The Anion Gap is a Predictive Clinical Marker for Death in Patients with Acute Pesticide Intoxication

Abstract

Pesticide formulation includes solvents (methanol and xylene) and antifreeze (ethylene glycol) whose metabolites are anions such as formic acid, hippuric acid, and oxalate. However, the effect of the anion gap on clinical outcome in acute pesticide intoxication requires clarification. In this prospective study, we compared the anion gap and other parameters between surviving versus deceased patients with acute pesticide intoxication. The following parameters were assessed in 1,058 patients with acute pesticide intoxication: blood chemistry (blood urea nitrogen, creatinine, glucose, lactic acid, liver enzymes, albumin, globulin, and urate), urinalysis (ketone bodies), arterial blood gas analysis, electrolytes (Na+, K+, Cl- HCO3-, Ca++), pesticide field of use, class, and ingestion amount, clinical outcome (death rate, length of hospital stay, length of intensive care unit stay, and seriousness of toxic symptoms), and the calculated anion gap. Among the 481 patients with a high anion gap, 52.2% had a blood pH in the physiologic range, 35.8% had metabolic acidosis, and 12.1% had acidemia. Age, anion gap, pesticide field of use, pesticide class, seriousness of symptoms (all P < 0.001), and time lag after ingestion (P = 0.048) were significant risk factors for death in univariate analyses. Among these, age, anion gap, and pesticide class were significant risk factors for death in a multiple logistic regression analysis (P < 0.001). In conclusions, high anion gap is a significant risk factor for death, regardless of the accompanying acid-base balance status in patients with acute pesticide intoxication.

<p>Psychiatric comorbidities in patients with intentional methanol intoxication</p>

“…Although some pesticides, such as carbamates and triazoles, are less toxic, the additive methanol caused morbidity and mortality. Our study is in line with studies from Korea, which brought the toxicity of additives or solvents in pesticides to our attention 15–17. The dissimilarity in sources of methanol worldwide is important for clinical practice and public health.…”

Anion gap and base deficit are predictors of mortality in acute pesticide poisoning

“…The traditional risk factors for death by acute pesticide poisoning are the toxicity of the major component, ingestion amount, time taken to arrive at the hospital, and the clinical characteristics of the patient after arriving at the hospital: age, illness or medical condition, vital signs, and consciousness. 17 In addition, previous studies have shown that acute organophosphate poisoning is a predictive factor of severity and mortality, and it may be expressed using APACHE II, BD, and RDW. 11, 12, 27 Patients with ethylene glycol, methanol, and cyanide poisoning have high AG levels in plasma.…”

Rapid Diagnosis of Ethylene Glycol Poisoning by Urine Microscopy

“…Ethylene glycol poisoning remains an important presentation in Emergency Departments; quick diagnosis and treatment are necessary to prevent serious harm [ 9 , 10 ]. The limited access to directly diagnostic method often leaves clinicians with undiagnosed patients; the several differential diagnoses may challenge the clinicians to initiate relevant treatment and presents the dilemma of whether to treat on a presumptive basis.…”