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Acil Servise Demir Zehirlenmesi İle Başvuran Çocuk Vakalarının Değerlendirilmesi

Year 2022, Volume 10, Issue 3, 108 - 112, 31.12.2022
https://doi.org/10.21765/pprjournal.1123775

Abstract

Amaç: Bu çalışma ile oral demir alımı sonrası intoksikasyon nedeniyle başvuran hastaların; demografik, epidemiyolojik, klinik özellikleri, tedavileri ve komplikasyonlarının geriye dönük olarak değerlendirilmesi neticesinde ülkemiz çocukluk çağı demir zehirlenmeleri verilerine katkı sağlamak amaçlandı. Gereç ve Yöntem: 2018-2020 yılları arasında demir intoksikasyonu tanısı ile bir Tıp Fakültesi Çocuk Acil Polikliniği’ne başvurmuş hastalar retrospektif olarak tarandı. Hastaların demografik özellikleri, intoksikasyona ait bilgiler ve labaratuvar tetkik sonuçları kayıt altına alınarak istatistiksel analizleri gerçekleştirildi. Bulgular: Çalışmaya dahil edilen 12 hastanın %66.7’si kadın %33.3’ü erkekti. Ortalama yaş 81,3± 83.52 aydı. Yaş gruplarına göre ayrıldıklarında olguların %66.6’sı 5 yaşından küçük çocuklar olarak gözlendi. Hastaneye bir ambulans yardımı ile gelenler sadece %25’ini oluşturmaktaydı. Ortalama 40±15 dk içerisinde tüm hastaların hastaneye nakli gerçekleştirilmiştir. 7 hastanın hayati bir riski bulunmazken, 5 hastanın durumu ciddi idi. Hastalardan sadece 2 tanesi suisid amaçlı zehirlenmişti. Tüm vakalar demiri oral yoldan almıştır. 1 hastada karın ağrısı, 2 hasta da bulantı, kusma oluşmuştur. Hastalardan 4’üne tedavide aktif kömür uygulandı. Hastaların laboratuvar takiplerinde demir dışındaki diğer tüm değerlerin ortalama sonuçları normal bulundu. Ayrıca hastaların başvuru esnasındaki kan gazları kompanse metabolik sendrom şeklindedir. Sonuç: Pediatrik acil olarak; çocuklarda demir intoksikasyonu, önlenebilir morbidite ve mortalitenin nedenlerinden birisi olarak halen önemini korumaktadır. Demir preparatlarının tek doz şeklinde paketlenmesinin yanı sıra cocukların cezbedici tat ve görünümünde olmaması, koruyucu kapakların ilaç kutularında mutlaka kullanılması, hekimlerin demir ilaçlarını reçete ettiği yetişkin hastalarını çocuklardaki toksisite açısından uyararak gerekli bilgileri vermesi mortalite ve morbiditeyi azaltacağı kanaatindeyiz.

