Kardiyovasküler ilaç zehirlenmelerinin ileriye dönük analizi

Year 2022, Volume: 47 Issue: 2, 835 - 843, 30.06.2022

Mustafa Oguz Tugcan , Ahmet Sebe , Ayça Açıkalın , Rana Dişel , Yagmur Tugcan , Ömer Taşkın , Talha Karahan , Begüm Şeyda Avci , Hilmi Erdem Sümbül , Akkan Avci

https://doi.org/10.17826/cumj.1088964

Abstract

Amaç: Bu çalışmanın amacı, kardiyovasküler sisteme etkili ilaçlarla olan zehirlenme hastalarını inceleyerek literatüre tanı, tedavi ve sonuçlarla ilgili veri kazandırmaktır.
Gereç ve Yöntem: Çalışmaya hastanemiz acil servisine kardiyovasküler sisteme etkili ilaç zehirlenmesiyle başvuran 18 yaş ve üzeri hastalar alındı. Olguların demografik verileri, aldıkları ilaçlar ve dozları, acil tedavisi ve yatışı sırasında şok veya bradikardi gibi hayati bulguların gelişme zamanı, zehirlenmenin tedavisi, antidotlar ve yapılan invaziv girişimler kaydedildi.
Bulgular: Çalışmaya 8 (% 32,0)’i erkek, 17 (% 68,0)’si kadın olmak üzere 25 hasta dahil edildi. Olguların başvurusunda % 56,0 (n:14)’sında hipotansiyon, % 8,0 (n:2)’inde bradikardi saptanırken, 2. saat vitallerinde % 76,0 (n:19)’sınde hipotansiyon, % 16,0 (n:4)’sında bradikardi olduğu belirlendi. Başvurudan sonraki 6 saat içerisinde % 80 (n:20) hastada hipotansiyon, % 28 (n:7) hastada bradikardi en az bir kere görüldü. Hastaların; % 52,0 (n: 13)’sine kalsiyum, % 36,0 (n: 9)’sına glukagon, % 32,0 (n: 8)’sine lipit, % 12,0 (n: 3)’sine atropin, % 20,0 (n: 5)’sine pozitif inotrop kullanıldı.
Sonuç: Kalsiyum, glukagon ve sıvı tedavisi ile sonuç alınamayan hastalarda lipit tedavisinin olumlu sonuçlar yarattığı görülmüştür. Kalsiyum kanal blokeri alan hastalarda beta-bloker alan hastalara oranla daha çok kardiyojenik şok, beta-bloker alanlarda ise daha çok bradikardi görülmüştür.

Keywords

Kardiyovasküler ilaç zehirlenmeleri, Beta-bloker, Zehirlenme, Kalsiyum kanal blokeri, lipid emülsiyon tedavisi, acil

Prospective analysis of cardiovascular drug intoxication

Abstract

Purpose: The aim of this study is to provide data about diagnosis, treatment, and results of the patients poisoned by drugs affecting the cardiovascular system.
Materials and Methods: Patients aged 18 and over who applied to the emergency department with drug poisoning affecting cardiovasculer system were included in the study. The demographic data, drugs and doses, emergency treatment and the time of development of shock or bradycardia, treatment, antidotes and invasive procedures were recorded.
Results: In our study twenty-five patients, 8 (32 %) male and 17 (68 %) female, were included. At the admission, 56 % (n=14) had hypotension, 8 % (n=2) had bradycardia, at the second hour 76 % (n=19) had hypotension, 16 % (n=4) had bradycardia. Within 6 hours after admission, 80 % (n=20) patients had hypotension, 28 % (n=7) patients had bradycardia at least once. Fifty-two percent (n=13) of the patients calcium, 36 % (n=9) glukagon, 32 % (n=8) lipid, 12 % (n=3) atropine, 20 % (n=5) positive inotropes were given.
Conclusion: Lipid therapy produces positive results in patients who did not improve with calcium, glucagon and fluid therapy. Patients who received calcium channel blockers experienced more cardiogenic shock and bradycardia was more common in patients receiving beta-blockers.

