Retrospective Investigation of Alcohol Intoxications Followed in Intensive Care Unit

Yıl 2024, Cilt: 8 Sayı: 2, 144 - 151, 30.08.2024

Bengü Gülhan Köksal , Keziban Bollucuoğlu , Çağdaş Baytar , Rahşan Dilek Okyay , Özcan Pişkin , Gamze Küçükosman , Hilal Ayoğlu

https://doi.org/10.29058/mjwbs.1371333

Öz

Aim: The majority of alcohol-related deaths are due to acute alcohol consumption. There are many factors affecting the prognosis of alcohol toxicity. It has been reported that by determining these factors, mortality rates can be reduced by early diagnosis and early initiation of treatment. In this study, we aimed to determine the prognosis by evaluating the clinical status and laboratory factors of patients followed up in intensive care unit (ICU) due to acute alcohol intoxication.
Materials and Methods: The study included 21 patients with acute alcohol intoxication who were followed up in the ICU of our hospital between 2013-2021.Laboratory parameters, demographic characteristics and clinical status of the patients were recorded. Patients were divided into both exitus and survivors and according to the type of alcohol consumed (ethanol and methanol).
Results: All patients were male with a mean age of 40.10 ± 15.9 years. 52.4% of the admissions were ethanol poisoning and 47.6% were methanol poisoning. Mortality rate was 33.3%. It was observed that symptoms appeared later in methanol intoxication compared to ethanol intoxication (p<0.001). When ethanol and methanol groups were compared, pH and HCO3- levels were lower and lactate and creatinine levels were higher in Group M. Advanced age, low Glasgow coma scale (GCS) and Acute Physiology and Chronic Health Evaluation (APACHE II) scores, high neutrophil/lymphocyte ratio (NLR), lactate, anion gap, creatinine, osmolarity and low pH, HCO3- were associated with mortality (p<0.05).
Conclusion: In this study, advanced age, low GCS and APACHE scores, metabolic acidosis with high anion gap in laboratory findings, increased NLR, lactate level and creatine elevation were found to be associated with mortality in acute alcohol intoxication. We think that patients with these findings should be followed closely.

Anahtar Kelimeler

Ethanol, Methanol, Intoxication, Mortality

Yoğun Bakımda Takip Edilen Alkol Zehirlenmelerinin Retrospektif İncelenmesi

Öz

Amaç: Alkolle ilişkili ölümlerin büyük bir kısmı akut alkol tüketiminden kaynaklanmaktadır. Alkol toksisitesinin prognozunu etkileyen birçok faktör vardır. Bu faktörlerin belirlenmesi ile erken tanı konulup tedaviye erken başlanarak mortalite oranlarının azaltılabileceği bildirilmiştir. Bu çalışmada akut alkol zehirlenmesi nedeni ile yoğun bakımda takip edilen hastaların klinik durumu ve laboratuvar faktörleri değerlendirilerek prognozun belirlenmesi amaçlanmıştır.
Gereç ve Yöntemler: Çalışmaya 2013-2021 yılları arasında hastanemiz yoğun bakım ünitesine(YBÜ) takip edilen ve akut alkol intoksikasyonu tanısı alan 21 hasta dahil edildi. Hastaların laboratuvar parametreleri, demografik özellikleri ve klinik durumları kaydedildi. Hastalar hem eksitus olanlar ve hayatta kalanlar olmak üzere hem de tüketilen alkol tipine (etanol ve metanol) göre gruplara ayrıldı.
Bulgular: Olguların tümü erkek hastalardan oluşuyordu ve yaş ortalaması 40.10 ± 15.9 yıl olarak tespit edildi. Başvuruların %52.4’ü ethanol, %47.6’sı metanol zehirlenmesiydi. Mortalite oranı %33.3 tü. Metanol zehirlenmesinde semptomların, etanol zehirlenmesine kıyasla geç dönemde ortaya çıktığı gözlendi (p<0.001). Etanol ve metanol grupları karşılaştırıldığında Grup M'de pH, HCO3- düzeyleri daha düşük, laktat ve kreatinin değerleri ise daha yüksek bulundu. İleri yaş, düşük Glaskow koma skalası (GKS) ve Akut Fizyoloji ve Kronik Sağlık Değerlendirmesi (APACHE II) skoru, yüksek nötrofil/lenfosit oranı (NLO), laktat, anyon açığı, kreatin, osmolarite ve düşük pH, HCO3- mortalite ile ilişkiliydi (p<0.05).
Sonuç: Bu çalışmada, akut alkol zehirlenmesinde ileri yaş, düşük GKS ve APACHE skoru, laboratuvar bulgularında yüksek anyon açığı ile seyreden metabolik asidoz, artmış NLO, laktat düzeyi ve kreatin yüksekliği mortalite ile ilişkili bulunmuştur. YBÜ yatışı sırasında bu bulgulara sahip hastaların yakından takip edilmesi gerektiğini düşünüyoruz.

