Utility of serum lactate to predict drug-overdose fatality

Abstract

Context Poisoning is the second leading cause of injury-related fatality in the United States. An elevated serum lactate concentration identifies medical and surgical patients at risk for death; however, its utility in predicting death in drug overdose is controversial and unclear. Objective We aimed to evaluate the prognostic utility of serum lactate concentration for fatality in emergency department (ED) patients with acute drug overdose. Materials and Methods This was a case–control study at two urban university teaching hospitals affiliated with a regional poison control center. Data were obtained from electronic medical records, poison center data, and the office of the chief medical examiner. Controls were consecutive acute drug overdoses over a 1-year period surviving to hospital discharge. Cases were subjects over a 7-year period with fatality because of drug overdose. Serum lactate concentration was obtained from the initial blood draw in the ED and correlated with fatality. Results During the study period, 873 subjects were screened with 50 cases and 100 controls included. Drug exposures and baseline characteristics were similar between groups. Mean lactate concentration (mmol/L) was 9.88 ± 6.7 for cases and 2.76 ± 2.9 for controls (p < 0.001). The receiver operating characteristic area under the curve for prediction of fatality was 0.87 (95% CI: 0.81–0.94). The optimal lactate cutpoint was 3.0 mmol/L (84% sensitivity, 75% specificity), which conferred a 15.8-fold increase in odds of fatality (p < 0.001). Conclusion In this derivation study, serum lactate concentration had excellent prognostic utility to predict drug-overdose fatality. Prospective validation in the ED evaluation of drug overdoses is warranted.

Dramatic resuscitation with Intralipid in an epinephrine unresponsive cardiac arrest following overdose of amitriptyline and propranolol

“…The absence of a significant metabolic acidosis was unusual for a significant amitriptyline overdose and we do not have an explanation for this. The peak lactate was remarkably low, given the degree of haemodynamic compromise, but this is an observed phenomenon of β blocker overdose which fits with the current understanding on the role of adrenergic stimulation in generating hyperlactataemia 1 2. The episodes of hypoglycaemia are typical with excess β blockade and relate to inhibition of glycogenolysis and gluconeogenesis.…”

Metformin-Associated Lactic Acidosis (MALA): Case Files of the Einstein Medical Center Medical Toxicology Fellowship

“…However, the lactic acidosis resulting from intentional acute ingestions is less well understood. In previous studies, lactate levels have demonstrated a sensitivity of 84 % to predict fatality in general poisoning [30]. Lactate levels in metformin toxicity have not been specifically correlated with predicting morbidity and mortality in the literature at this point.…”

“…Some will remain asymptomatic, while others will progress to a severe lactic acidosis. Lactate levels may help to risk-stratify patients requiring earlier intervention such as HD, CVVH, or bicarbonate therapy [30]. Unfortunately, dialysis may be most effective before metformin distributes in significant, enough quantities to elevate the lactate.…”

Lactate and creatine phosphokinase as potential independent predictors of organophosphrus poisoning severity in Zagazig University Hospital Patients, Egypt

“…Evaluation of the blood lactate level is generally used in diagnosis and management of the patients with signs and symptoms of sepsis or shock and is a sign of tissue hypoperfusion (Kompanje et al, 2007). The role of blood lactate level has been studied as a prognostic factor in drug and chemical poisoning too (Dell'Aglio et al, 2009;Seidowsky et al, 2009;Manini et al, 2010;Mégarbane et al, 2010;Inoue et al, 2008;Lee et al, 2012).…”