armillarisin-a and Acute-Kidney-Injury

Diethylene glycol (DEG) poisoning is life-threatening. The clinical characteristics of patients with liver disease exposed to intravenous DEG have not been clarified.. Sixty-four patients with moderate to severe liver disease exposed to DEG in China in 2006 were investigated.. The daily exposure total dose was 3-6 mL of a 30% (v/v) mixture. Acute renal failure (ARF), the predominant clinical manifestation, occurred in 23.4% (15/64) of these patients. The average time to onset was 6.53 +/- 3.48 days after exposure to DEG. ARF could be differentiated from the hepatorenal syndrome that usually occurs in patients with severe liver disease. The occurrence of ARF was significantly related to pre-existing renal function abnormality, and was not influenced by the allele distribution of DEG-metabolizing enzyme. The liver function profiles did not significantly change after DEG exposure.. ARF was the main clinical manifestation in this intravenous DEG poisoning accident. The influence of underlying liver disease on DEG poisoning or that of DEG exposure on liver disease has many implications.

Topics: Acute Kidney Injury; Adult; Benzopyrans; Case-Control Studies; China; Cholagogues and Choleretics; Drug Compounding; Drug Contamination; Ethylene Glycols; Female; Hepatorenal Syndrome; Humans; Injections, Intravenous; Kidney Function Tests; Liver Diseases; Liver Function Tests; Male; Middle Aged; Risk Factors; Severity of Illness Index; Time Factors

There was a hospital outbreak of venous diethylene glycol poisoning in Guangzhou, China. It is the only massive episode of venous diethylene glycol poisoning in history. Here we report its clinical features, laboratory findings, and imaging appearances.. The clinical features of 15 venous diethylene glycol poisoning patients with liver disease were analyzed and summarized. Their laboratory findings and imaging appearances were comparatively analyzed before and after poisoning.. All poisoned patients presented with oliguric acute renal failure with anuria after a mean of 6 days. Carbon dioxide combination power of 13 patients dropped after a mean of 9 days with valley value on the 10th day, when metabolic acidosis developed. Gastroenteric symptoms or aggravation of gastroenteric symptoms were displayed in 11 patients after a mean of 9 days. Neurological system impairment was observed in 10 patients after a mean of 14 days. Seven patients had low fever after a mean of 6 days. Causes of death of 14 patients included multiple organ dysfunction syndrome, severe lung infection and massive haemorrhage of digestive tract. Blood creatinine and urea nitrogen were abnormal after a mean of 5 days with peak value on the 11th and 14th days, respectively. Serum calcium had no obvious change, and phosphorus was distinctively increased. Liver functions did not change significantly. Poisoned patients had higher white blood cell counts, but lower red blood cell counts and hemoglobin value. Of the 7 patients who exhibited mild, moderate or severe patchy consolidation shadowing in the lung, 2 manifested mild or severe gaseous distention and dilation of gastroenteric tract.. Main features of venous diethylene glycol poisoning in patients with liver disease include oliguric acute renal failure, metabolic acidosis, gastroenteric symptoms or aggravation of gastroenteric symptoms, neurological system impairment and low fever, with a mortality rate of 93.33% in poisoned patients. There is also higher white blood cell counts and anemia, patchy consolidation shadowing in the lung, gaseous distention and dilation of gastroenteric tract, which occurs later than mild patchy consolidation shadowing and earlier than moderate patchy consolidation shadowing in the lung.

Topics: Acute Kidney Injury; Adolescent; Adult; Aged; Benzopyrans; Child; Child, Preschool; Drug Contamination; Ethylene Glycols; Female; Humans; Liver Diseases; Male; Middle Aged

To analyze the clinical presentation of venous diethylene glycol (DEG) poisoning in patients with preexisting severe liver disease and factors that correlate with DEG poisoning.. Retrospective chart review was performed to analyze the epidemiology, clinical presentation, hepatorenal functions, hemodynamics and pathological characteristics of 64 patients with severe liver disease who received intravenous armillarisin-A, the solvent of which was DEG. Comparative analyses of correlating factors and causes for poisoning were based on the presence or absence of poisoning.. Of the 64 patients who received armillarisin-A, 15 were found to have DEG poisoning. Twelve poisoned patients died. After a mean of 5 d, the poisoned patients displayed acute renal failure. Metabolic acidosis occurred in 13 cases. BUN, Cr, and CO2 values were significantly elevated and exacerbation of digestive tract symptoms and/or symptom was noted in 11 cases. Neurological system impairment was observed in 10 cases after 2 wk. Compared to the 49 non-poisoned patients, the poisoned patients exhibited significantly lower RBC and Hb values and higher WBC count. Renal biopsy from the poisoned patients revealed acute tubular necrosis and interstitial nephritis. Significant differences in preexisting severe hepatitis, ascites, renal disease, and diuretic therapy were found between groups. Prior to diethylene glycol injections, the mean values for neutral granular cells, BUN, Cr, calcium and phosphorous ions differed significantly between groups.. Venous diethylene glycol poisoning is characterized by oliguric acute renal failure, metabolic acidosis, digestive symptoms, nervous system impairment, and a high probability of anemia and WBC proliferation. Mortality is high. Correlative factors include preexisting severe liver disease, renal disease, and infection.

Topics: Acidosis; Acute Kidney Injury; Adolescent; Adult; Aged; Anemia; Benzopyrans; Child; China; Ethylene Glycols; Female; Gastrointestinal Diseases; Humans; Injections, Intravenous; Liver Diseases; Male; Middle Aged; Nervous System Diseases; Oliguria; Poisoning; Retrospective Studies; Severity of Illness Index; Solvents