Michael J Hodgman, Jeanna M Marraffa, Brian G Wiener, Mary Ann Howland, Christine Stork, Maria Mercurio-Zappala, Mark Su
{"title":"乙二醇中毒患者血清初始钙浓度的作用评估。","authors":"Michael J Hodgman, Jeanna M Marraffa, Brian G Wiener, Mary Ann Howland, Christine Stork, Maria Mercurio-Zappala, Mark Su","doi":"10.1007/s13181-023-00958-y","DOIUrl":null,"url":null,"abstract":"<p><strong>Introduction: </strong>Assays for ethylene glycol (EG) with a rapid turn-around time are not routinely available. Clinicians must rely on historical features and readily available clinical tests, combined with clinical acumen, to guide the initial management of suspected EG poisoning. Hypocalcemia has been suggested as a clue supporting the diagnosis of EG poisoning in patients presenting with an unexplained high anion gap metabolic acidosis (HAGMA). A previous small study challenged this assumption.</p><p><strong>Methods: </strong>This was a retrospective case series of one state's poison control system of confirmed EG-poisoned patients between September 2017 and April 2021. The definition of EG poisoning was based on suspected EG ingestion and a serum EG concentration > 5 mg/dL. Patients who were suspected to have EG toxicity but did not have a confirmed EG concentration or the EG concentration was less than 5 mg/dL were excluded. Routine laboratory studies were recorded for all patients. Comparisons between serum calcium on presentation to presenting blood pH, bicarbonate, anion gap, and creatinine were assessed for correlation.</p><p><strong>Results: </strong>There was no correlation between the presenting calcium and either pH or creatinine. There was a weak positive correlation between the initial serum calcium and anion gap, a weak negative correlation between the initial serum calcium and bicarbonate.</p><p><strong>Conclusion: </strong>On hospital presentation, hypocalcemia was not associated with EG poisoning, even in patients with a HAGMA. A normal serum calcium on presentation does not exclude the diagnosis of EG poisoning.</p>","PeriodicalId":16429,"journal":{"name":"Journal of Medical Toxicology","volume":" ","pages":"368-373"},"PeriodicalIF":2.5000,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10522548/pdf/","citationCount":"0","resultStr":"{\"title\":\"Assessing the Role of Initial Serum Calcium Concentration in Patients with Ethylene Glycol Poisoning.\",\"authors\":\"Michael J Hodgman, Jeanna M Marraffa, Brian G Wiener, Mary Ann Howland, Christine Stork, Maria Mercurio-Zappala, Mark Su\",\"doi\":\"10.1007/s13181-023-00958-y\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Introduction: </strong>Assays for ethylene glycol (EG) with a rapid turn-around time are not routinely available. Clinicians must rely on historical features and readily available clinical tests, combined with clinical acumen, to guide the initial management of suspected EG poisoning. Hypocalcemia has been suggested as a clue supporting the diagnosis of EG poisoning in patients presenting with an unexplained high anion gap metabolic acidosis (HAGMA). A previous small study challenged this assumption.</p><p><strong>Methods: </strong>This was a retrospective case series of one state's poison control system of confirmed EG-poisoned patients between September 2017 and April 2021. The definition of EG poisoning was based on suspected EG ingestion and a serum EG concentration > 5 mg/dL. Patients who were suspected to have EG toxicity but did not have a confirmed EG concentration or the EG concentration was less than 5 mg/dL were excluded. Routine laboratory studies were recorded for all patients. Comparisons between serum calcium on presentation to presenting blood pH, bicarbonate, anion gap, and creatinine were assessed for correlation.</p><p><strong>Results: </strong>There was no correlation between the presenting calcium and either pH or creatinine. There was a weak positive correlation between the initial serum calcium and anion gap, a weak negative correlation between the initial serum calcium and bicarbonate.</p><p><strong>Conclusion: </strong>On hospital presentation, hypocalcemia was not associated with EG poisoning, even in patients with a HAGMA. A normal serum calcium on presentation does not exclude the diagnosis of EG poisoning.</p>\",\"PeriodicalId\":16429,\"journal\":{\"name\":\"Journal of Medical Toxicology\",\"volume\":\" \",\"pages\":\"368-373\"},\"PeriodicalIF\":2.5000,\"publicationDate\":\"2023-10-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10522548/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Medical Toxicology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1007/s13181-023-00958-y\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2023/7/26 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q3\",\"JCRName\":\"TOXICOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Medical Toxicology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s13181-023-00958-y","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2023/7/26 0:00:00","PubModel":"Epub","JCR":"Q3","JCRName":"TOXICOLOGY","Score":null,"Total":0}
Assessing the Role of Initial Serum Calcium Concentration in Patients with Ethylene Glycol Poisoning.
Introduction: Assays for ethylene glycol (EG) with a rapid turn-around time are not routinely available. Clinicians must rely on historical features and readily available clinical tests, combined with clinical acumen, to guide the initial management of suspected EG poisoning. Hypocalcemia has been suggested as a clue supporting the diagnosis of EG poisoning in patients presenting with an unexplained high anion gap metabolic acidosis (HAGMA). A previous small study challenged this assumption.
Methods: This was a retrospective case series of one state's poison control system of confirmed EG-poisoned patients between September 2017 and April 2021. The definition of EG poisoning was based on suspected EG ingestion and a serum EG concentration > 5 mg/dL. Patients who were suspected to have EG toxicity but did not have a confirmed EG concentration or the EG concentration was less than 5 mg/dL were excluded. Routine laboratory studies were recorded for all patients. Comparisons between serum calcium on presentation to presenting blood pH, bicarbonate, anion gap, and creatinine were assessed for correlation.
Results: There was no correlation between the presenting calcium and either pH or creatinine. There was a weak positive correlation between the initial serum calcium and anion gap, a weak negative correlation between the initial serum calcium and bicarbonate.
Conclusion: On hospital presentation, hypocalcemia was not associated with EG poisoning, even in patients with a HAGMA. A normal serum calcium on presentation does not exclude the diagnosis of EG poisoning.
期刊介绍:
Journal of Medical Toxicology (JMT) is a peer-reviewed medical journal dedicated to advances in clinical toxicology, focusing on the diagnosis, management, and prevention of poisoning and other adverse health effects resulting from medications, chemicals, occupational and environmental substances, and biological hazards. As the official journal of the American College of Medical Toxicology (ACMT), JMT is managed by an editorial board of clinicians as well as scientists and thus publishes research that is relevant to medical toxicologists, emergency physicians, critical care specialists, pediatricians, pre-hospital providers, occupational physicians, substance abuse experts, veterinary toxicologists, and policy makers. JMT articles generate considerable interest in the lay media, with 2016 JMT articles cited by various social media sites, the Boston Globe, and the Washington Post among others. For questions or comments about the journal, please contact jmtinfo@acmt.net.
For questions or comments about the journal, please contact jmtinfo@acmt.net.