Serial Estimations of Blood Lactate, Phosphate and Hyaluronic acid For Survival Prediction In Acute Acetaminophen (Paracetamol) Toxicity
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This study aimed to evaluate the prognostic value of serial estimations of serum phosphate (Ph) and hyaluronic acid (HA) and arterial lactate levels in patients with severe acetaminophen (AAP) poisoning. Patients & Methods: The study comprised 40 patients; 25 females and 15 males, aged 14-51 years. Inclusion criteria included a history of AAP ^igestion and serum aspartate aminotransferase (AST) level >1000 IU/L. All patients were managed according to a standard protocol at ICU. Blood samples were taken at admission, 12,48 and 96 hours after admission for estimation of serum AST, Ph and HA and arterial blood lactate. Results: The mean dose of AAP ingested was 27H8.6 gm and the mean serum AST level was 1252+139 IU/L- Within 6 days, 16 patients had died. There was a significant (p<8.661) decrease of blood lactate at 12-hours compared to levels estimated at admission in both survivors and non-survivors with a significant (p<0.05) increase of blood lactate in non-survivors. There was a non-significant (pX).O5) hypo-phosphatepria at 48 hours after admission compared to levels estimated at admission, but with a significantSpS.Q5) decrease of serum phosphate in non-survivors. Serum HA showed significant (p<0.05) increase at 48-hr compared to admission levels with a significant (p<0.05) increase in nonsurvivors. At 96-hr after admission, there was a significant (p<6.05) increase of serum HA compared to levels estimated at either admission or at 48-hr in both survivors and non-survivors with a significant increase in non-survivors. There was a negative significant correlation between survival rate and blood lactate, 0=-0.605, p<0.001) and HA, (r=-0.343, p=0.03) levels and positive significant correlation with serum Ph, (r=0.791, p<0.001) estimated at time of admission, however, the correlation increases with time progression between survival rate and blood levels of Ph, (r=0.796, p<8.QM) and HA, (r=-8.530, p<8.081) but decrease with lactate, (r=-8.594, p<8.081) despite being still significant The correlation was intimate between elevated serum levels of HA, (r^-0.934, p^0.000) and mortality at 96-hr after ^igestion. Using linear regression (Stepwise exclusion method) blood lactate level estimated at admission is the only significant predictor of survival, serum Ph is the only significant predictor within the first 48-hr and serum HA is the only significant predictor after 48-hrs. Conclusion: It could be concluded that estimation of blood levels of the three parameters could define the time elapsed since digestion of AAP tablets and predict the outcome of acute AAP toxicity and thus could aid in designing resuscitation measures for these patients.