Journal of The Korean Society of Clinical Toxicology (대한임상독성학회지)

Korean society of Clincal Toxicology (대한임상독성학회)
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Clinical Characteristics and Risk Factors of Acute Kidney Injury in Patients with Glyphosate Poisoning

글리포세이트 중독 환자에서 급성 신손상 발생의 임상 양상과 위험 인자

  • Park, Hyung Hun (Department of Emergency Medicine, Daegu Fatima Hospital) ;
  • Choi, Kyu Ill (Department of Emergency Medicine, Daegu Fatima Hospital) ;
  • Lee, Je Won (Department of Emergency Medicine, Daegu Fatima Hospital) ;
  • Park, Jung Min (Department of Emergency Medicine, Daegu Fatima Hospital) ;
  • Park, Jinwook (Department of Emergency Medicine, Daegu Fatima Hospital) ;
  • Noh, Sang Moon (Department of Emergency Medicine, Daegu Fatima Hospital) ;
  • Cho, Jaekyung (Department of Emergency Medicine, Daegu Fatima Hospital) ;
  • Lee, Daero (Department of Emergency Medicine, Daegu Fatima Hospital) ;
  • Cho, Jae Chul (Department of Emergency Medicine, Daegu Fatima Hospital) ;
  • Park, Dong Chan (Department of Emergency Medicine, Daegu Fatima Hospital) ;
  • Kim, Yang Hun (Department of Emergency Medicine, Daegu Fatima Hospital) ;
  • Lee, Joo Hwan (Department of Emergency Medicine, Daegu Fatima Hospital)
  • 박형훈 (대구파티마병원 응급의학과) ;
  • 최규일 (대구파티마병원 응급의학과) ;
  • 이제원 (대구파티마병원 응급의학과) ;
  • 박정민 (대구파티마병원 응급의학과) ;
  • 박진욱 (대구파티마병원 응급의학과) ;
  • 노상문 (대구파티마병원 응급의학과) ;
  • 조재경 (대구파티마병원 응급의학과) ;
  • 이대로 (대구파티마병원 응급의학과) ;
  • 조재철 (대구파티마병원 응급의학과) ;
  • 박동찬 (대구파티마병원 응급의학과) ;
  • 김양헌 (대구파티마병원 응급의학과) ;
  • 이주환 (대구파티마병원 응급의학과)
  • Received : 2020.05.10
  • Accepted : 2020.08.11
  • Published : 2020.12.31
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Abstract

Purpose: Acute kidney injury (AKI) in patients with glyphosate poisoning has a poor prognosis. This study aimed to predict the risk factors for AKI in patients with glyphosate poisoning at the emergency department (ED). Methods: Clinical data on glyphosate poisoning patients at ED who were older than 18 years were collected retrospectively between January 2013 and December 2019. The clinical characteristics and clinical outcomes of the AKI group in patients with glyphosate poisoning were compared with the non-AKI (NAKI) group. Results: Of 63 glyphosate poisoning patients, AKI was observed in 15 (23.8%). The AKI patients group showed the following: old age (p=0.038), low systolic blood pressure (p=0.021), large amount of ingestion (p=0.026), delayed hospital visits (p=0.009), high white blood cells (WBC) (p<0.001), high neutrophil counts (p<0.001), high neutrophil-lymphocyte (LN) ratios (p<0.001), high serum potassium (p=0.005), low arterial blood pH (p=0.015), and low pO2 (p=0.021), low bicarbonate (p=0.009), and high Poisoning Severity Score (PSS) (p<0.001). AKI patients required hemodialysis, ventilator care (p<0.001, p=0.002), and inotropics (p<0.001). They also showed more intensive care unit admission (p<0.001), longer hospitalization (p<0.001), and high mortality (p<0.001). Logistic multivariate regression analysis showed that high WBCs (OR, 1.223) and increased LN ratios (OR, 1.414) were independently associated with the occurrence of AKI. Conclusion: In patients with glyphosate poisoning at ED, high WBCs and increased LN ratios can help predict the occurrence of AKI.

