*Ankara Numune Training and Research Hospital Department of Emergency Medicine, Ankara/Turkey - **Dr. Abdurrahman Yurtaslan Oncology Training and Research Hospital, Department of Emergency Medicine, Ankara/Turkey - ***Sakarya University School of Medicine, Department of Obstetrics and Gynecology, Sakarya/Turkey


Introduction: Nowadays, referrals to emergency departments due to intoxication remain to be important in terms of mortality and morbidity. Among these intoxications, cases with cardiac involvement should be closely monitored. Brain Natriuretic Peptide (BNP) is considered as a sensitive marker of cardiac dysfunction at recent years measurement of BNP levels provides considerable information about cardiac functions in a short time. In the present study, it is aimed to evaluate the relationship between blood Brain Natriuretic Peptide (BNP) level and severity of intoxication in order to identify cardiac dysfunction caused by intoxication with cardiotoxic agents.

Material and methods: Patients who arrived to adult emergency departments of two public hospitals due to poisoning caused by tricyclic antidepressants (TCAs), beta blockers and calcium channel blockers (CCBs) were recruited to the study. Taken drugs time, vital signs, and electrocardiograms were recorded. Blood BNP was analyzed within 2 hours after arrival to emergency department in order to determine BNP level.

Results: 44 patients included in the study. When patients with BNP levels above or below the cut-off value were compared, it was found that hypotension rate was significantly higher and need for intensive care unit admission was significantly greater in patients with high BNP levels. When patients were considered regarding their ECG, no statistically significant relationship was found between BNP level and PR or QTc interval. However, a significant prolongation was detected in QRS interval in patients with high BNP levels, which is an indicator of ventricle contraction.

Discussion and conclusion: Cardiotoxic drugs intoxication, hypotension and widening in QRS on ECG were found in patients with high blood BNP levels. In addition, intensive care unit admission ratio was found higher in patients with BNP level was above cut-off value. Regarding all these data, measurement of blood BNP level could be used for evaluation of cardiovascular toxicity risk.


Poisoning, Brain Natriuretic Peptide (BNP), cardiotoxicity, tricyclic antidepressants, beta blockers, calcium channel blockers