Abstract
Baldıran otu (Conium maculatum) zehirli bir bitkidir. Yanlışlıkla alımı sonucu merkezi sinir sistemi depresyonu, solunum yetersizliği, akut rabdomiyoliz, akut böbrek yetersizliği ve hatta ölüm meydana gelebilir. Bu zehirlenmede tedavi destekleyicidir. Burada, baldıran otu alımı sonrası solunum arresti ile acil servise başvuran ve beş dakika süren kardiyopulmoner resüsitasyon sonrası entübe olarak çocuk yoğun bakım ünitemize transfer edilen 3 yaşında bir kız olgu sunulmaktadır. Hastaya, Ulusal Zehir Danışma tarafından tam barsak irrigasyonu önerilmesi üzerine Golytely kullanılarak gaita çıkışı takibi yapıldı. Rektal akıntı berrak bir hale gelene kadar her 15 dakikada bir 125 ml olarak nazogastrik sonda ile enteral uygulandı. Toksik metabolitleri uzaklaştırmak amacıyla terapötik plazma değişimi bir kez yapıldı. Karaciğer ve böbrek fonksiyon testleri yakın aralıklı izlendi. Aspirasyon pnömonisi de gelişen hasta altı gün entübe olarak izlendikten sonra ekstübe edildi. Onuncu günde sekelsiz olarak taburcu edildi. Bu olgu, çevredeki bazı bitkilerin günlük tüketilen sebzelere benzerlikleri nedeni ile yanlışlıkla alım sonucu ciddi zehirlenme bulgularına ve hatta ölüme neden olabileceklerini vurgulamak amacı ile sunuldu.
References
- 1. Cortinovis C, Caloni F. Alkaloid-containing plants poisonous to cattle and horses in Europe. Toxins. 2015;7:5301–7. 2) Leete EB. Becoming a hospice volunteer. Am J Hosp Palliat Care 1994;11:27-32. 3) Ferah AU, Dilek MO, Ercument Y, Oktay D. Hemlock poisoning (case report): die like socrates. Resuscitation 2006;70:337 4) Rizzi D, Basile C, Di Maggio A, Sebastio A, Introna F Jr, Rizzi R, et al. Clinical spectrum of accidental hemlock poisoning: neurotoxic manifestations, rhabdomyolysis and acute tubular necrosis. Nephrol Dial Transplant 1991;6:939-43. 5) Krenzelok EP, Jacobsen TD, Aronin JM. Hemlock ingestions: The most deadly plant exposures. J Toxicol Clin Toxicol 1996;34:601-2. 6) Karakasi MV, Tologkos S, Papadatou V, Raikos N, Lambropoulou M, Pavlidis P. Conium maculatum intoxication: Literature review and case report on hemlock poisoning. Forensic Sci Rev. 2019 Jan;31(1):23-36. 7) Froberg B, Ibrahim D, Furbee RB. Plant poisoning. Emerg Med Clin North Am 2007;25:375-433. 8) West PL, Horowitz BZ, Montanaro MT, Lindsay JN. Poison hemlock-induced respiratory failure in a toddler. Pediatr Emerg Care 2009;25:761-3. 9) Thanacoody R, Caravati EM, Troutman B, et al. Position paper update: whole bowel irrigation for gastrointestinal decontamination of overdose patients. Clin Toxicol (Phila) 2015;53:5
Abstract
Hemlock (Conium Maculatum) is a poisonous plant. Ingestion by mistake can cause central nervous system depression, respiratory failure, acute rhabdomyolysis, acute renal failure or even death. The treatment is supportive. In this case report, we present a three year-old girl who was brought to an emergency department with respiratory arrest, after ingestion of hemlock. Cardiopulmonary resuscitation was performed for 5 minutes and then she was transferred to our pediatric intensive care unit as in intubated state. Whole bowel irrigation was suggested by National Poison Counselling Center and 125 ml Golytely was used for bowel irrigation in every 15 minutes via nasogastric tube, until rectal drainage became clear. Therapeutic Plasma Exchange was performed once so as to remove toxic metabolites. Liver and renal function tests were closely monitored. The patient was intubated for 6 days because of aspiration pneumoniae and then extubated. She was discharged on day 10 with no sequelae. This case was reported to emphasize that some plants can be mistaken for commonly used vegetables because they look similar and can cause serious poisoning and can even cause death.
References
- 1. Cortinovis C, Caloni F. Alkaloid-containing plants poisonous to cattle and horses in Europe. Toxins. 2015;7:5301–7. 2) Leete EB. Becoming a hospice volunteer. Am J Hosp Palliat Care 1994;11:27-32. 3) Ferah AU, Dilek MO, Ercument Y, Oktay D. Hemlock poisoning (case report): die like socrates. Resuscitation 2006;70:337 4) Rizzi D, Basile C, Di Maggio A, Sebastio A, Introna F Jr, Rizzi R, et al. Clinical spectrum of accidental hemlock poisoning: neurotoxic manifestations, rhabdomyolysis and acute tubular necrosis. Nephrol Dial Transplant 1991;6:939-43. 5) Krenzelok EP, Jacobsen TD, Aronin JM. Hemlock ingestions: The most deadly plant exposures. J Toxicol Clin Toxicol 1996;34:601-2. 6) Karakasi MV, Tologkos S, Papadatou V, Raikos N, Lambropoulou M, Pavlidis P. Conium maculatum intoxication: Literature review and case report on hemlock poisoning. Forensic Sci Rev. 2019 Jan;31(1):23-36. 7) Froberg B, Ibrahim D, Furbee RB. Plant poisoning. Emerg Med Clin North Am 2007;25:375-433. 8) West PL, Horowitz BZ, Montanaro MT, Lindsay JN. Poison hemlock-induced respiratory failure in a toddler. Pediatr Emerg Care 2009;25:761-3. 9) Thanacoody R, Caravati EM, Troutman B, et al. Position paper update: whole bowel irrigation for gastrointestinal decontamination of overdose patients. Clin Toxicol (Phila) 2015;53:5
Details
| Primary Language | Turkish |
|---|---|
| Subjects | Internal Diseases |
| Journal Section | CASE REPORTS |
| Authors | |
| Publication Date | January 22, 2021 |
| Submission Date | June 4, 2020 |
| Published in Issue | Year 2021 Volume: 15 Issue: 1 |
The publication language of Turkish Journal of Pediatric Disease is English.
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