Anahtar Kelimeler

Etanol, Metanol, İntoksikasyon, Mortalite

Kaynakça

• 1. Marmet S, Rehm J, Gmel G, Frick H, Gmel G. Alcohol-attributable mortality in Switzerland in 2011--age-specific causes of death and impact of heavy versus non-heavy drinking. Swiss Med Wkly. 2014;144:w13947.
• 2. Jung YC, Namkoong K. Alcohol: intoxication and poisoning - diagnosis and treatment. Handb Clin Neurol. 2014;125:115-21.
• 3. Vonghia L, Leggio L, Ferrulli A, Bertini M, Gasbarrini G, Addolorato G; Alcoholism Treatment Study Group. Acute alcohol intoxication. Eur J Intern Med. 2008;19(8):561-7. doi: 10.1016/j. ejim.2007.06.033.
• 4. Wartenberg AA, Manegement of alcohol intoxication and withdrawal. In: Ries R K, Fiellin D A, Miller S C, Saiz R, editors. The ASAM Principles of Addiction Medicine. 5th ed. China;2014. 1283-90.
• 5. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Washington, DC: American Psychiatric Publishing; 2013.
• 6. Noble JM, Weimer LH. Neurologic complications of alcoholism. Continuum (Minneap Minn). 2014 J;20:624-41.
• 7. Morteza Bagi HR, Tagizadieh M, Moharamzadeh P, Pouraghaei M, Kahvareh Barhagi A, Shahsavari Nia K. Epidemiology of Alcohol Poisoning and Its Outcome in the North-West of Iran. Emerg (Tehran). 2015;3(1):27-32.
• 8. Büberci R, Karahisar Şirali S, Duranay M. The predictors of mortality in patients with methyl alcohol intoxication. J Health Sci Med 2022; 5(4): 1139-1144
• 9. Sejersted OM, Jacobsen D, Ovrebø S, Jansen H. Formate concentrations in plasma from patients poisoned with methanol. Acta Med Scand. 1983;213(2):105-10.
• 10. Jacobsen D, McMartin KE. Methanol and ethylene glycol poisonings. Mechanism of toxicity, clinical course, diagnosis and treatment. Med Toxicol. 1986;1(5):309-34.
• 11. Williams R, Erickson T. Evaluating toxic alcohol poisoning in the emergency setting. Lab Med. 1998;29(2):102-8.
• 12. Gabow PA, Kaehny WD, Fennessey PV, Goodman SI, Gross PA, Schrier RW. Diagnostic importance of an increased serum anion gap. N Engl J Med. 1980;303(15):854-8.
• 13. Kraut J, Kurtz I. Toxic alcohol ingestions: clinical features, diagnosis, and management. Clin J Am Soc Nephrol. 2008;3(1):208- 25.
• 14. Cömertpay E. , Eroğlu O. , Deniz T. Metanol Zehirlenmesi Nedeniyle Acil Servise Başvuran Hastaların Retrospektif Analizi. Kırıkkale Üniversitesi Tıp Fakültesi Dergisi. 2021; 23(3): 530- 537
• 15. Ashurst JV, Nappe TM. Methanol Toxicity. (Updated 2022 Jun 21). In: StatPearls (Internet). Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm. nih.gov/books/NBK482121/
• 16. Sullivan M, Chen CL, Madden JF. Absence of metabolic acidosis in toxic methanol ingestion: a case report and review. Del Med J. 1999 Oct;71(10):421-6.
• 17. Kraut J, Madias N. Serum anion gap: its uses and limitations in clinical medicine. Clin J Am Soc Nephrol. 2007;2(1):162-74.
• 18. Basile DP, Anderson MD, Sutton TA. Pathophysiology of acute kidney injury. Compr Physiol. 2012 Apr;2(2):1303-53.
• 19. Grufferman S, Morris D, Alvarez J. Methanol poisoning complicated by myoglobinuric renal failure. Am J Emerg Med. 1985 Jan;3(1):24-6.
