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- 저자 : ( Carlos R Camara Lemarroy ) (검색결과 1 건)
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Poster Session : PS 0470 ; Nephrology ; Acute Toluene Intoxication: Prospective Observational Study
( Rene Rodriguez Gutierrez ),( Roberto Monreal Robles ),( Carlos R Camara Lemarroy ),( Jose G Gonzalez Gonzalez ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1
Background: Toluene is one of the most widely abused inhaled drugs and dangerous metabolic abnormalities are associated to its acute intoxication. It has been previously reported that rhabdomyolysis and acute hepatorenal injury could be hallmarks of the disease, and could constitute risk factors for poor outcomes. The objective was to describe the clinical presentation, to characterize the renal and liver abnormalities, the management and prognosis associated to acute toluene intoxication. Methods: We prospectively assessed 20 patients that were admitted to a single center`s emergency department from 2007-2014 with clinical and metabolic alterations due to acute toluene intoxication. Results: Patients were severely acidotic on admission (mean pH: 7.14 ± 0.09) with a mean anion gap of 16 ± 6.9 mmol/L and mean potassium level of 2.19 mmol/L ± 1.32. The main clinical presentation consisted of weakness associated to severe hypokalemia and acidosis. Renal glomerular injury (proteinuria) was ubiquitous. Serum creatine-phosphokinase levels were elevated in 16 cases, with a mean elevation of 6 times the upper normal limit (1,544 ± 1,864 U/L). Liver function tests were normal, except for ALP, which was elevated in 15 patients. Gamma-glutamyl transpeptidase was elevated in all patients, with a mean of 103.9 ± 66.9. Rhabdomyolysis occurred in 80% of patients, probably due to hypokalemia and hypophosphatemia. There were three deaths, all associated with altered mental status, severe acidosis, hypokalemia and acute oliguric renal failure. The causes of death were cardiac rhythm abnormalities. Conclusions: The hallmarks of acute toluene intoxication are hypokalemic paralysis and metabolic acidosis. Liver injury and rhabdomyolysis are common. Altered mental state on admission, renal failure, severe acidemia and female gender could be associated with a poor outcome, and patients with these characteristics should be treated in an intensive care unit.
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