteína/química , Animais , Masculino , Ratos , Ratos Wistar
9.
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue ; 31(8): 1013-1017, 2019 Aug.
Artigo em Chinês | MEDLINE | ID: mdl-31537230

RESUMO

OBJECTIVE: To evaluate the prognostic value of early white blood cell count (WBC) in patient of acute paraquat poisoning. METHODS: The literatures about the studies on early WBC and prognosis after paraquat poisoning published in journals at home and abroad were searched. The Chinese literature database contained CNKI, VIP, Wanfang Database, and China Biomedicine Database (CBM), and the journals were limited to the core journals. The foreign language database included PubMed, Embase and Cochrane library clinical controlled trial database. The retrieval date was from the initial publication to April 22nd in 2019, without the limitation of languages. Two researchers independently extracted literature information, and the Newcastle-Ottawa Scale (NOS) was used to evaluate literature quality. The odds ratio (OR), sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR) and the area under the summary receiver operating characteristic (SROC) were combined and analyzed through the Stata 15.0 software to evaluate the predictive value of early WBC after acute paraquat poisoning. Publication bias was analyzed by Deeks funnel graph. RESULTS: There were 7 retrospective studies and 1 prospective study in a total of 980 paraquat poisoning patients, 5 of them were English literatures, the others were Chinese literatures. There was no heterogeneity among the studies (I2 = 43.5%, P > 0.05). The OR and its 95% confidence interval (95%CI) of the literature was combined through the fixed effect model. The Meta-analysis results were statistically significant (OR = 18.63, 95%CI = 13.63-25.48, P < 0.001), suggesting that the WBC was significantly correlated with the mortality of patients. The combined sensitivity, specificity, PLR, NLR and DOR were 0.75 (95%CI = 0.66-0.82), 0.85 (95%CI = 0.80-0.90), 5.14 (95%CI = 3.86-6.86), 0.29 (95%CI = 0.22-0.39), 17.53 (95%CI = 12.23-25.13) respectively, and the area under the SROC of the WBC was 0.88 (95%CI = 0.85-0.91). Deeks funnel plot was symmetrical (P = 0.21), and there was no obvious publication bias. CONCLUSIONS: The early WBC has a certain predictive value for the prognosis of acute paraquat poisoning patients.


Assuntos
Herbicidas/envenenamento , Paraquat/envenenamento , Envenenamento/mortalidade , China , Humanos , Contagem de Leucócitos , Estudos Prospectivos , Estudos Retrospectivos
10.
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue ; 31(8): 1043-1044, 2019 Aug.
Artigo em Chinês | MEDLINE | ID: mdl-31537237

RESUMO

OBJECTIVE: Paraquat (PQ) poisoning has become one of the common pesticide poisoning in China. PQ is extremely toxic to human beings. The fatality rate of oral PQ poisoning is more than 90%. So far, there is no specific antidote. Seek effective treatment measures for PQ poisoning has become the focus of clinical medical research. In November 2017, a patient with acute severe PQ poisoning was treated in the intensive care unit (ICU) of Shouguang People's Hospital Affiliated to Weifang Medical College. The patient refused blood purification therapy and was rescued successfully only by continuous fluid therapy, diuresis, catharsis and routine treatment. By reviewing the treatment process of this case, new treatment ideas for the clinical treatment of PQ poisoning in primary hospitals were provided. Patients with acute PQ poisoning should be rescued by immediate administration of emetic, gastric lavage, catharsis and oral montmorillonite powder. For those without dysfunction of heart, lung and and kidney, a large amount of fluid treatment and diuresis should be given immediately to promote the excretion of poison. The key to improve the success rate of rescue of acute PQ poisoning is to eliminate PQ from the body as soon as possible.


Assuntos
Hidratação , Herbicidas/envenenamento , Paraquat/envenenamento , Envenenamento/terapia , China , Lavagem Gástrica , Humanos , Pulmão
11.
Daru ; 27(2): 885-888, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31489576

RESUMO

Paraquat is one of the most commonly used lethal herbicide. Even the small amount of paraquat is hazardous to human beings. Poisoning by paraquat is most commonly happening in agricultural based economical country. This poison is a threat to public health and its high mortality rate is responsible for a significant number of death. We hereby report a case of 38-year-old male with a history of accidental paraquat ingestion. He works as a gardener which contributes to the ease in availability of the poison. He had the post accidental paraquat consumption complaints of lip sores, swallowing difficulty and hypersalivation in more amount. The patient was admitted in the Casualty and underwent the supportive treatment. Laboratory investigations were found to be normal except WBC count which was elevated. Early diagnosis and proper management can reduce the mortality rate and even small amount of paraquat can lead to some major fatal outcomes. At present there is no specific antidote available so there is a need to focus more on the prevention and management of paraquat poisoning.