References

  • 1. Nistor N, Frasinariu OE, Rugina A, Ciomaga IM, Jitareanu C, et al. Epidemiological study on accidental poisonings in children from northeast Romania. Medicine. 2018;97:29(e11469).
  • 2. Watson WA, Litovitz TL, Rodgers GC Jr, Klein-Schwartz W, Reid N, Youniss J, et al. 2004 Annual report of the American association of poison control centers toxic exposure surveillance system. Am J Emerg Med 2005;23:589-666.
  • 3. Proudfoot AT, Simpson D, Dyson EH. Management of Acute Iron Poisoning. Med Toxicol 1986;1:83-100.
  • 4. Tenenbein M. Hepatotoxicity in Acute Iron Poisoning. J Toxicol Clin Toxicol 2001;39:721–726.
  • 5. Smolinske SC, Kaufman MM. Consumer perception of household hazardous materials. Clin Toxicol 2007;45:522-5.
  • 6. Baranwal AK, Singhi SC. Acute Iron Poisoning: Management Guidelines. Indian Pediatr 2003;40:534-40.
  • 7. American Academy of Clinical Toxicology, European Association of Poison Centres and Clinical Toxicologists: Position Paper: Whole Bowel Irrigation. J Toxicol Clin Toxicol 2004;42:843-54. http://dx.doi.org/10.1081/CLT-200035932 PMid:15533024.
  • 8. Audimoplam VK, Wendon J, Bernal W, Heaton N, O'Grady J, Auzinger G. Iron and Acetaminophen a Fatal Combination? Transpl Int 2011;24:85-8.
  • 9. Bronstein AC, Spyker DA, Louis R, et al. 2007 Annual Report of The American Association of Poison Control Centers National Poison Data System (NPDS): 25th Annual Report. Clinical Toxicology 2008; 46: 927-1057.
  • 10. Petridou E, Kouri N, Polychronopoulou A, et al. Risk factors for childhood poisoning: a case control study in Greece. Injury Prevention 1996; 2: 208-11.
  • 11. Sümer V, Güler E, Karanfil R, Dalkıran T, et al. Gürsoy H. Evaluation of the poisoning cases who applied to the pediatrics emergency unit. Turk Arch Ped 2011; 46: 234-240.
  • 12. Ödek Ç, Erol M, Demir R, Tunç M et al. Retrospective Analysis of Demographic, Epidemiologic, and Clinical Characteristics of Poisoning Cases Followed in Pediatric Intensive Care Unit. J Pediatr Emerg Intensive Care Med 2019;6(2).
  • 13. Akgül F, Er A, Çelik FÇ, Çağlar A, Ulusoy E, ve ark. Çocukluk çağı zehirlenmelerinin geriye dönük olarak incelenmesi. J Pediatr Emerg Intensive Care Med. 2016;3:91-6.
  • 14. Azab SMS, Hirshon JM, Hayes BD, El-Setouhy M, Smith GS, et al. Epidemiology of acute poisoning in children presenting to the poisoning treatment center at Ain Shams University in Cairo, Egypt, 2009-2013. Clin Toxicol. 2016;54:20-6.
  • 15. Akın Y, Ağzıkuru T, Cömert S, Atılkan P, Erdağ GÇ, ve ark. Hospitalizations for pediatric intoxication: a study from İstanbul. Turk J Pediatr. 2011;53:369-74.
  • 16. Mills KC, Curry SC. Acute iron poisoning. Emerg Med Clın North Am 1994;12:397-413. PMid:8187690.
  • 17. Curry SC, Braitberg G. Poisoning in pregnancy. In: Foley MR, Strong T, eds. Obstetric Intensive Care. Philadelphia, WB Saunders; 1997, 347-67.

Evaluation of Children Presenting to the Emergency Department with Iron Intoxication

Year 2022, Volume 10, Issue 3, 108 - 112, 31.12.2022
https://doi.org/10.21765/pprjournal.1123775

Abstract

Purpose: In this study, it was aimed to contribute to the data on childhood iron intoxication in our country due to the retrospective evaluation of demographic, epidemiological, clinical features, treatments, and complications of the patients who applied for intoxication after oral iron intake. Materials and Methods: Patients admitted to a Pediatric Emergency Service of the Faculty of Medicine diagnosed with iron intoxication between 2018 and 2020 were retrospectively investigated. The patients' demographic characteristics, information about intoxication, and laboratory results were recorded, and statistical analyzes were performed. Results: Of the 12 patients included in the study, 66.7% were female, and 33.3% were male. The mean age was 81.3±83.52 months. When separated by age group, 66.6% of the patients were younger than 5-year-old. Those who came to the hospital via an ambulance were only 25%. All patients were transported to the hospital within an average of 40±15 minutes. While there was no life-threatening risk in 7 patients, the condition of 5 patients was severe. Only 2 of the patients took it to suicide. All cases received iron orally. 1 patient presented abdominal pain, and 2 patients presented nausea and vomiting. Activated charcoal was administered to 4 of the patients. In the laboratory follow-ups of the patients, all mean results, excluding iron, were normal. In addition, the blood gases of the patients at the time of admission were compensated metabolic syndrome. Conclusion: As a pediatric emergency, Iron intoxication in children remains important as one of the preventable morbidity and mortality causes. We believe that iron preparations are packaged in a single-dose form and do not have an attractive taste and appearance for children, have protective caps in medicine boxes, and when physicians prescribe iron drugs to adult patients, warning them about toxicity in children will reduce mortality and morbidity.