Keywords

References

  1. Hoffman RS, Howland MA, Lewin NA, et al. Goldfrank's toxicologic emergencies. 10th ed. New York:McGraw-Hill; 2015. p.1402-3.
  2. Lee CH, Shih CP, Hsu KH, et al. The early prognostic factors of glyphosate-surfactant intoxication. Am J Emerg Med 2008; 26:275-81. https://doi.org/10.1016/j.ajem.2007.05.011
  3. Lee HL, Chen KW, Chi CH, et al. Clinical presentations and prognostic factors of a glyphosate-surfactant herbicide intoxication. a review of 131 cases. Acad Emerg Med 2000;7:906-10. https://doi.org/10.1111/j.1553-2712.2000.tb02069.x
  4. Garlich FM, Goldman M, Pepe J, et al. Hemodialysis clearance of glyphosate following a life-threatening ingestion of glyphosatesurfactant herbicide. Clin Toxicol (Phila) 2014;52:66-71. https://doi.org/10.3109/15563650.2013.870344
  5. Moon JM, Min YI, Chun BJ. Can early hemodialysis affect the outcome of the ingestion of glyphosate herbicide? Clin Toxicol (Phila) 2006;44:329-32. https://doi.org/10.1080/15563650600584550
  6. Kidney Disease: Improving Global Outcomes (KDIGO) Acute Kidney Injury Work Group. KDIGO Clinical Practice Guideline for Acute Kidney Injury. Kidney Int Suppl 2012;2:19-36. https://doi.org/10.1038/kisup.2011.32
  7. Moon JM, Chun BJ. Predicting acute complicated glyphosate intoxication in the emergency department. Clin Toxicol (Phila) 2010;48:718-24. https://doi.org/10.3109/15563650.2010.488640
  8. Seok SJ, Park JS, Hong JR, et al. Surfactant volume is an essential element in human toxicity in acute glyphosate herbicide intoxication. Clin Toxicol (Phila) 2011;49:892-9. https://doi.org/10.3109/15563650.2011.626422
  9. Tai T, Yamashita M, Wakimori H. Hemodynamic effects of Roundup, glyphosate and surfactant in dogs. Jpn J Toxicol 1990;3:63-8.
  10. Talbot AR, Shiaw MH, Huang JS, et al. Acute poisoning with a glyphosate-surfactant herbicide ('Roundup'): a review of 93 cases. Hum Exp Toxicol 1991;10:1-8. https://doi.org/10.1177/096032719101000101
  11. Son CH, Lee SH, Jang TC, et al. Clinical characteristics and mortality-predictive factors analyses of glyphosate intoxication. J Korean Soc Emerg Med 2018;29:304-10.
  12. Menkes DB, Temple WA, Edward IR. Intentional selfpoisoning with glyphosate-containing herbicides. Hum Exp Toxicol 1991;10:103-7. https://doi.org/10.1177/096032719101000202
  13. Amanvermez R, Baydin A, Yardan T, et al. Emergency laboratory abnormalities in suicidal patients with acute organophosphate poisoning. Turk J Biochem 2010;35:29-34.
  14. Lee EY, Hwang KY, Yang JO, et al. Predictors of successful outcome of acute paraquat poisoning: An analysis of 602 cases. Korean J Med 2003;64:625-32.
  15. Dundar ZD, Ergin M, Koylu R, et al. Neutrophil-lymphocyte ratio in patients with pesticide poisoning. J Emerg Med 2014; 47:286-93. https://doi.org/10.1016/j.jemermed.2014.01.034
  16. Kim JH, Park JM, Kim MJ, et al. Hematological parameters predicting complications of caustic ingestion: A Retrospective Study. J Korean Soc Emerg Med 2015;26:591-7.
  17. de Jager CP, van Wijk PT, Mathoera RB, et al. Lymphocytopenia and neutrophil-lymphocyte count ratio predict bacteremia better than conventional infection markers in an emergency care unit. Crit Care 2010;14:R192. https://doi.org/10.1186/cc9309
  18. El-Shenawy NS. Oxidative stress responses of rats exposed to Roundup and its active ingredient glyphosate. Environ Toxicol Pharmacol 2009;28:379-85. https://doi.org/10.1016/j.etap.2009.06.001
  19. Modesto KA, Martinez CB. Effects of roundup transorb on fish: hematology, antioxidant defenses and acetylcholinesterase activity. Chemosphere 2010;81:781-7. https://doi.org/10.1016/j.chemosphere.2010.07.005
  20. Mladinic M, Berend S, Vrdoljak AL, et al. Evaluation of genome damage and its relation to oxidative stress induced by glyphosate in human lymphocytes in vitro. Environ Mol Mutagen 2009; 50:800-7. https://doi.org/10.1002/em.20495