Keywords

Cardiovascular drug poisoning, beta-blocker, poisoning, calcium channel blocker, lipid emulsion treatment, emergency

References

• Chirasirisap K, Ussanawarong S, et al. A study of major causes and types of poisoning in Khonkaen, Thailand. Vet Hum Toxicol. 1992 Dec;34(6):489-92. PMID: 1287966.
• Neuvonen PJ, Kivistö DK, Elonen E, Laine DK, Olkkola KO. Acute poisonings: epidemiology and gastrointestinal decontamination. 2001:11-4 (http://ethesis.helsinki.fi).
• Hanssens Y, Deleu D, Taqi A. Etiologic and demographic characteristics of poisoning: a prospective hospital-based study in Oman. J Toxicol Clin Toxicol. 2001;39(4):371-80. doi: 10.1081/clt-100105158. PMID: 11527232.
• Özcan N, İkincioğulları D. Ulusal Zehir Danışma Merkezi 2008 Yılı Çalışma Raporu Özeti. Turk Hij Den Biyol Derg. 2009;66(ER-3):29-58 (https://www.turkhijyen.org/jvi.aspx?pdir=turkhijyen&plng=tur&un=THDBD-65807).
• Howarth DM, Dawson AH, Smith AJ, Buckley N, Whyte IM. Calcium channel blocking drug overdose: an Australian series. Hum Exp Toxicol. 1994 Mar;13(3):161-6. doi: 10.1177/096032719401300304. PMID: 7909677.
• Wax PM, Erdman AR, Chyka PA, et al. Beta-blocker ingestion: an evidence-based consensus guideline for out-of-hospital management. Clin Toxicol (Phila). 2005;43(3):131-46. PMID: 15906457.
• DeWitt CR, Waksman JC. Pharmacology, pathophysiology and management of calcium channel blocker and beta-blocker toxicity. Toxicol Rev. 2004;23(4):223-38. doi: 10.2165/00139709-200423040-00003. PMID: 15898828.
• Love JN, Elshami J. Cardiovascular depression resulting from atenolol intoxication. Eur J Emerg Med. 2002 Jun;9(2):111-4. doi: 10.1097/00063110-200206000-00002. PMID: 12131631.
• Janion M, Stepień A, Sielski J, Gutkowski W. Is the intra-aortic balloon pump a method of brain protection during cardiogenic shock after drug intoxication? J Emerg Med. 2010 Feb;38(2):162-7. doi: 10.1016/j.jemermed.2007.10.037. Epub 2008 Apr 9. PMID: 18403163.
• Love JN, Enlow B, Howell JM, Klein-Schwartz W, Litovitz TL. Electrocardiographic changes associated with beta-blocker toxicity. Ann Emerg Med. 2002 Dec;40(6):603-10. doi: 10.1067/mem.2002.129829. PMID: 12447337.
• Lund C, Drottning P, Stiksrud B, et al. A one-year observational study of all hospitalized acute poisonings in Oslo: complications, treatment and sequelae. Scand J Trauma Resusc Emerg Med. 2012;20:49. Published 2012 Jul 24. doi:10.1186/1757-7241-20-49
• Benson BE, Hoppu K, Troutman WG, et al. American Academy of Clinical Toxicology; European Association of Poisons Centres and Clinical Toxicologists. Position paper update: gastric lavage for gastrointestinal decontamination. Clin Toxicol (Phila). 2013 Mar;51(3):140-6. doi: 10.3109/15563650.2013.770154. Epub 2013 Feb 18. PMID: 23418938.
• Kaya E, Yilmaz A, Saritas A, et al. Acute intoxication cases admitted to the emergency department of a university hospital. World J Emerg Med. 2015;6(1):54-59. doi:10.5847/wjem.j.1920-8642.2015.01.010
• Edhag O, Swahn A. Prognosis of patients with complete heart block or arrhythmic syncope who were not treated with artificial pacemakers. A long-term follow-up study of 101 patients. Acta Med Scand. 1976;200(6):457-63. PMID: 1015354.
• Gammage MD. Temporary cardiac pacing. Heart. 2000;83(6):715-720. doi:10.1136/heart.83.6.715