Pre-embarkment Hiroshi
Prognostication
for Acute
Paraquat Poisoning
3& 1 Shigehito Sato,2 Seiji Watanabe Yamaguchi,
1 Hiroshi Naito
Department Department of Anesthesiology, Institute of Clinical Medicine, University of Tsukuba, 2 1 Anesthesia, Tsuchiura Kyodo Hospital, 3Department of Anesthesia and Mito Saiseikai General
of
Hospital, Japan 1 In order to assess which laboratory parameters could be related to the prognosis of with acute paraquat poisoning, we reviewed the medical records of 160 patients who had ingested paraquat in an attempt at suicide. 2 Serum creatinine and potassium concentrations, arterial blood bicarbonate and base excess levels, arterial blood pH, volume of paraquat ingested and the strength of the urinary paraquat qualitative test (sodium dithionate colour reaction) on admission in the surviving patients were significantly different from those of the patients who died within 48 h of ingestion. 3 The relationship of the quantity Eq 1 defined as:
patients
-1 l [HCO ] 3 ) / ([Cre] × 0.088) (mEq ) to admission had a the interval of time after (T) significant correlation against ingestion × < > with prognosis ( Patients with 399 P 0.01). 1 (1500 Eq LogT) had a 90% survival × < × 399 and Eq 399 38% rate, Eq (930 (1500 LogT) LogT) 1 ≤ (930 - 399 × : 1 1 Eq ≤ < 0.01. LogT) 3%, P 1 Eq
=
] + ([K
×
Introduction As intensive therapeutic modalities for patients with acute paraquat poisoning, gastrointestinal lavage followed by a number of administrations of activated charcoal, lengthy haemodialysis, haemoperfusion, plasmapheresis and forced diuresis have been attempted.l2 However, these elaborate and costly treatments have not improved the survival rate. 2-8 From the standpoint of cost performance it is mandatory to predict the prognosis prior to treatment. On the other hand, the quality of life of both those patients who have ingested more than a lethal amount of paraquat as well as their relatives should be emphasized.9 It is important to establish both physical and mental management plans as early as possible to avoid useless and uncomfortable treatment for the patients with ’poor prognosis quod vitam’. Until now there have been no reliable prognostic indicators besides plasma and urinary paraquat concentration,10-=15 and respiratory index. 6 Since it is not possible to assess plasma
paraquat concentration in every hospital, intensive therapy has often been undertaken without a prognosis. On the other hand, laboratory data such as serum creatinine and electrolyte concentrations, as well as arterial blood gas analysis are readily available after admission. The relationship between these laboratory parameters and the prognosis of acute paraquat poisoning has not been extensively studied except with respect to serum potassium levels In the present study, we determined which laboratory parameters, on admission, bore a significant relationship to the prognosis of acute paraquat poisoning, and subsequently put together a predictive formula. Materials and methods We reviewed the medical records of 160 patients with acute paraquat poisoning (32 survived and 128 died). All of the patients were treated in the
Correspondence: Shigehito Sato, Anesthetist in Chief, Department Manabe-Shinmachi, Tsuchiura-city, Ibaraki, 300, Japan.
of
Anesthesia, Tsuchiura Kyodo Hospital,
.
Prognostication
for Acute
Paraquat Poisoning
3& 1 Shigehito Sato,2 Seiji Watanabe Yamaguchi,
1 Hiroshi Naito
Department Department of Anesthesiology, Institute of Clinical Medicine, University of Tsukuba, 2 1 Anesthesia, Tsuchiura Kyodo Hospital, 3Department of Anesthesia and Mito Saiseikai General
of
Hospital, Japan 1 In order to assess which laboratory parameters could be related to the prognosis of with acute paraquat poisoning, we reviewed the medical records of 160 patients who had ingested paraquat in an attempt at suicide. 2 Serum creatinine and potassium concentrations, arterial blood bicarbonate and base excess levels, arterial blood pH, volume of paraquat ingested and the strength of the urinary paraquat qualitative test (sodium dithionate colour reaction) on admission in the surviving patients were significantly different from those of the patients who died within 48 h of ingestion. 3 The relationship of the quantity Eq 1 defined as:
patients
-1 l [HCO ] 3 ) / ([Cre] × 0.088) (mEq ) to admission had a the interval of time after (T) significant correlation against ingestion × < > with prognosis ( Patients with 399 P 0.01). 1 (1500 Eq LogT) had a 90% survival × < × 399 and Eq 399 38% rate, Eq (930 (1500 LogT) LogT) 1 ≤ (930 - 399 × : 1 1 Eq ≤ < 0.01. LogT) 3%, P 1 Eq
=
] + ([K
×
Introduction As intensive therapeutic modalities for patients with acute paraquat poisoning, gastrointestinal lavage followed by a number of administrations of activated charcoal, lengthy haemodialysis, haemoperfusion, plasmapheresis and forced diuresis have been attempted.l2 However, these elaborate and costly treatments have not improved the survival rate. 2-8 From the standpoint of cost performance it is mandatory to predict the prognosis prior to treatment. On the other hand, the quality of life of both those patients who have ingested more than a lethal amount of paraquat as well as their relatives should be emphasized.9 It is important to establish both physical and mental management plans as early as possible to avoid useless and uncomfortable treatment for the patients with ’poor prognosis quod vitam’. Until now there have been no reliable prognostic indicators besides plasma and urinary paraquat concentration,10-=15 and respiratory index. 6 Since it is not possible to assess plasma
paraquat concentration in every hospital, intensive therapy has often been undertaken without a prognosis. On the other hand, laboratory data such as serum creatinine and electrolyte concentrations, as well as arterial blood gas analysis are readily available after admission. The relationship between these laboratory parameters and the prognosis of acute paraquat poisoning has not been extensively studied except with respect to serum potassium levels In the present study, we determined which laboratory parameters, on admission, bore a significant relationship to the prognosis of acute paraquat poisoning, and subsequently put together a predictive formula. Materials and methods We reviewed the medical records of 160 patients with acute paraquat poisoning (32 survived and 128 died). All of the patients were treated in the
Correspondence: Shigehito Sato, Anesthetist in Chief, Department Manabe-Shinmachi, Tsuchiura-city, Ibaraki, 300, Japan.
of
Anesthesia, Tsuchiura Kyodo Hospital,
.
