THE EFFECT OF LACTATE AND LACTATE CLEARANCE ON PROGNOSIS AND THERAPY OUTCOME IN MUSHROOM POISONING

Introduction: Mushroom poisoning is a serious poisoning that may have a fatal course. Typically, the signs of hepatotoxicity appear 24-36 hours after ingestion. The lactate clearance naturally decreases in impaired hepatic fraction. The purpose of this study was to assess the effect of lactate and lactate clearance on the prognosis and the efficacy of therapy in patients with mushroom poisoning hospitalized in the Toxicology Unit. Materials and methods: This retrospective study included 236 patients who had been diagnosed with mushroom poisoning upon referral to the Emergency Unit, hospitalized, and treated between July 2008 and March 2013. The patients were divided into two groups as those undergone hemoperfusion and those not undergone hemoperfusion. The patients were also divided into two groups as those with abnormal liver fraction tests and those with normal liver function tests. The lactate clearance of each patient was calculated according to the values of lactate upon referral, lactate at hours 6 and 24 in the blood gas analyses. Results: The mean lactate value upon referral in patients with normal liver enzymes was 0.97 +/- 0.48 mmol/L, whereas this was 1.68 +/- 0.63 mmol/L in patients with elevated liver enzymes. The mean lactate clearance values at the 24th hour were 25.76 +/- 14.80% and 36.05 +/- 14.22%, respectively. The mean lactate clearance values at the 24th hour in patients undergoing hemoperfusion and patients not undergoing hemoperfusion were 14.26 +/- 23.52% and 39.48 +/- 14.33%, respectively. The lactate clearance at the 24th hour was significantly higher; particularly in patients with elevated liver enzymes who had received hemoperfusion along with supportive therapy (p<0.001). Conclusion: Mushroom poisoning patients with high blood lactate levels on admission to the hospital should be approached carefully with regard to requirement for hemoperfusion and the prognosis.