The Anion Gap is a Predictive Clinical Marker for Death in Patients with Acute Pesticide Intoxication.
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.
['Lee|Sun-Hyo|SH|0000-0002-5337-0756', 'Park|Samel|S|0000-0002-5717-0743', 'Lee|Jung-Won|JW|0000-0001-6940-9750', 'Hwang|Il-Woong|IW|0000-0002-0510-8251', 'Moon|Hyung-Jun|HJ|0000-0001-9985-8100', 'Kim|Ki-Hwan|KH|0000-0002-9011-265X', 'Park|Su-Yeon|SY|0000-0002-6391-557X', 'Gil|Hyo-Wook|HW|0000-0003-2550-2739', 'Hong|Sae-Yong|SY|0000-0003-1119-4456']
D000136:Acid-Base Equilibrium D000138:Acidosis D000293:Adolescent D000328:Adult D000368:Aged D000369:Aged, 80 and over D000838:Anions D015415:Biomarkers D001784:Blood Gas Analysis D064419:Chemically-Induced Disorders D004573:Electrolytes D005260:Female D006801:Humans D007362:Intensive Care Units D016015:Logistic Models D008297:Male D008875:Middle Aged D016017:Odds Ratio D010575:Pesticides D011446:Prospective Studies D012307:Risk Factors D016019:Survival Analysis D016482:Urinalysis D055815:Young Adult
Pesticides Acidosis Acid-base Equilibrium Biomarkers