BackgroundThis study aims to evaluate the treatment modalities of adult patients presenting with mushroom poisoning treated in the intensive care unit (ICU) with special consideration of extracorporeal liver support systems.
Material and MethodsRecords of patients with mushroom poisoning treated in the ICU between January 2007 and December 2014 were analyzed retrospectively. Results Sixteen adult patients were treated in the ICU for mushroom poisoning during the designated study period. Average time from ingestion of mushrooms to first symptoms was 17.81 hours, and to ICU admission was 2.38 days. In cases with elevated liver transaminases, penicillin G, silibinin and N-acetyl cysteine were used. Extracorporeal support systems were used for detoxification and as a bridge to liver transplantation in 9 cases. Of these, 4 were plasmapheresis, 3 were selective plasma exchange, 1 was hemoperfusion and 1 was direct adsorption from plasma. Two cases underwent emergency liver transplantation. Conclusions Liver transplantation is the most definitive and effective treatment in indicated cases of mushroom poisoning. Extracorporeal support systems should be considered in the early period both as a treatment modality on their own or to save time until the definitive treatment is possible. The question of which extracorporeal detoxification technique to use is difficult to answer and controlled clinical trials which compare their efficacy are needed.
BackgroundThis study aims to evaluate the treatment modalities of adult patients presenting with mushroom poisoning treated in the intensive care unit (ICU) with special consideration of extracorporeal liver support systems.
Material and MethodsRecords of patients with mushroom poisoning treated in the ICU between January 2007 and December 2014 were analyzed retrospectively. Results Sixteen adult patients were treated in the ICU for mushroom poisoning during the designated study period. Average time from ingestion of mushrooms to first symptoms was 17.81 hours, and to ICU admission was 2.38 days. In cases with elevated liver transaminases, penicillin G, silibinin and N-acetyl cysteine were used. Extracorporeal support systems were used for detoxification and as a bridge to liver transplantation in 9 cases. Of these, 4 were plasmapheresis, 3 were selective plasma exchange, 1 was hemoperfusion and 1 was direct adsorption from plasma. Two cases underwent emergency liver transplantation. Conclusions Liver transplantation is the most definitive and effective treatment in indicated cases of mushroom poisoning. Extracorporeal support systems should be considered in the early period both as a treatment modality on their own or to save time until the definitive treatment is possible. The question of which extracorporeal detoxification technique to use is difficult to answer and controlled clinical trials which compare their efficacy are needed.
Bu olgu 20. Klinik Toksikoloji Kongresi'nde yazılı bildiri olarak sunulmuştur. ÖZ Trisiklik antidepresan intoksikasyonuna yaygın kullanımları nedeniyle çocuklarda ve erişkinlerde sıklıkla rastlanır. Amitriptilin majör trisiklik antidepresanlardandır. Kardiyovasküler, solunum ve santral sinir sistemini etkiler. Amitriptilin intoksikasyonununda gastrik lavaj, aktif kömür, bikarbonat infüzyonu, antiaritmik ve antikonvülzan ilaç kullanımı gibi çeşitli tedaviler uygulanmaktadır. Bu yazıda, uygulanan tedavilere yanıt vermeyen fakat hemoperfüzyon ile dramatik olarak klinik tablosu düzelen ciddi amitriptilin intoksikasyonu olan olguyu sunduk. Otuz üç yaşında kadın, suisid amacıyla 2,000 mg amitriptilini oral yoldan aldıktan yarım saat sonra acil servise başvurdu. Başvuru anında Glasgow koma skalası (GKS) 10, kan basıncı 100/60 mmHg, kalp tepe atımı dakikada 160 idi. Elektrokardiyogramında (EKG) geniş QRS ve ventriküler taşikardi olduğu görüldü. GKS'si yediye gerileyen olgu entübe edilerek başlangıç tedavileri sonrası yoğun bakıma kabul edildi. Yarım saat içinde hemoperfüzyon uygulanmaya başlandı. Hemoperfüzyon devam ederken EKG'sinin sinüs taşikardisine döndüğü görüldü. Kardiyovasküler ve nörolojik muayenesi ikinci günde normale dönen olgu yatışının dördüncü gününde yoğun bakımdan taburcu edildi. Yüksek oranda proteine bağlanması ve geniş dağılım hacmi nedeniyle amitriptilin doz aşımında klasik tedavide hemoperfüzyon rutin olarak önerilmemekle birlikte, son yıllarda hemoperfüzyonun etkinliğini gösteren güncel yayınlar da giderek artmaktadır. Oral alım sonrası trisiklik antidepresanlar hızla absorbe olur ve özellikle akciğer, kalp ve beyin gibi dokularda etkin konsantrasyona ulaşır. Bu nedenle, alımın erken evresinde uygulanan hemoperfüzyon etkin bir tedavidir ve klasik tedavilere cevap alınamayan durumlarda erken dönemde bu yöntemin kullanılabileceği göz önünde bulundurulmalıdır.
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