Journal of The Korean Society of Clinical Toxicology (대한임상독성학회지)

Korean society of Clincal Toxicology (대한임상독성학회)
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Poisoning patients' clinical features according to the blood level of propranolol

프로프라놀롤 혈중 농도에 따른 중독환자의 임상 양상 분석

  • Sungheon Kim (Department of Emergency Medicine, College of Medicine, The Catholic University of Korea) ;
  • Byung Hak So (Department of Emergency Medicine, College of Medicine, The Catholic University of Korea) ;
  • Hyung Min Kim (Department of Emergency Medicine, College of Medicine, The Catholic University of Korea) ;
  • Kyeong Man Cha (Department of Emergency Medicine, College of Medicine, The Catholic University of Korea) ;
  • Hwan Song (Department of Emergency Medicine, College of Medicine, The Catholic University of Korea) ;
  • Won Jung Jeong (Department of Emergency Medicine, College of Medicine, The Catholic University of Korea)
  • 김승현 (가톨릭대학교 의과대학 응급의학교실) ;
  • 소병학 (가톨릭대학교 의과대학 응급의학교실) ;
  • 김형민 (가톨릭대학교 의과대학 응급의학교실) ;
  • 차경만 (가톨릭대학교 의과대학 응급의학교실) ;
  • 송환 (가톨릭대학교 의과대학 응급의학교실) ;
  • 정원중 (가톨릭대학교 의과대학 응급의학교실)
  • Received : 2023.06.16
  • Accepted : 2023.06.21
  • Published : 2023.06.30
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Abstract

Purpose: Propranolol is widely prescribed to psychiatric patients to control adrenergic symptoms. However, propranolol poisoning can be fatal due to cardiovascular complications. We analyzed associations between blood levels of propranolol and patients' clinical features, with the aim of predicting progression to severe complications. Methods: Data were collected from patients aged 18 years or older who presented to the emergency department with propranolol poisoning between January 2016 and May 2022. We retrospectively analyzed their medical records and compared blood levels of propranolol between those who had cardiovascular complications and those who did not. Results: Two hundred patients were included in this study. The blood levels of propranolol were significantly higher in patients with hypotension, bradycardia, and prolonged QT intervals, with median values of 247.0 ng/mL (interquartile range [IQR], 56.5-333.8 ng/mL), 275.8 ng/mL (IQR, 154.3-486.4 ng/mL), and 159.0 ng/mL (IQR, 33.9-310.8 ng/mL), respectively. In the predictive analysis of cardiovascular complications using a receiver operating characteristic curve, the area under the curve was 0.729 with a cut-off value of 72.40 ng/mL (sensitivity, 0.667; specificity, 0.819). In addition, the correlation coefficient between blood levels and the amount of drug described during the history-taking at the time of presentation was 0.634, and this value means a relatively high relationship between the two variables. Conclusion: Because blood levels of propranolol can be used as predictors of exacerbation in patients with propranolol poisoning, patients with blood levels above 72.40 ng/mL require careful treatment and observation from their initial presentation at the emergency department.

Keywords

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