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Abstract: TH-OR076

Intravenous Sodium Bicarbonate Replacement in Patients with Toluene Intoxication

Session Information

Category: Fluid and Electrolytes

  • 902 Fluid and Electrolytes: Clinical

Authors

  • Enriquez, Raul Valeriano, Hospital Universitario U.A.N.L., Monterrey, Mexico
  • Ibarra-Sifuentes, Héctor Raúl, Universidad Autonoma de Nuevo Leon, Monterrey, Mexico
  • Olivo, Mara Cecilia, Hospital Universitaro, Monterrey, NUEVO LEON, Mexico
  • Gongora rivera, Juan fernando, Hospital Universitario U.A.N.L., Monterrey, Mexico
Background

Toluene is widely available in over-the-counter products and is used as an inhaled abuse substance in developing countries. The treatment is not established and is expert opinion based on hydration and potassium replacement; however, acidosis treatment is not established.

Methods

Randomized single blind controlled clinical trial, in patients with toluene intoxication, in the emergency department. Inclusion criteria were patients >18 years, toluene poisoning clinical diagnosis, recently inhaled toluene history (<7 days), pH ≤7.25, and serum potassium between 1.1-5.5mmol/L. Patients were randomized to the administration on Group A, sodium bicarbonate (HCO3) and group B, No HCO3. Group A were given 100 mmol HCO3 as 4 hours infusion for up to 3 doses if the pH was still <7.30. In group B, HCO3 was not administered. All patients underwent serum electrolytes and venous or arterial blood gases every 4 hours since admission for up to 3 samples. The main outcome is to evaluate the time of metabolic acidosis resolution.

Results

In the study 19 patients were included, the mean age was 27 years, 53% were male. The resolution time of group A was 34.6 hours, while the group B was 19.5 hours, without significant difference (Table1). The hospital stay days (4.5 vs 3.2 days, p 0.14), the amount of potassium administered (568 vs 476 mEq, p 0.53) and the amount of fluid administered (8194 vs 7777 mL, p 0.859) were not significant between groups.

Conclusion

In the first clinical trial on toluene intoxication, there is no clear benefit of sodium bicarbonate intravenous replacement in patients with metabolic acidosis due to toluene intoxication. It is relevant to note no difference was found in the potassium administered between groups.

Table 1. Time to resolution, blood gases and serum potassium between groups.
ParameterGroup AGroup Bp
Time to resolution, h34.719.60.344
pH
0 h
4 h
8 h
12 h
24 h
.
7.10
7.22
7.27
7.32
7.34
.
7.14
7.19
7.20
7.27
7.32
.
0.528
0.601
0.301
0.275
0.413
K+
0 h
4 h
8 h
12 h
24 h
.
1.94
2.21
2.51
2.66
3.12
.
1.78
2.18
2.57
2.32
3.10
.
0.684
0.964
0.784
0.296
0.937
Hospital stay, days4.63.20.149
Saline solution, mL8,1947,7770.859
Administered K, mEq5684760.539
Number, (%)7 (70)6 (66)0.835

Group A, Saline solution + Sodium Bicarbonate 100 mmol; Group B, Saline solution, K+, potassium.