The prospective analysis of intoxicated patients who developed shock and/or organ failure

Objective: The aim of this study was to investigate the intoxicated patients with high mortality because of shock and organ prospectively and to contribute to the literature with valuable data about diagnosis, treatment, clinical course and results. Material and Method: After getting the approval of the local ethics committee, our study was carried out in the Academic Emergency Department of Çukurova University Faculty of Medicine between the dates of September 2015 and January 2019. 89 sequenced patients over 18 years of age with shock or acute organ failure due to severe intoxication who were accepted to the Academic Emergency Department were included in the study. Not only the demographic characteristics of the patients, the type, the mode of administration, and the dose of the drugs or substances they take received were inquired and recorded. The development time of the shock or acute organ failure during the emergency treatment or hospital stay, the type of acute organ failure, the treatment of intoxication, the type of antidotes that are used and the extracorporeal methods were recorded in details. Intoxication safety index was used to determine the severity of intoxication. SPSS v.23.0 program was used for the statistical evaluation of the data which was obtained from the study. The clinical outcomes of the patients who were included in the study were reported. Findings: A total of 89 patients with shock and acute organ failure were included in the study. 72 (80.9%) of the patients were male and 17 (19.1%) of them were female. While the average age of the patients was 49.1 (19-90), the average age of the female patients was 42.7 (19-90), and the average age of the male patients was 50.6 (19-90). When the agents that the patients with shock or acute organ failure received were questioned; it was seen that 51 patients were exposed to methyl alcohol, 12 patients were exposed to cardiovascular agent (KKB, BB, ARB), 6 patients were exposed to aluminium phosphate, 4 patients were exposed to carbon monoxide, 4 patients were exposed to fungus. The average period of hospitalization of 89 patients who were included in the study was 6.29 (1-50) days. The average period of hospitalization was 7.60 (1-50) days after the complaint of intoxication. Of the 89 patients who were accepted to the emergency department, 30 patients died and 52 patients were discharged. It was found that mortality was low in patients to whom extracorporeal treatment methods were implemented and it was high in patients with shock due to hypotension when they were accepted to the emergency department. When the laboratory findings were taken into consideration, it was seen that mortality was high in intoxicated patients with low wbc, lactate, base deficit, high potassium and low blood pH, bicarbonate. Result: Determination of the type of intoxication and implementing the necessary antidote treatment and extracorporeal methods without losing time may increase the survival rates in intoxicated patients with high mortality. Among the acute organ failure and shocking intoxications, methyl alcohol and aluminium phosphate intoxications still have high mortality despite all treatments. While the emergency physicians determine the severity of intoxication, it can suggested in this particular study that they can use the hypotension which was found significant about the mortality level in the first hour, and leucocyte value, base deficit, high lactate level and blood pH, bicarbonate levels can be used as prognostic criteria in determining the severity of intoxication in addition to the intoxication safety index. Keywords: Emergency, Shock, Acute Organ Failure, Intoxication, Lactate, Base Deficit