Acil Serviste Akut Abdomen Bulgularını Taklit Eden Farklı Bir Neden: Kodein ve Kafein Kombinasyonlarının Oral Alımı

Abstract

Kodein ağrı tedavisinde az etkinliği olan bir metilmorfindir. Kafein (1, 3, 7-trimetilksantin) ise birçok yiyecek ve içecekte bulunan bitkisel bir alkaloidtir. Kodeinin yan etkileri, bulantı, kramp tarzı ağrı ve konstipasyondur. Kafein toksik etkileri ise kusma, abdominal ağrı, kardiyovasküler etkiler ve santral sinir sistemi (SSS) semptomlarını içerir. Yirmi dört yaşında erkek hasta ani başlayan karın ağrısı şikayeti ile Acil Servis’e başvurdu. Hastanın intihar amaçlı 275 mg kafein, 120 mg kodein, 4350 mg parasetamol, 14 mg klorfeniramin maleat ve 450 mg propifenazon içeren kodein ve kafein kombinasyonu aldığı öğrenildi. Fizik muayenesinde abdominal hassasiyet ve rebound vardı. Abdominal ağrı kodein ve kafein kombinasyonlarının yan etkisi olarak yorumlandı. İki-üç saat süren ve ağrısız periodların takip ettiği abdominal ağrı atakları tekrarladı. Seri olarak çalışılan lökosit sayımları normal değerlerde seyretti. Hastanın gözlemlemek amacıyla genel cerrahi kliniğine yatışı yapıldı. Kodein, kafein kombinasyonlarının her ikisi de yan etki olarak abdominal ağrıya neden olur ve abdominal bulgular akut batın ile karışabilir. Bu nedenle tanı ve tedavide öykü ve tekrarlayan abdominal muayenenin önemli bir rolü vardır.

Keywords

• Kodein, kafein, abdominal ağrı, intihar girişimi

A Different Cause of Mimicking Acute Abdominal Findings in the Emergency Department: Ingestion of Codeine and Caffeine Combinations

Abstract

Codeine is a methylmorphine which has a minor role in the ambulatory treatment of pain. Caffeine (1, 3, 7-trimethylxanthine) is a plant alkaloid found in a wide variety of foods and beverages. Nausea, cramping, and constipation are side effects of codeine. Toxic effects of caffeine include vomiting, abdominal pain, cardiovascular effects and central nervous system (CNS) symptoms. A 24 year old male patient was admitted to our Emergency Department with a sudden beginning abdominal pain. It was learned that codeine and caffeine combination tablets containing 275 mg caffeine, 120 mg codeine, 4350 mg paracetamol, 14 mg chlorpheniramine maleate and 450 mg propyphenazone were ingested as a suicide attempt. The physical exam revealed diffuse abdominal tenderness and rebound. Abdominal pain was interpreted as an adverse affect of ingestion of codeine and caffeine combinations. Abdominal pain attacks continuing 2 to 3 hours, followed by painless periods, were recurred. Consecutive leukocyte counts remained in normal ranges. The patient was hospitalized for observation at general surgery ward. Codeine, caffeine combinations both cause abdominal pain as an adverse effect and abdominal findings can be confused with acute abdomen. Therefore the story and the serial abdominal examinations have significant role in diagnosis and management

Keywords

• Codeine, caffeine, abdominal pain, suicide attempt

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