Yonsei Med J.  2016 Jan;57(1):254-259. 10.3349/ymj.2016.57.1.254.

Initial Serum Ammonia as a Predictor of Neurologic Complications in Patients with Acute Glufosinate Poisoning

• Lee DK
• Youk H
• Kim H
• Kim OH
• Go J
• Kim TH
• Cha K
• Lee KH
• Hwang SO
• Cha YS

• KMID: 2466378
• DOI: http://doi.org/10.3349/ymj.2016.57.1.254

Abstract

PURPOSE
Glufosinate poisoning can cause neurologic complications that may be difficult to treat due to delayed manifestation. Studies assessing possible predictors of complications are lacking. Although serum ammonia level is a potential predictor of severe neurotoxicity, it has only been assessed via case reports. Therefore, we investigated factors that predict neurologic complications in acute glufosinate-poisoned patients.
MATERIALS AND METHODS
We conducted a retrospective review of 45 consecutive glufosinate-poisoning cases that were diagnosed in the emergency department (ED) of Wonju Severance Christian Hospital between May 2007 and July 2014. Patients with a Glasgow Coma Scale (GCS) score of <8, seizure, and/or amnesia were defined to a neurologic complication group.
RESULTS
The neurologic complication group (29 patients, 64.4%) comprised patients with GCS<8 (27 patients, 60.0%), seizure (23 patients, 51.1%), and amnesia (5 patients, 11.1%). Non-neurologic complications included respiratory failure (14 patients, 31.1%), intubation and ventilator care (23 patients, 51.1%), shock (2 patients, 4.4%), pneumonia (16 patients, 35.6%), acute kidney injury (10 patients, 22.2%), and death (4 patients, 8.9%). Complications of GCS<8, seizure, respiratory failure, and intubation and ventilator care appeared during latent periods within 11 hrs, 34 hrs, 14 hrs, and 48 hrs, respectively. Initial serum ammonia was a predictor of neurologic complications [odds ratio 1.039, 95% confidence interval (1.001-1.078), p=0.046 and area under the curve 0.742].
CONCLUSION
Neurologic complications developed in 64.4% of patients with acute glufosinate poisoning. The most common complication was GCS<8. Initial serum ammonia level, which can be readily assessed in the ED, was a predictor of neurologic complications.

Keyword

Glufosinate; herbicide; poisoning; complication; predictor

MeSH Terms

Adult
Aged
Aged, 80 and over
Aminobutyrates/blood/*poisoning
Ammonia/*blood
*Emergency Service, Hospital
Female
Glasgow Coma Scale
Humans
Male
Middle Aged
Nausea/etiology
Neurotoxicity Syndromes/blood/immunology/*physiopathology
Respiratory Insufficiency/etiology
Retrospective Studies
Seizures/etiology
Severity of Illness Index
Vomiting/etiology
Aminobutyrates
Ammonia

Figure

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  Fig. 1 Numbers of patients assessed, excluded, and included.

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  Fig. 2 Daily serum ammonia levels between the non-neurologic complication and neurologic complication groups. ED, emergency department; HD, hospital day.

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