Characteristics of toxic coma and the role of Total antioxidant capacity (TAC) as a prognostic marker

ABSTRACT
Objectives: Coma is a state of loss of consciousness due to disfunction of ascending reticular activating system. It is considered a life-threatening condition that needs immediate intervention. The total antioxidant capacity (TAC) of the body is a biomarker that represents the amount of all endogenous antioxidants in the blood and body fluids. This study aims to analyze the characteristics of toxic coma and evaluate the predictive role of TAC analysis and other variables on the toxic coma outcome. Methodology: This is a prospective study done on all patients diagnosed with toxic coma and admitted to MPCC of Menoufia university hospitals over one year of study. Socio demographic data (including age, sex, residence), causative toxic agent, time passed from poison exposure to the hospital arrival, the manner of poisoning, duration of hospital stays, and outcome (Recovery or death) were recorded. Investigations as arterial blood gases (pH, PO2 PCO2, HCO3) and serum TAC were measured. Results: The study found that the incidence of toxic coma was higher in the age group 15 - < 40 years, male gender, and delayed hospital arrivals. Drug overdose is the most common causative toxic agent followed by insecticides, suicidal manner, longer duration of hospitalization, and residence in a rural area. Mortality was associated with male sex, delayed hospital arrival (> 4 hours), higher coma grades (Ⅲ& Ⅳ), long duration of hospital stay (> one week), abnormal ABG (acidosis, low PO₂, decreased HCO₃, low PCO₂). Factors that predispose the patients to poor outcomes and predict mortality are long hospital stay, decreased HCO3, delayed hospital arrival, low level of TAC. TAC can be used as a prognostic factor in toxic coma cases. Conclusion: TAC may be used as a prognostic marker in cases of toxic coma together with other predictive factors. Recommendations: Future studies on large-scale populations are needed to confirm the results of the present study.

Keywords: Toxic Coma; Mortality; Total antioxidant capacity; Predictive factors.