CLINICAL PRESENTATION AND PROGNOSTIC FACTORS IN SODIUM MONOFLUOROACETATE INTOXICATION

Background: The diagnosis of sodium monofluoroacetate intoxication in humans is usually based on a history of ingestion and clinical finding s. Although several previous reports have described the clinical cours e and outcome of patients who ingested this drug, prognostic indicator s of short-term survival are not available. Methods: A retrospective s tudy of 38 consecutive cases of sodium monofluoroacetate poisoning at the National Cheng Kung University Hospital, 1988-1993, to analyze the clinical findings and to predict mortality. Results: Seven of 38 pati ents (18%) died. The most common symptom was nausea or vomiting (74%). The most frequent ECG finding was nonspecific ST-T and T wave abnorma lities (72%). Hypocalcemia (42%) and hypokalemia (65%) were the common electrolyte abnormalities. The clinical and laboratory characteristic s were compared for the survival and mortality groups. Significant dif ferences in hypotension, respiratory rate, pulse rate, creatinine, pot assium, elevated alanine aminotransferase, pH, PCO2, APACHE II score, and subjective respiratory distress were noted. Discriminant analysis identified hypotension, increased serum creatinine, and decreased pH a s the most important predictors of mortality, with sensitivity of 86% and specificity of 96%. Conclusions: Hypotension and the early onset o f metabolic acidosis and increased serum creatinine are associated wit h poor short-term survival. These prognostic variables can be useful i n the care of patients with suspected sodium monofluoroacetate intoxic ation. It is suggested that all such patients should be observed inten sively for at least 48 h.