Citation

Sharif AF, Kasemy ZA, Alshabibi RA, Almufleh SJ, Abousamak FW, Alfrayan AA, Alshehri M, Alemies RA, Almuhsen AS, AlNasser SN, Al-Mulhim KA. Toxicol. Res. (Camb.) 2023; 12(1): 62-75.

Copyright

(Copyright © 2023, RSC Publishing)

DOI

10.1093/toxres/tfac084

PMID

36866212

PMCID

PMC9972822

Abstract

BACKGROUND: Acute intoxication with central nervous system (CNS) xenobiotics is an increasing global problem. Predicting the prognosis of acute toxic exposure among patients can significantly alter the morbidity and mortality. The present study outlined the early risk predictors among patients diagnosed with acute exposure to CNS xenobiotics and endorsed bedside nomograms for identifying patients requiring intensive care unit (ICU) admission and those at risk of poor prognosis or death.

METHODS: This study is a 6-year retrospective cohort study conducted among patients presented with acute exposure to CNS xenobiotics.

RESULTS: A total of 143 patients' records were included, where (36.4%) were admitted to the ICU, and a significant proportion of which was due to exposure to alcohols, sedative hypnotics, psychotropic, and antidepressants (P = 0.021). ICU admission was associated with significantly lower blood pressure, pH, and HCO(3) levels and higher random blood glucose (RBG), serum urea, and creatinine levels (P < 0.05). The study findings indicate that the decision of ICU admission could be determined using a nomogram combining the initial HCO(3) level, blood pH, modified PSS, and GCS. HCO(3) level < 17.1 mEq/L, pH < 7.2, moderate-to-severe PSS, and GCS < 11 significantly predicted ICU admission. Moreover, high PSS and low HCO(3) levels significantly predicted poor prognosis and mortality. Hyperglycemia was another significant predictor of mortality. Combining initial GCS, RBG level, and HCO(3) is substantially helpful in predicting the need for ICU admission in acute alcohol intoxication.

CONCLUSION: The proposed nomograms yielded significant straightforward and reliable prognostic outcomes predictors in acute exposure to CNS xenobiotics.

Language: en

Keywords

prognosis; mortality; acute drug poisoning; central nervous system; intensive care unit; nomogram