Assuntos
Herbicidas/envenenamento , Paraquat/envenenamento , Sialorreia/induzido quimicamente , Adulto , Terapia Combinada , Humanos , Índia , Masculino , Sialorreia/terapia
13.
Medicine (Baltimore) ; 98(30): e16590, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31348300

RESUMO

RATIONALE: Oral ingestion of glyphosate can induce gastrointestinal symptoms such as vomiting, abdominal pain, and hematochezia. Timely and effective treatment of pyloric stenosis caused by glyphosate poisoning is important. PATIENT CONCERNS: The patient had a poor appetite, accompanied by nausea and vomiting of a small amount of dark brown material that resembled blood clots several times a day. Gastroscopy revealed gastric ulcer, a large pyloric antrum ulcer, and a deformed stomach cavity. DIAGNOSIS: Pyloric stenosis due to glyphosate poisoning in a 36-year-old man. INTERVENTIONS: The patients received distal gastrectomy and subsequently transferred to the ICU for further treatment. A mechanical ventilator was used to assist breathing. OUTCOMES: Follow-up was conducted 3 years after surgery. The patient had no problem with food ingestion and experienced no discomfort, such as vomiting, nausea, coughing, or expectoration. LESSONS: Gastrectomy is necessary to treat pyloric stenosis caused by glyphosate poisoning.


Assuntos
Gastrectomia/métodos , Glicina/análogos & derivados , Herbicidas/envenenamento , Estenose Pilórica/induzido quimicamente , Estenose Pilórica/cirurgia , Adulto , Glicina/envenenamento , Humanos , Masculino
14.
J Pharmacol Toxicol Methods ; 100: 106610, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31302166

RESUMO

INTRODUCTION: Paraquat (PQ) is one of the most toxic herbicides to humans. However, it is still in use in many countries, including Japan, and many incidents, such as homicides, intentional ingestions, and occupational accidents, have been reported thus far. In PQ poisoning cases, it is possible to predict severity and prognosis using nomograms. Therefore, if the serum PQ level is determined immediately, a treatment plan can be rapidly established. However, most known analytical methods are time-consuming and therefore hardly ever contribute to patient treatment. METHODS: We developed a new method for PQ quantitation in serum by combining a probe electrospray ionization technique with mass spectrometry. This method requires virtually no serum pretreatment and can yield quantitation values in 18 s. RESULTS: We applied the proposed method to samples from real poisoning cases and compared the results with those obtained via liquid-chromatography-tandem mass spectrometry, revealing the absence of any significant differences at the 5% significance level (t(8) = 1.000, p > .05). The limits of detection and quantitation were 0.004 and 0.015 µg/L, respectively, and the calibration curve exhibited good linearity over the concentration range of 0.015-4.0 µg/mL (r2 = 0.998). DISCUSSION: As the proposed method is fast and easy to perform, it should be useful in emergency medical settings.


Assuntos
Herbicidas/sangue , Paraquat/sangue , Espectrometria de Massas por Ionização por Electrospray/métodos , Espectrometria de Massas em Tandem/métodos , Cromatografia Líquida , Herbicidas/envenenamento , Humanos , Limite de Detecção , Paraquat/envenenamento , Fatores de Tempo
15.
Value Health Reg Issues ; 20: 110-114, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31181392

RESUMO

INTRODUCTION: Paraquat (PQ) poisoning is a public health problem that affects developing countries. The lack of information regarding the economic impact generated by this problem in the country constitutes a barrier to the correct allocation of health priorities. OBJECTIVE: Estimate the annual cost of PQ poisoning in Colombia. METHODS: A cost-disease study was made, using a decision tree model from the perspective of society, taking an approach based on prevalence. A probabilistic sensitivity analysis was made using the Monte Carlo technique with a simulation of a hypothetical cohort of 10,000 patients intoxicated by PQ. RESULTS: An average cost per patient of US$ 2.642 (CI 95% 2.237-6.638 US$) was estimated for acute PQ poisoning. Taking into account the national report during 2017 of 344 cases to national surveillance system; the total cost of PQ poisoning in Colombia amounts to US $ 892 336 per year. CONCLUSIONS: The average cost per patient intoxicated by PQ exceeds that of various chronic diseases prevalent in our country. This reveals the impact not only clinical, but also economical, of this poisoning in our country, necessitating strategies that regulate commercialization to avoid premature deaths.


