Acil Servise Kabul Edilen Parasetamol İntoksikasyon Olgularının Geriye Dönük İncelenmesi

Year 2016, Volume: 17 Issue: 1, 11 - 16, 01.04.2016

Kıvanç Karaman Mücahit Avcil Burçak Kantekin Yunus Emre Özlüer Hüseyin Emre Yaşar Sibelnur Avcil Mücahit Kapçı

Abstract

Amaç: Acil servisimize parasetamol intoksikasyonu nedeniyle başvuran olgularda demografik ve klinik değişkenlerin hastaların takibi ve laboratuvar bulguları üzerine olan etkisinin incelenmesi amaçlanmıştır.Gereç ve Yöntemler: Adnan Menderes Üniversitesi, Uygulama ve Araştırma Hastanesi acil servise 01.04.2013-01.04.2015 tarihleri arasında ilaç alımı şikayetiyle başvuran 164 hastanın geriye dönük kayıtları incelendi ve parasetamol alımı olan hastalar çalışmaya dahil edildi. Sonuç olarak toplam 44 hasta çalışmaya dahil edildi. Hastaların kan değerleri ve demografik verileri taranarak kaydedildi. Bu çalışma için Adnan Menderes Üniversitesi Tıp Fakültesi, Girişimsel Olmayan Klinik Araştırmalar Etik Kurulu’nun onayı alındı.Bulgular: Çalışmaya dahil edilen 44 hastanın 29’u (%65,9) acil servis gözlem ünitesinde, 15’i (%34,1) Acil yoğun bakım ünitesinde (AYBÜ) takip edildi. İki grup arasında yaş, cinsiyet ve ek ilaç kullanımı açısından anlamlı bir farklılık izlenmedi. Parasetamol dozu AYBÜ’de yatan hastalarda, acil gözlemde takip edilen hastalara göre anlamlı olarak daha yüksekti (15013±6942; 5351±3382 mg, p<0,001). Antidot uygulaması AYBÜ’de takip edilen hastaların 14’üne (%93,3) uygulanmışken acil gözlemde takip edilen hastaların ise 12’sine (%41,1) uygulanmıştır (p=0,003). Hastanede yatış süreleri yoğun bakımda yatan hastalarda anlamlı olarak daha yüksekti (2,93±0,25, 1,55±0,6 gün, p<0,001). Hastalar antidot tedavisi alıp almamasına göre incelendiğinde, antidot tedavisi alan grupta alınan ortalama parasetamol dozu (12344±6388, 3302±1291 mg, p<0,001) ve ortalama yatış süreleri (2,46±0,7, 1,39±0,6 gün, p<0,001) antidot uygulanmayan hastalara göre anlamlı olarak daha yüksekti. Antidot tedavisi uygulanan ve antidot tedavisi uygulanmayan hastalar Uluslararası normalleştirilmiş oran (İNR) açısından karşılaştırıldığında antidot alan grupta almayan gruba göre anlamlı olarak daha yüksekti (1,14±0,14; 1,05±0,13; p=0,042).Sonuç: Acil servise başvuran parasetamol intoksikasyonu olan hastaların triajında kan parametrelerinin bir önemi yoktur. Acil uzmanının triajdaki rolü büyük önem arz etmektedir. Antidot olarak intravenöz N-asetil sistein tedavisinin İNR değerlerini düşürücü etkisi bulunmaktadır

Keywords

Parasetamol intoksikasyonu, N-asetil sistein, Uluslararası normalleştirilmiş oran

Evaluation of Patients with Paracetamol Intoxication Who Admitted to Emergency Service

Abstract

Objective: To evaluate the effects of demographic and clinical features on follow-up period and laboratory parameters in patients with paracetamol intoxication who were admitted to our emergency department. Materials and Methods: One hundred sixty-four patients, who were admitted to the emergency department at Adnan Menderes University Faculty of Medicine between April 2013 and April 2015, were retrospectively evaluated and a total of 44 patients who have ingested paracetamol were enrolled in the study. The demographic and laboratory data of the patients were recorded. The study protocol was approved by the Ethics Committee and Institutional Review Board of Adnan Menderes University Faculty of Medicine. Results: Of the 44 patients, 29 were followed up in the observation unit at the emergency department (OUED), while 15 were followed up in the critical care unit at the emergency department (CCUED). There was no difference in age, sex and additional drug usage between the groups. Paracetamol dose was significantly higher in CCUED group than in OUED group (15013±6942 vs. 5351±3382 mg, p<0.001). Antidote administration was performed in 14 patients in CCUED (93.3%) and 12 patients in OUED groups (41.1%) (p=0.003). When we compared the patients who received antidote treatment with those who did not, it was observed that the dose of paracetamol (12344±6388 vs. 3302±1291 mg, p<0.001) and the length of hospitalization (2.46±0.7 vs. 1.39±0.6 day, p<0.001) were significantly higher in antidote-administered patients. The international normalized ratio (INR) was also significantly higher in patients who received antidote treatment than in those who did not receive (1.14±0.14 vs. 1.05±0.13, p=0.042). Conclusion: The role of emergency physicians in triage is very important. Laboratory findings are not important in the management of paracetamol intoxication in patients admitted to the emergency department. Intravenous administration of N-acetylcysteine as antidote has a lowering effect on INR in patients with paracetamol poisoning.

Keywords

Paracetamol intoxication, N-acetylcysteine, International normalized ratio

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