Evaluation of extracorporeal treatment methods in poisoned patients admitted to an university hospital

OBJECTIVE To evaluation poisonings concerning treated with extracorporeal methods that were consulted to Dokuz Eylul University Drug and Poison Information Center (DEUDPIC) between January 01, 2011 and December 31, 2017. METHOD In this cross-sectional, descriptive study, characteristics of hospital admission, demographic data, characteristics of exposures, clinical signs and symptoms, extracorporeal treatment and non-extracorporeal treatment methods, clinical follow-up and outcomes of poisonings were evaluated. The clinical signs and symptoms of the patients were graded according to the Poisoning Severity Score. The data obtained from standard forms of DEUDPIC, Nephrology Department and data of hospital automation system and then recorded to SPSS-24 (SPSS INC., Chicago, IL, USA) program. Student's t-test, Mann-Whitney U, chi-square test, Fisher's exact test and logistic regression analysis were used for statistical analysis. RESULTS Seventy-five patients who had been treated with extracorporeal treatment for poisoning were included in the study. The mean age of cases was 51.5±19.7 years, and males were dominating (45, 60.0%). Acute exposures were the main type of exposures in 58.7% of the cases, followed by chronic exposure (25.3%) and acute toxicity on chronic use (16.0%). Unintentional exposures were more common (58.7%) than intentional exposures (41.3%). The most frequent agent were methanol (37.3%), lithium (18.7%), carbamazepine (10.7%) and digoxin (6.7%), respectively. The mean of Glaskow Coma Score (GCS) at admission was 11.4±4.5. There were no clinical signs and symptoms in 2.7% (2) of the cases, 24.0% (18) had mild, 26.7% (20) moderate, 46.7% (35) had severe signs and symptoms of toxicity. In all cases, the hemodialysis was performed. Specific antidotes were given in approximately one third (29.3%) of the cases. The reason of hemodialysis was "increased elimination of the toxin" in 74.7% and "renal support" in 25.3% of the cases. The mean number of hemodialysis sessions was 2.5±2.7 and the mean flow time was 478.1±567.7 minutes. The most common complication during hemodialysis was hypotension. While most of the cases (73.3%, 55) were transferred to the intensive care unit, 26.7% of patients were observed in the emergency room. It was found that the rate of requirement for observation and treatment in intensive care unit was significantly higher in males aged 50 and older than females (p<0.05). While 3 cases were discharged with sequelae (4.0%), 21 cases was died (28.0%). CONCLUSION Supportive treatment and hemodialysis were performed in all cases who had been treated with extracorporeal treatment. In addition, important factors on mortality were identified as; requirement of mechanical ventilation, age 50 and over, GCS below 8 at admission, hypotension development during hemodialysis, low blood pH and bicarbonate values are important and should be considered in the management of treatment.