title: Factors associated with severe effects following acute glufosinate poisoning.
abstract: BACKGROUND
  In acute glufosinate poisoning, sudden respiratory arrest and convulsion can occur after a latent period of 4-60 h. There is still no factor that accurately predicts the occurrence of these symptoms.
  
  
  OBJECTIVE
  To elucidate the predictors of severe effects following acute glufosinate poisoning.
  
  
  METHODS
  This study is a retrospective observational case series. The subjects were 16 patients who had acute glufosinate poisoning. They were divided into a group with respiratory arrest or convulsion during hospitalization (severe group) and a group without (non-severe group). The following characteristics (or predictors) were compared between the groups: age, sex, calculated amount of glufosinate (volume of ingested poison (glufosinate-containing herbicide) × glufosinate concentration of the product), time duration from poison ingestion to arrival at our hospital, use of gastric lavage, use of whole bowel irrigation, Glasgow Coma Scale, laboratory parameters, PaO₂/FiO₂ ratio (P/F ratio), shock index, and presence or absence of systemic inflammatory response syndrome (SIRS) on arrival.
  
  
  RESULTS
  The P/F ratio was significantly lower in the severe group than in the non-severe group (median, 287.5 vs. 409.0; P = 0.049). The receiver operating characteristic (ROC) curve was plotted for the predictor of increasing severity based on the P/F ratio. The area under the curve was 0.714, and the optimal cutoff point for increasing severity was 374.0. The sensitivity was 75.0%, specificity of 71.4%, and accuracy of 75.0%. The shock index was significantly higher (median, 0.52 vs. 0.41; P = 0.031). Significantly more patients had SIRS in the severe group than in the non-severe group (P = 0.015). Logistic regression analysis was performed with a backward elimination procedure. SIRS was selected as the independent predictor of increasing severity (odds ratio, 29.810; 95% confidence interval, 1.011-878.952; P = 0.049).
  
  
  CONCLUSIONS
  Severe effects following acute glufosinate poisoning were associated with two positive SIRS criteria. A low P/F ratio may be useful for predicting the occurrence of respiratory complications.
authors.affiliation: Department of Emergency Medicine, Iwate Medical University, School of Medicine , Morioka, Iwate , Japan.
authors.forename: Y
authors.initials: Y
authors.lastname: Inoue
authors.forename: M
authors.initials: M
authors.lastname: Onodera
authors.forename: Y
authors.initials: Y
authors.lastname: Fujita
authors.forename: Y
authors.initials: Y
authors.lastname: Fujino
authors.forename: S
authors.initials: S
authors.lastname: Kikuchi
authors.forename: S
authors.initials: S
authors.lastname: Endo
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000613:Aminobutyrates / Q000633:toxicity*; D004791:Enzyme Inhibitors / Q000633:toxicity*; D005260:Female; D005968:Glutamate Decarboxylase / Q000037:antagonists & inhibitors; D005974:Glutamate-Ammonia Ligase / Q000037:antagonists & inhibitors; D006540:Herbicides / Q000633:toxicity*; D006801:Humans; D008297:Male; D008875:Middle Aged; D020258:Neurotoxicity Syndromes / Q000097:blood / Q000276:immunology / Q000503:physiopathology*; D010100:Oxygen / Q000097:blood; D011652:Pulmonary Circulation / Q000187:drug effects; D012372:ROC Curve; D012131:Respiratory Insufficiency / Q000209:etiology*; D012189:Retrospective Studies; D012640:Seizures / Q000209:etiology*; D012720:Severity of Illness Index; D018746:Systemic Inflammatory Response Syndrome / Q000209:etiology*; D055815:Young Adult
chemical_list: D000613:Aminobutyrates; D004791:Enzyme Inhibitors; D006540:Herbicides; C003121:phosphinothricin; D005968:Glutamate Decarboxylase; D005974:Glutamate-Ammonia Ligase; D010100:Oxygen