Acute Poisoning Induced Coma: Characteristics and Predictive Role of Early Creatine Phosphokinase on Its Outcome

Abstract

Background: Emergency physicians are often challenged with a comatose patient; 30% of patients with coma of unknown origin are due to intoxication. Comatose patients are at high risk for morbidity and mortality. Objective: The present study assessed poisoning-induced coma regarding demographic and intoxication data, causative agents, clinical data, management modalities and outcome. In addition to evaluation of the role of creatine phosphokinase (CPK) level on admission and other variables as predictive factors for the outcome in toxic coma. Subjects and Methods: This study was conducted prospectively on one hundred comatose intoxicated patients, admitted to Poison Control Center Ain Shams University Hospitals (PCCASU). Results: The majority of patients (64%) were in the age group 18-40 year, and there was male predominance (56%). Organophosphorus, carbamazepine and tramadol were the most common toxic agents inducing coma. Death rate was 12% and mortality is much higher in patients with older age, elevated admission creatine phosphokinase, longer duration of hospital stay and higher grade of Reed’s classification of coma. Conclusion: Organophosphorus followed by carbamazepine and tramadolwere the most common toxic agents inducing coma. Older age, elevated admission creatine phosphokinase, longer duration of hospitalization and higher grade of Reed’s classification of coma can predict the mortality. In addition, respiratory acidosis and the need of intubation and mechanical ventilation indicated poorer outcome, while administration of antidotes was correlated with better outcome.