Significance of an Anion Gap and an Osmol Gap in Poisoning

PURPOSE: In the management of acute poisoning, the anion gap and the osmol gap are easily derived from serum laboratory findings and arterial blood gas analysis. The anion gap is known to be increased by the effects of the toxic material itself and secondary complications or by an exacerbation of an underlying illness. The osmol gap can be increased by the presence of osmotically active materials in the body, such as alcohol, glycols and mannitol. This study was proposed to investigate the significance of an increased anion gap in acutely poisoned patients and the effect of alcohol ingestion in increasing the osmol gap, which might help to understand the significance of an increased osmol gap in acutely poisoned patients. METHODS: A retrospective chart review of poisoned patients who had visited the emergency departments of the Anam and the Ansan hospitals of Korea University was used in this study. Serum laboratory findings and arterial blood gas analysis were used to measure the anion gap and the osmol gap. Patients were categorized into a non anion-gap group versus a high anion-gap group and a normal osmolgap group versus a high osmol-gap group. Frequency of toxidrome, blood pH and drinking history were included to evaluate the relations between the groups. RESULTS: Of 204 patients, 195 patients who completed the tests were included in the study. In the 99 patients with a high anion-gap, 38 (38.38%) patients showed development of toxidrome. In the 96 patients with a non anion-gap, only 15 (15.62%) patients showed toxidrome. Forty-six (80.7%) of the 57 patients with a high osmol-gap and 20 (22.2%) of the 90 patients with a normal osmol-gap had a history of drinking. CONCLUSION: In poisoned patients, the group with a higher anion gap showed a higher frequency of toxidrome. This suggests that in the management of a poisoning victim with an uncertain history, should a high anion gap be found, an intense observation and evaluation is necessary to identify the cause. An increase in the osmol gap in poisoned patients is generally considered to be from alcohol ingestion. Thus, for a patient with an increased osmol gap, measurement of the serum ethanol level should be done to exclude the effect of alcohol.

Prognostic Value of Base Deficit in Severe Trauma Patients

BACKGROUND: This study's objective was to determine the prognostic value of the base deficit measured in the emergency department(ED) and to determine whether base deficit can provide information not provided by advanced injury scoring system. METHODS: This study was a retrospective analysis of data collected for two years. Thirty-two severe trauma patients who were admitted to the Emergency Department of Korea University Hospital were included in this study. The patients were divided into two groups: the normal base deficit group(-3 mmol/L to 3 mmol/L) and the elevated base deficit group(>3 mmol/L). The base-deficit value, age, sex, head injury, organ failure rate, and survival were considered, and the also Revised Trauma Score(RTS), Acute Physiology And Chronic Health Evaluation(APACHE II), and Injury Severity Score(ISS) were measured. RESULT: The elevated base-deficit group showed a lower survival rate and a higher organ failure rate compared to the normal base deficit group. Logistic Regression showed a strong association between base deficit and mortality rate. Among the previous injury scoring Systems(RTS, APACHE II, ISS), base deficit had the strongest correlation with RTS. By using base deficit value and the RTS together, we obtained a higher positive predictive value than that obtained by using base deficit or RTS alone. CONCLUSION: The admission value of the base deficit in the ED is a useful tool in predicting the outcome in severe trauma patients, and it can be an adjunct to previous injury scoring systems. As an advanced injury scoring System is developed in the future, the base deficit may have some significant role.