• 20. Chang ST, Wang YT, Hou YC, Wang IK, Hong HH, Weng CH, Huang WH, Hsu CW, Yen TH. Acute kidney injury and the risk of mortality in patients with methanol intoxication. BMC Nephrol. 2019 ;20(1):205.
• 21. Stankevic E, Israelsen M, Juel HB, Madsen AL, Ängquist L, Aldiss PSJ, Torp N, Johansen S, Hansen CD, Hansen JK, Thorhauge KH, Lindvig KP, Madsen BS, Sulek K, Legido-Quigley C, Thiele MS, Krag A, Hansen T. Binge drinking episode causes acute, specific alterations in systemic and hepatic inflammation- related markers. Liver Int. 2023 Aug 17.
• 22. Massey VL, Arteel GE. Acute alcohol-induced liver injury. Front Physiol. 2012 Jun 12;3:193.
• 23. Zahorec R. Ratio of neutrophil to lymphocyte counts--rapid and simple parameter of systemic inflammation and stress in critically ill. Bratisl Lek Listy. 2001;102(1):5-14.
• 24. Biyik M, Ucar R, Solak Y, Gungor G, Polat I, Gaipov A, Cakir OO, Ataseven H, Demir A, Turk S, Polat H. Blood neutrophil-to-lymphocyte ratio independently predicts survival in patients with liver cirrhosis. Eur J Gastroenterol Hepatol. 2013;25(4):435-41.
• 25. Buonacera A, Stancanelli B, Colaci M, Malatino L. Neutrophil to Lymphocyte Ratio: An Emerging Marker of the Relationships between the Immune System and Diseases. Int J Mol Sci. 2022 Mar 26;23(7):3636.
• 26. Forget P, Khalifa C, Defour JP, Latinne D, Van Pel MC, De Kock M. What is the normal value of the neutrophil-to-lymphocyte ratio? BMC Res Notes. 2017 Jan 3;10(1):12.
• 27. Heard K, Bebarta VS. Reliability of the Glasgow Coma Scale for the emergency department evaluation of poisoned patients. Hum Exp Toxicol. 2004 Apr;23(4):197-200.
• 28. Gruettner J, Walter T, Lang S, Reichert M, Haas S. Risk assessment in patients with acute alcohol intoxication. In Vivo. 2015 Jan-Feb;29(1):123-7.
• 29. Paasma R, Hovda KE, Hassanian-Moghaddam H, Brahmi N, Afshari R, Sandvik L, Jacobsen D. Risk factors related to poor outcome after methanol poisoning and the relation between outcome and antidotes--a multicenter study. Clin Toxicol (Phila). 2012 Nov;50(9):823-31.
• 30. Lee CY, Chang EK, Lin JL, Weng CH, Lee SY, Juan KC, Yang HY, Lin C, Lee SH, Wang IK, Yen TH. Risk factors for mortality in Asian Taiwanese patients with methanol poisoning. Ther Clin Risk Manag. 2014;10:61-7.
• 31. Mumtaz H, Ejaz MK, Tayyab M, Vohra LI, Sapkota S, Hasan M, Saqib M. APACHE scoring as an indicator of mortality rate in ICU patients: a cohort study. Ann Med Surg (Lond). 2023 Mar 24;85(3):416-421.
• 32. Van Hee P, Neels H, De Doncker M, Vrydags N, Schatteman K, Uyttenbroeck W, Hamers N, Himpe D, Lambert W. Analysis of gamma-hydroxybutyric acid, DL-lactic acid, glycolic acid, ethylene glycol and other glycols in body fluids by a direct injection gas chromatography-mass spectrometry assay for wide use. Clin Chem Lab Med. 2004;42(11):1341-5.
• 33. Rubinstein D, Escott E, Kelly JP. Methanol intoxication with putaminal and white matter necrosis: MR and CT findings. AJNR Am J Neuroradiol. 1995;16(7):1492-4.