Karbon Monoksit Zehirlenmelerinde, Serum Laktat Düzeyleri ve Tedavinin Etkinliğinin Belirlenmesinde Laktat Klirenslerinin Kullanılması

Year 2017, Volume: 19 Issue: 2, 60 - 65, 31.08.2017

Emine Emektar , Hayri Ramadan , Yücel Yüzbaşıoğlu , Sevilay Vural Figen Coşkun

https://doi.org/10.24938/kutfd.293081

Cited By: 1

Abstract

Amaç: Bu çalışmanın konusu karbon monoksit (CO) zehirlenmelerinde,
başvuru anındaki laktat düzeylerinin ölçülmesi ve 6 saat sonra alınan laktat
düzeylerine göre laktat klirens hızına bakarak tedavide metabolik cevabı
değerlendirilmesindeki kullanılabilirliğini belirlemektir.

Gereç ve Yöntemler: Ankara Eğitim ve Araştırma Hastanesi Acil servise, Kasım 2010-
Şubat 2011 tarihleri arası CO zehirlenmesi nedeniyle başvuran 18 yaş üstü
hastalar dâhil edildi. Geliş laktatı (laktat 1) ve 6. saatteki laktat (laktat
2) sonuçlarından laktat klirensi hesaplandı. Laktat> 1.7 mmol/lt ve üzeri
pozitif kabul edildi.

Bulgular: Çalışmaya 100 hasta dâhil edilmiştir. Hastaların %62'si
kadın, %38'i erkektir. Hastaların %94’ünde hastaneye başvuru anlarındaki laktat
oranları yüksekti. Hastaların laktat düzeyleri ile CO seviyelerine
bakıldığında, laktat düzeyi yüksek olan grupta, normal olan gruba göre CO
düzeyi anlamlı olarak daha büyüktü. Standart oksijen tedavisi alan grupta
laktat klirensi %52 iken hiperbarik alan grupta %64 idi ve bu durum hiperbarik
oksijen tedavisi alan grupta laktatın ortadan kaldırılması daha hızlı olduğunu
göstermektedir.

Sonuç: Bizim çalışmamıza göre CO zehirlenmelerinde laktat
yükselmektedir ve düzeyleri karboksi hemoglobin (COHb) düzeyleri ile koreledir.
Tedavi etkinliğini değerlendirmede laktatklirens hızı kullanılabilir. Özellikle
belirgin laktat yüksekliği ve metabolikasidozu olan hastalar erken dönemde
hiperbarik oksijen tedavisine gönderilmelidir.

Keywords

Laktat, laktat klirensi, karbon monoksit zehirlenmesi

USE OF LACTATE CLEARANCE IN DETERMINING SERUM LACTATE LEVELS AND EFFECTIVENESS OF TREATMENT IN CARBON MONOXIDE POISONINGS

Abstract

Objective: This study aims to determine the feasibility of using
the rate of lactate clearance to evaluate the metabolic response to treatment
in patients with carbon monoxide (CO) poisoning after their lactate levels were
measured on initial presentation to the emergency department (ED).

Material and Methods: Patients older than 18, who presented with CO
poisoning to the ED of Ankara Training and Research Hospital
between November 2010 and February 2011 were enrolled in the study. Lactate
levels upon admission (Lactate-1) and after 6 hours of treatment (Lactate-2)
were compared to calculate the lactate clearance rate. Lactate levels of 1.7
mmol/l or greater were considered as positive.

Results: A total of 100 patients were enrolled in the study (62
females and 38 males). We found that 94% of patients had elevated lactate
levels on admission to the ED. When lactate levels and CO values were compared,
the CO values were found to be significantly higher in the elevated lactate
level group compared to non-elevated patients. The rate of lactate clearance
was 52% in the standard oxygen therapy group compared to 64% in the hyperbaric
oxygen therapy (HOT) group, which suggests a faster removal of lactate with
this treatment modality.

Conclusion: We conclude that lactate levels increase in patients
with CO poisoning, and that those levels are correlated with carboxyhemoglobin
(COHb) levels. The rate of lactate clearance can be used to evaluate the
effectiveness of therapy. Patients with metabolic acidosis and significantly
increased lactate should be referred for HOT in early phases of management.

Keywords

Lactate, lactate clearance, carbon monoxide poisoning

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