Assuntos
Custos de Cuidados de Saúde/estatística & dados numéricos , Herbicidas/envenenamento , Paraquat/envenenamento , Colômbia/epidemiologia , Árvores de Decisões , Humanos
16.
Medicine (Baltimore) ; 98(23): e15973, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31169729

RESUMO

BACKGROUND: Although the prognostic significance of base excess (BE) in patients with paraquat (PQ) poisoning has been investigated for several years, the results remain controversial. Thus, we performed for the first time a comprehensive meta-analysis to explore the value of BE in predicting the prognosis of patients with PQ poisoning. METHODS: We searched PubMed, EMBase, Web of Science, ScienceDirect, Cochrane Library, and the Chinese National Knowledge Infrastructure to identify all relevant papers that were published up to August 2018. The data were extracted for pooled analysis, heterogeneity testing, sensitivity analysis, publication bias analysis, and subgroup analysis. RESULTS: Pooled analysis revealed that a decreased BE is correlated with poor mortality (pooled OR = 21.358, 95% CI: 12.716-35.873, P < .001). Pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio were 78% (95% CI: 0.66-0.86), 88% (95% CI: 0.66-0.97), 6.6 (95% CI: 2.2-19.9), 0.25 (95% CI: 0.18-0.36), and 26 (10-69), respectively. No publication bias was detected by Egger test (P = .263) and Begg test (P = .462). Sensitivity analyses indicated no important differences among the estimates of effects. CONCLUSION: Our findings show that BE is useful for predicting the prognosis of PQ poisoning.


Assuntos
Equilíbrio Ácido-Base , Herbicidas/envenenamento , Paraquat/envenenamento , Envenenamento/mortalidade , Humanos , Prognóstico , Estudos Prospectivos , Estudos Retrospectivos , Fatores de Risco
17.
J Pharm Biomed Anal ; 174: 175-181, 2019 Sep 10.
Artigo em Inglês | MEDLINE | ID: mdl-31170631

RESUMO

Glufosinate and glyphosate, which are non-selective herbicides that include an amino acid moiety in their structures, are frequently used worldwide to control unwanted vegetation. Unfortunately, these readily available herbicides are also used by people to commit suicide, and thus represent important chemicals of interest in the fields of clinical medicine and forensics. Because of the high water solubility of these herbicides, most analytical methods for their detection require a derivatization step, which results in longer analysis times. Therefore, derivatization-based methods do not currently contribute to judgements on treatment decisions in emergency medicine. In this study, we addressed this limiting factor by developing an ultra-rapid and simple analytical technique using a combination of probe electrospray ionization (PESI) and tandem mass spectrometry (MS/MS), which gives quantitative results within 0.3 min. Herbicide standards were added to human serum that was then subjected to analysis (N = 5 per concentration). The analysis was repeated daily over eight consecutive days. The limit of detection (LOD) was 0.59 µg/mL for glufosinate and 0.20 µg/mL for glyphosate. The limit of quantitation (LOQ), i.e., the lowest point on the calibration curves, was 1.56 µg/mL for both the herbicides. The matrix effects were observed at three different concentrations (between 95.7%-104% for glufosinate, and between 90.7%-95.7% for glyphosate). When applied to samples taken from actual poisoning cases (six samples for each herbicide), the present method gave almost the same quantitative values as those obtained by conventional high-performance liquid chromatography with fluorescence detection. Thus, we believe that PESI-MS/MS could emerge as a rapid diagnosis method in the clinical emergency field.


Assuntos
Aminobutiratos/sangue , Glicina/análogos & derivados , Herbicidas/sangue , Espectrometria de Massas por Ionização por Electrospray/métodos , Espectrometria de Massas em Tandem/métodos , Aminobutiratos/envenenamento , Calibragem , Cromatografia Líquida de Alta Pressão , Cromatografia Líquida , Glicina/sangue , Glicina/envenenamento , Herbicidas/envenenamento , Humanos , Limite de Detecção , Padrões de Referência , Reprodutibilidade dos Testes , Extração em Fase Sólida
18.
Hum Exp Toxicol ; 38(9): 1007-1013, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31146590

RESUMO

BACKGROUND: The mortality rate associated with human glufosinate poisoning is high. We evaluated the usefulness of serum ammonia and sequential organ failure assessment (SOFA) and acute physiology and chronic health evaluation II (APACHE II) scores for early prediction of in-hospital mortality in glufosinate ammonium poisoning. METHODS: A prospectively collected pesticide poisoning registry at a single academic medical center was retrospectively analyzed. Data were collected from consecutive patients diagnosed with glufosinate ammonium poisoning between May 2007 and February 2018. The initial serum ammonia level was defined as the highest serum ammonia level measured within 12 h after emergency department (ED) arrival. The SOFA and APACHE II scores were calculated using data obtained within the first 12 h after ED arrival. The patients were divided into survivor and nonsurvivor groups by in-hospital death status. RESULTS: In total, 110 patients were included. Ten patients (9.1%) died in the hospital despite treatment. Median initial serum ammonia level was significantly higher in the nonsurvivor group than in the survivor group (219 (range: 158-792) versus 100.5 (range: 25-317) µg/dL, p < 0.001). Median SOFA and APACHE II scores in the survivor and nonsurvivor groups were 2 (range: 0-10) versus 5 (range: 1-8) (p = 0.044) and 7 (range: 0-28) versus 16 (range: 8-22) (p = 0.001), respectively. In the multiple logistic regression analysis, the initial serum ammonia level was the only independent predictor (cutoff value: 151 µg/dL). CONCLUSION: An initial serum ammonia level >151 µg/dL was an independent early predictor of in-hospital mortality in glufosinate ammonium poisoning.


