Diagnosis of acute intoxications in critically ill patients: focus on biomarkers - part 1: epidemiology, methodology and general overview

Biomarkers. 2020 Feb;25(1):9-19. doi: 10.1080/1354750X.2019.1694994. Epub 2019 Nov 26.

Abstract

Acute intoxications account for a significant proportion of the patient population in intensive care units and sedative medications, ethanol, illicit drugs, inhalable poisons and mixed intoxications are the most common causes. The aim of this article is to describe biomarkers for screening and diagnosis of acute intoxications in critically ill patients. For this purpose, a survey of the relevant literature was conducted, and guidelines, case reports, expert assessments, and scientific publications were reviewed. In critical care, it should always be attempted to identify and quantify the poison or toxin with the assistance of enzyme immunoassay (EIA), chromatography, and mass spectrometry techniques and this section is critically appraised in this publication. The principles for anion gap, osmol gap and lactate gap and their usage in intoxications is shown. Basic rules in test methodology and pre-analytics are reviewed. Biomarkers in general are presented in part one and biomarkers for specific intoxications including ethanol, paracetamol, cardiovascular drugs and many others are presented in part two of these publications.

Keywords: Intoxications; biomarkers; critical care; intensive care unit; poisoning.

Publication types

  • Systematic Review

MeSH terms

  • Acute Disease
  • Biomarkers / metabolism*
  • Critical Illness
  • Drug Overdose / diagnosis*
  • Drug Overdose / epidemiology
  • Drug Overdose / metabolism
  • Drug Overdose / therapy
  • Drug-Related Side Effects and Adverse Reactions / diagnosis*
  • Drug-Related Side Effects and Adverse Reactions / epidemiology
  • Drug-Related Side Effects and Adverse Reactions / metabolism
  • Drug-Related Side Effects and Adverse Reactions / therapy
  • Humans
  • Poisoning / diagnosis*
  • Poisoning / epidemiology
  • Poisoning / metabolism
  • Poisoning / therapy
  • Predictive Value of Tests
  • Prognosis

Substances

  • Biomarkers