References

  • 1. Nistor N, Frasinariu OE, Rugina A, Ciomaga IM, Jitareanu C, et al. Epidemiological study on accidental poisonings in children from northeast Romania. Medicine. 2018;97:29(e11469).
  • 2. Watson WA, Litovitz TL, Rodgers GC Jr, Klein-Schwartz W, Reid N, Youniss J, et al. 2004 Annual report of the American association of poison control centers toxic exposure surveillance system. Am J Emerg Med 2005;23:589-666.
  • 3. Proudfoot AT, Simpson D, Dyson EH. Management of Acute Iron Poisoning. Med Toxicol 1986;1:83-100.
  • 4. Tenenbein M. Hepatotoxicity in Acute Iron Poisoning. J Toxicol Clin Toxicol 2001;39:721–726.
  • 5. Smolinske SC, Kaufman MM. Consumer perception of household hazardous materials. Clin Toxicol 2007;45:522-5.
  • 6. Baranwal AK, Singhi SC. Acute Iron Poisoning: Management Guidelines. Indian Pediatr 2003;40:534-40.
  • 7. American Academy of Clinical Toxicology, European Association of Poison Centres and Clinical Toxicologists: Position Paper: Whole Bowel Irrigation. J Toxicol Clin Toxicol 2004;42:843-54. http://dx.doi.org/10.1081/CLT-200035932 PMid:15533024.
  • 8. Audimoplam VK, Wendon J, Bernal W, Heaton N, O'Grady J, Auzinger G. Iron and Acetaminophen a Fatal Combination? Transpl Int 2011;24:85-8.
  • 9. Bronstein AC, Spyker DA, Louis R, et al. 2007 Annual Report of The American Association of Poison Control Centers National Poison Data System (NPDS): 25th Annual Report. Clinical Toxicology 2008; 46: 927-1057.
  • 10. Petridou E, Kouri N, Polychronopoulou A, et al. Risk factors for childhood poisoning: a case control study in Greece. Injury Prevention 1996; 2: 208-11.
  • 11. Sümer V, Güler E, Karanfil R, Dalkıran T, et al. Gürsoy H. Evaluation of the poisoning cases who applied to the pediatrics emergency unit. Turk Arch Ped 2011; 46: 234-240.
  • 12. Ödek Ç, Erol M, Demir R, Tunç M et al. Retrospective Analysis of Demographic, Epidemiologic, and Clinical Characteristics of Poisoning Cases Followed in Pediatric Intensive Care Unit. J Pediatr Emerg Intensive Care Med 2019;6(2).
  • 13. Akgül F, Er A, Çelik FÇ, Çağlar A, Ulusoy E, ve ark. Çocukluk çağı zehirlenmelerinin geriye dönük olarak incelenmesi. J Pediatr Emerg Intensive Care Med. 2016;3:91-6.
  • 14. Azab SMS, Hirshon JM, Hayes BD, El-Setouhy M, Smith GS, et al. Epidemiology of acute poisoning in children presenting to the poisoning treatment center at Ain Shams University in Cairo, Egypt, 2009-2013. Clin Toxicol. 2016;54:20-6.
  • 15. Akın Y, Ağzıkuru T, Cömert S, Atılkan P, Erdağ GÇ, ve ark. Hospitalizations for pediatric intoxication: a study from İstanbul. Turk J Pediatr. 2011;53:369-74.
  • 16. Mills KC, Curry SC. Acute iron poisoning. Emerg Med Clın North Am 1994;12:397-413. PMid:8187690.
  • 17. Curry SC, Braitberg G. Poisoning in pregnancy. In: Foley MR, Strong T, eds. Obstetric Intensive Care. Philadelphia, WB Saunders; 1997, 347-67.

Details

Primary Language English
Subjects Health Care Sciences and Services
Journal Section Original Articles
Authors

Bahar ÜRÜN UNAL> (Primary Author)
SELÇUK ÜNİVERSİTESİ, TIP FAKÜLTESİ, DAHİLİ TIP BİLİMLERİ BÖLÜMÜ, AİLE HEKİMLİĞİ ANABİLİM DALI
0000-0001-5433-168X
Türkiye


Duygu İlke YILDIRIM>
SELÇUK ÜNİVERSİTESİ, TIP FAKÜLTESİ, DAHİLİ TIP BİLİMLERİ BÖLÜMÜ, AİLE HEKİMLİĞİ ANABİLİM DALI
0000-0002-3893-5173
Türkiye


Sevil ŞEN>
SELÇUK ÜNİVERSİTESİ, TIP FAKÜLTESİ, DAHİLİ TIP BİLİMLERİ BÖLÜMÜ, ÇOCUK SAĞLIĞI VE HASTALIKLARI ANABİLİM DALI
0000-0002-7155-388X
Türkiye


Alaaddin YORULMAZ>
SELÇUK ÜNİVERSİTESİ, TIP FAKÜLTESİ, DAHİLİ TIP BİLİMLERİ BÖLÜMÜ, ÇOCUK SAĞLIĞI VE HASTALIKLARI ANABİLİM DALI
0000-0001-5478-1197
Türkiye

Early Pub Date September 4, 2022
Publication Date December 31, 2022
Acceptance Date July 22, 2022
Published in Issue Year 2022, Volume 10, Issue 3

Cite

Vancouver Ürün Unal B. , Yıldırım D. İ. , Şen S. , Yorulmaz A. Evaluation of Children Presenting to the Emergency Department with Iron Intoxication. Pediatric Practice and Research. 2022; 10(3): 108-112.