title: 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.
authors.affiliation: Department of Internal Medicine, Soonchunhyang University Cheonan Hospital, Cheonan, Korea .
authors.forename: Sun-Hyo
authors.identifier: 0000-0002-5337-0756
authors.initials: SH
authors.lastname: Lee
authors.affiliation: Department of Internal Medicine, Soonchunhyang University Cheonan Hospital, Cheonan, Korea .
authors.forename: Samel
authors.identifier: 0000-0002-5717-0743
authors.initials: S
authors.lastname: Park
authors.affiliation: Department of Emergency Medicine, Soonchunhyang University Cheonan Hospital, Cheonan, Korea .
authors.forename: Jung-Won
authors.identifier: 0000-0001-6940-9750
authors.initials: JW
authors.lastname: Lee
authors.affiliation: Department of Emergency Medicine, Soonchunhyang University Cheonan Hospital, Cheonan, Korea .
authors.forename: Il-Woong
authors.identifier: 0000-0002-0510-8251
authors.initials: IW
authors.lastname: Hwang
authors.affiliation: Department of Emergency Medicine, Soonchunhyang University Cheonan Hospital, Cheonan, Korea .
authors.forename: Hyung-Jun
authors.identifier: 0000-0001-9985-8100
authors.initials: HJ
authors.lastname: Moon
authors.affiliation: Department of Emergency Medicine, Soonchunhyang University Cheonan Hospital, Cheonan, Korea .
authors.forename: Ki-Hwan
authors.identifier: 0000-0002-9011-265X
authors.initials: KH
authors.lastname: Kim
authors.affiliation: Department of Biostatistics, Soonchunhyang University, College of Medicine, Seoul, Korea .
authors.forename: Su-Yeon
authors.identifier: 0000-0002-6391-557X
authors.initials: SY
authors.lastname: Park
authors.affiliation: Department of Internal Medicine, Soonchunhyang University Cheonan Hospital, Cheonan, Korea .
authors.forename: Hyo-Wook
authors.identifier: 0000-0003-2550-2739
authors.initials: HW
authors.lastname: Gil
authors.affiliation: Department of Internal Medicine, Soonchunhyang University Cheonan Hospital, Cheonan, Korea .
authors.forename: Sae-Yong
authors.identifier: 0000-0003-1119-4456
authors.initials: SY
authors.lastname: Hong
mesh_terms: D000136:Acid-Base Equilibrium; D000138:Acidosis / Q000209:etiology; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000838:Anions / Q000737:chemistry* / Q000378:metabolism; D015415:Biomarkers / Q000737:chemistry* / Q000378:metabolism; D001784:Blood Gas Analysis; D064419:Chemically-Induced Disorders / Q000401:mortality / Q000473:pathology; D004573:Electrolytes / Q000032:analysis; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010575:Pesticides / Q000506:poisoning*; D011446:Prospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D016482:Urinalysis; D055815:Young Adult
chemical_list: D000838:Anions; D015415:Biomarkers; D004573:Electrolytes; D010575:Pesticides
keywords: Acid-base Equilibrium; Acidosis; Biomarkers; Pesticides