Early Predictors of Delayed Respiratory Failure after Glufosinate Ammonium Ingestion

Abstract

Mu et al.: Respiratory Failure in Glufosinate PoisoningAcute glufosinate ammonium poisoning can cause neurological complications and respiratory failure, which are usually delayed and difficult to predict. Serum ammonia level might be an indicator of severe glufosinate poisoning, but it has not been confirmed. We aimed to investigate the potential predictors of respiratory failure after glufosinate poisoning. We conducted a retrospective review of 21 cases of glufosinate poisoning between 2010 and 2019. Patients were assigned to intubated due to respiratory failure and non-intubated groups. The following characteristics were compared between these two groups; age, sex and period from poisoning to hospital arrival, vital signs, Glasgow coma scale, laboratory parameters and electrocardiogram measurements. Furthermore, the outcomes of morbidity and mortality were analyzed. Totally, 12 cases were be intubated and the other 9 were not intubated. Leukocytosis, hyperglycemia, increased serum creatinine, peak ammonia level and decreased Glasgow coma scale score found at emergency visits were significantly different between these two groups. The white blood cell count (median: 9100 vs. 15 785, p=0.046) and serum creatinine (median: 0.88 vs. 1.20, p=0.019) and blood sugar (median: 114.0 vs. 138.5, p=0.032) levels were higher and the initial Glasgow coma scale score was lower in the intubated group than in the non-intubated group (median: 15 vs. 13, p=0.030). Moreover, six patients who presented with a decreased Glasgow coma scale score and an increased ammonia level developed respiratory failure. In cases of glufosinate poisoning, leukocytosis, hyperglycemia, impaired renal function and decreased Glasgow coma scale score initially can use to predict respiratory failure. Moreover, conscious change combined with an early increase in serum ammonia level implied that, intensive monitoring should be required to prevent lethal complications from delayed onset of respiratory failure.