title: Initial Serum Ammonia as a Predictor of Neurologic Complications in Patients with Acute Glufosinate Poisoning.
abstract: OBJECTIVE
  Glufosinate poisoning can cause neurologic complications that may be difficult to treat due to delayed manifestation. Studies assessing possible predictors of complications are lacking. Although serum ammonia level is a potential predictor of severe neurotoxicity, it has only been assessed via case reports. Therefore, we investigated factors that predict neurologic complications in acute glufosinate-poisoned patients.
  
  
  METHODS
  We conducted a retrospective review of 45 consecutive glufosinate-poisoning cases that were diagnosed in the emergency department (ED) of Wonju Severance Christian Hospital between May 2007 and July 2014. Patients with a Glasgow Coma Scale (GCS) score of <8, seizure, and/or amnesia were defined to a neurologic complication group.
  
  
  RESULTS
  The neurologic complication group (29 patients, 64.4%) comprised patients with GCS<8 (27 patients, 60.0%), seizure (23 patients, 51.1%), and amnesia (5 patients, 11.1%). Non-neurologic complications included respiratory failure (14 patients, 31.1%), intubation and ventilator care (23 patients, 51.1%), shock (2 patients, 4.4%), pneumonia (16 patients, 35.6%), acute kidney injury (10 patients, 22.2%), and death (4 patients, 8.9%). Complications of GCS<8, seizure, respiratory failure, and intubation and ventilator care appeared during latent periods within 11 hrs, 34 hrs, 14 hrs, and 48 hrs, respectively. Initial serum ammonia was a predictor of neurologic complications [odds ratio 1.039, 95% confidence interval (1.001-1.078), p=0.046 and area under the curve 0.742].
  
  
  CONCLUSIONS
  Neurologic complications developed in 64.4% of patients with acute glufosinate poisoning. The most common complication was GCS<8. Initial serum ammonia level, which can be readily assessed in the ED, was a predictor of neurologic complications.
authors.affiliation: Department of Emergency Medicine, Wonju College of Medicine, Yonsei University, Wonju, Korea.
authors.forename: Dong Keon
authors.initials: DK
authors.lastname: Lee
authors.affiliation: Department of Emergency Medicine, Wonju College of Medicine, Yonsei University, Wonju, Korea.
authors.forename: Hyun
authors.initials: H
authors.lastname: Youk
authors.affiliation: Department of Emergency Medicine, Wonju College of Medicine, Yonsei University, Wonju, Korea.
authors.forename: Hyun
authors.initials: H
authors.lastname: Kim
authors.affiliation: Department of Emergency Medicine, Wonju College of Medicine, Yonsei University, Wonju, Korea.
authors.forename: Oh Hyun
authors.initials: OH
authors.lastname: Kim
authors.affiliation: Department of Emergency Medicine, Wonju College of Medicine, Yonsei University, Wonju, Korea.
authors.forename: Jin
authors.initials: J
authors.lastname: Go
authors.affiliation: Department of Emergency Medicine, Busan Baik Hospital, Inje University, Busan, Korea.
authors.forename: Tae Hoon
authors.initials: TH
authors.lastname: Kim
authors.affiliation: Department of Emergency Medicine, Wonju College of Medicine, Yonsei University, Wonju, Korea.
authors.forename: Kyoungchul
authors.initials: K
authors.lastname: Cha
authors.affiliation: Department of Emergency Medicine, Wonju College of Medicine, Yonsei University, Wonju, Korea.
authors.forename: Kang Hyun
authors.initials: KH
authors.lastname: Lee
authors.affiliation: Department of Emergency Medicine, Wonju College of Medicine, Yonsei University, Wonju, Korea.
authors.forename: Sung Oh
authors.initials: SO
authors.lastname: Hwang
authors.affiliation: Department of Emergency Medicine, Wonju College of Medicine, Yonsei University, Wonju, Korea. zza96@hanmail.net.
authors.forename: Yong Sung
authors.initials: YS
authors.lastname: Cha
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000613:Aminobutyrates / Q000097:blood / Q000506:poisoning*; D000641:Ammonia / Q000097:blood*; D004636:Emergency Service, Hospital; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D008297:Male; D008875:Middle Aged; D009325:Nausea / Q000209:etiology; D020258:Neurotoxicity Syndromes / Q000097:blood / Q000276:immunology / Q000503:physiopathology*; D012131:Respiratory Insufficiency / Q000209:etiology; D012189:Retrospective Studies; D012640:Seizures / Q000209:etiology; D012720:Severity of Illness Index; D014839:Vomiting / Q000209:etiology
chemical_list: D000613:Aminobutyrates; C003121:phosphinothricin; D000641:Ammonia
keywords: Glufosinate; complication; herbicide; poisoning; predictor