Citation

Sharif AF, Kasemy ZA, Mabrouk HA, Shoeib O, Fayed MM. Toxicol. Res. (Camb.) 2023; 12(2): 310-320.

Copyright

(Copyright © 2023, RSC Publishing)

DOI

10.1093/toxres/tfad023

PMID

37125326

PMCID

PMC10141764

Abstract

Methylxanthines are widely used to manage pulmonary disorders, particularly in developing countries. Methylxanthines are unsafe due to their narrow therapeutic index and associated morbidity and mortality. The current study aimed to investigate the role of glucose/potassium ratio as a substantially useful early predictor of life-threatening events (LTEs) in the form of cardiovascular and neurological complications among methylxanthine users. A retrospective cohort study was conducted using medical records of patients diagnosed with acute methylxanthine intoxications and presented to an Egyptian Poison Control Center for 2 years. A total of 366 patients were enrolled. Of them, 59 patients (16.1%) were complicated with LTEs. The most frequent serious arrhythmia was T wave inversion (45.6% of patients with LTEs). Laboratory investigations that could significantly predict LTEs were the random blood glucose and potassium levels, glucose/potassium ratio, pH, liver transaminases, HCO(3) level, hemoglobin, and platelet count (P < 0.05). The glucose/potassium ratio was the best predictor of LTEs (odds ratio = 2.92, and 95% confidence interval = 2.02-4.23). With an excellent area under the curve (0.906) and at a cutoff of 2.44, that ratio could correctly classify the patients based on their risk of LTEs with an overall accuracy of 73% (sensitivity of 88% and specificity of 70%). The current study endorsed an important, feasible, and easily obtainable ratio that could predictor stratify the patients according to severity and risk of LTEs, which guides the decision-making and prioritizes the treatment lines in methylxanthine intoxicated patients.

Language: en

Keywords

arrhythmia; glucose/potassium ratio; life threatening events; methylxanthine; seizures; theophylline