Assuntos
Aminobutiratos/envenenamento , Amônia/sangue , Herbicidas/envenenamento , Mortalidade Hospitalar , APACHE , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Escores de Disfunção Orgânica , República da Coreia , Centros de Atenção Terciária , Adulto Jovem
19.
Medicine (Baltimore) ; 98(20): e15702, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31096516

RESUMO

This study aimed to investigate the prognostic predictive value of the platelet-lymphocyte ratio (PLR) in patients with acute paraquat (PQ) intoxication.A total of 107 patients with acute PQ intoxication via oral ingestion were admitted in Cangzhou Central Hospital from May 2012 to September 2018. Valuable detection indices were screened out by using Cox proportional hazard regression and receiver operating characteristic (ROC) curve analyses, and their diagnostic efficiency was evaluated by using Kaplan-Meier curve.The 90-day mortality was 58.9% (63/107). The Kaplan-Meier curve showed that PLR was not associated with 90-day survival (log-rank test; P = .661). In Cox proportional hazard regression analyses, PLR was not an independent risk factor. Meanwhile, the ROC curves showed that PLR had an AUC value of 0.569 (95% confidence interval: 0.459-0.679, P = .227) in predicting 90-day survival.PLR is not a prognostic predictor for patients with acute PQ intoxication.


Assuntos
Plaquetas/citologia , Linfócitos/citologia , Intoxicação por Organofosfatos/sangue , Paraquat/envenenamento , Adulto , China/epidemiologia , Serviço Hospitalar de Emergência , Feminino , Lavagem Gástrica/métodos , Herbicidas/efeitos adversos , Herbicidas/envenenamento , Humanos , Masculino , Pessoa de Meia-Idade , Mortalidade , Intoxicação por Organofosfatos/complicações , Intoxicação por Organofosfatos/diagnóstico , Intoxicação por Organofosfatos/mortalidade , Paraquat/efeitos adversos , Contagem de Plaquetas/métodos , Estudos Retrospectivos , Tempo para o Tratamento/estatística & dados numéricos , Tempo para o Tratamento/tendências
20.
Am J Emerg Med ; 37(8): 1600.e5-1600.e6, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31053371

RESUMO

INTRODUCTION: This report describes changes in blood and urine concentrations of glyphosate potassium over time and their correlations with clinical symptoms in a patient with acute glyphosate potassium poisoning. CASE REPORT: A 67-year-old man visited the emergency center after ingesting 250 mL of a glyphosate potassium-based herbicide 5 h before. He was alert but presented with nausea, vomiting, and bradyarrhythmia with atrial fibrillation (tall T waves). Laboratory findings revealed a serum potassium level of 6.52 mEq/L. After treatment with an injection of calcium gluconate, insulin with glucose, bicarbonate, and an enema with polystyrene sulfonate, the patient's serum potassium level normalized and the bradyarrhythmia converted to a normal sinus rhythm. During admission, the blood and urine concentration of glyphosate and urine aminomethylphosphonic acid (AMPA, a glyphosate metabolite) was measured at regular time intervals. The patient's glyphosate blood concentration on admission was 11.48 mg/L, and it had decreased rapidly by 16 h and maintained about 1mgl/L by 70 h after admission. Urine glyphosate and AMPA levels had also decreased rapidly by 6 h after admission. DISCUSSION: Glyphosate potassium poisoning causes hyperkalemia. Blood concentrations of glyphosate were decreased rapidly by 16 h after admission, and urine concentrations were also decreased by 6 h after admission.


Assuntos
Glicina/análogos & derivados , Herbicidas/sangue , Herbicidas/envenenamento , Hiperpotassemia/induzido quimicamente , Idoso , Arritmias Cardíacas/induzido quimicamente , Glicina/sangue , Glicina/envenenamento , Glicina/urina , Herbicidas/urina , Humanos , Hiperpotassemia/sangue , Hiperpotassemia/tratamento farmacológico , Masculino , Náusea/induzido quimicamente , Potássio/sangue , Tentativa de Suicídio , Resultado do Tratamento , Vômito/induzido quimicamente
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