Çocuk Acil Servise Zehirlenme İle Başvuran Hastaların Sosyodemografik ve Laboratuvar Verilerinin İncelenmesi

Year 2021, Volume: 3 Issue: 1, 5 - 15, 30.03.2021

Hacer Efnan Melek Arsoy , Fatih Güneysu

https://doi.org/10.51262/ejtox.873819

Abstract

Amaç: Acil servise zehirlenme ile başvuran çocuk hastaların demografik özellikleri ve laboratuvar parametrelerini incelemek, bu hasta grubunu değerlendiren hekimlerin tedavi stratejilerini güncel tutup aydınlatmak, müdahalelerin hızlı ve etkin olmasını sağlamaktır.

Gereç ve Yöntem: Sakarya Eğitim Araştırma Hastanesi Çocuk Acil Servise 2018-2020 yıllarındaki 24 ay boyunca gerçekleşen kazara ve/veya intihar amaçlı zehirlenme nedeni ile başvuran 0-18 yaş arası olgular çalışmamıza dahil edilmiştir. Olguların yaşı, cinsiyeti, zehirlenme anında nerede olduğu, varsa aile tarafından yapılan ilk müdahale, zehirlenme sonrasında ne kadar süre içinde acil servise girişinin olduğu, zehirlenmeye neden olan madde, zehirlenme yolu, kazara/kasten maruziyet durumu, zehirlenme sonrasında antidot ya da aktif kömür kullanım durumu, yatış ya da yoğun bakım gerekliliği, hastanede kalış süresi, mortalite morbidite varlığı ile bazı laboratuvar verileri kaydedilmiştir. İnflamatuvar parametrelerin değişkenler ile ilişkisi de araştırılmıştır.

Bulgular: 74 kız (%23,0) ve 5 erkek (%1,7) çocuğunun intihar ettiği, 235 kız (%74,6), 266 erkeğin (%90,6) kazara zehirlendiği tespit edildi. Zehirlenme amacı ile yatış gün sınıfları arasında istatistiksel olarak anlamlı bir ilişki tespit edildi (χ2=13,776; p=0,008). AST, ALT, WBC, lenfosit, platelet, CRP, INR değerleri arasında zayıf anlamlı ilişki tespit edilmiş olup, fare zehiri ile zehirlenmede AST ve INR değerlerinin daha yüksek olduğu ancak istatistiksel düzeyde anlamlı olmadığı (p>0,05), temizlik malzemeleri ile zehirlenmede WBC değerinin anlamlı düzeyde yüksek (p<0,05), kostik koroziv madde zehirlenmelerinde de anlamlı derecede düşük olduğu tespit edildi (p<0,05). Nötrofil/lenfosit oranı ise yaşla birlikte artış göstermektedir (p<0,05) ve hastaneye geç gelen hastalarda da belirgin olarak artmaktadır (p<0,05).

Sonuç: Çocuk zehirlenme vakalarında acil servisteki ilk müdahale kadar önemli olan diğer faktörler, çocuk cerrahisi ve çocuk psikiyatrisi gibi branşlardan konsültasyon istenmesidir. Acile gelen hastalardan yapılan kan tetkikleri zehirlenmenin durumu ve prognoz hakkında bilgi verebilir. Karbon monoksit zehirlenmelerinde troponin I düzeyi tedavi planı açısından destekleyici olabilmektedir. Özellikle inflamatuar parametreler ve nötrofil/lenfosit oranı mutlaka değerlendirilmesi gereken parametreler içindedir. 

Keywords

zehirlenme, çocuk acil, İnflamatuar, NLR

Examination of Demographic and Laboratory Data of Patients Admitted to the Pediatric Emergency Department with Poisoning

Abstract

Objective: To keep up-to-date and enlighten the demographic characteristics of children admitted to the emergency department with poisoning and the treatment strategies of physicians, to examine laboratory parameters, and to ensure rapid and effective interventions.

Materials and Methods: Patients aged 0-18 years who were admitted to the Sakarya Training and Research Hospital Pediatric Emergency Service for 24 months in 2018-2020 for accidental or suicidal poisoning were included in our study. Age, gender, location of the cases at the time of poisoning, first intervention by the family, if any, how long after the poisoning, the substance causing the poisoning, the route of poisoning, the accidental / deliberate exposure, the use of antidote or active charcoal condition, need for hospitalization or intensive care, duration of hospital stay, presence of mortality and morbidity, and some laboratory data were recorded. The relationship between inflammatory parameters and variables was also investigated.

Results: It was determined that 74 girls (23.0%) and 5 boys (1.7%) committed suicide, 235 girls (74.6%) and 266 boys (90.6%) were accidentally poisoned. A statistically significant relationship was found between the purpose of poisoning and hospitalization day classes (χ2 = 13.776; p = 0.008). A weakly significant correlation was found between AST, ALT, WBC, lymphocyte, platelet, CRP, INR values, the AST and INR values were higher in mouse poisoning but not statistically significant (p> 0.05), WBC value in poisoning with cleaning materials It was found that it was significantly high (p <0.05), and it was significant in caustic corrosive substance intoxications (p <0.05). The CRP value is not significantly different (p> 0.05). Neutrophil / lymphocyte ratio (NLR) increases with age (p <0.05) and increases significantly in patients who come to the hospital late (p <0.05).

Conclusion: As first intervention is very important in patients who come to the emergency, it is very important to seek consultation from other branches such as pediatric surgery and child psychiatry. Blood tests performed from patients who come to the emergency room can give information about the status of poisoning and prognosis. Troponin I level can be supportive in terms of treatment plan in carbon monoxide poisoning. In particular, inflammatory parameters and neutrophil / lymphocyte ratio are among the parameters that must be evaluated.

Keywords

poisoning, pediatric emergency, Inflammatory, NLR

References

• 1. Mintegi S, Azkunaga B, Prego J, Qureshi N, Dalziel SR, Arana-Arri E, vd. International Epidemiological Differences in Acute Poisonings in Pediatric Emergency Departments. Pediatr Emerg Care. Ocak 2019;35(1):50-7.
• 2. Rodgers G. C., Jr., Condurache T., Reed M. D., Bestic M., Gal P. Poisonings. In: Kliegman R. M., Behrman R. E., Jenson H. B., Stanton B. F. Nelson’s Textbook of Pediatrics. New York, NY, USA: Saunders: Elsevier; 2007. pp. 689–732. İçinde: Nelson’s Textbook of Pediatrics. (18).
• 3. Mutlu M, Cansu A, Karakas T, Kalyoncu M, Erduran E. Doğu Karadeniz bölgesinde 2002-2006 yılları arasında pediatrik zehirlenme paterni: artan intihar zehirlenmesi. Hum Exp Toxicol. 01 Şubat 2010;29(2):131-6.
• 4. Characteristics of Emergency Department Presentations of Pediatric Poisoning Between 2011 and 2016: A Retrospective Observational Study in South Korea. - Abstract - Europe PMC [İnternet]. [a.yer 24 Ocak 2021]. Erişim adresi: https://europepmc.org/article/med/30557219
• 5. Song H, Kim HJ, Park KN, Kim SH, Oh SH, Youn CS. Neutrophil to lymphocyte ratio is associated with in-hospital mortality in older adults admitted to the emergency department. Am J Emerg Med [Internet]. 25 Ocak 2020 [a.yer 25 Ocak 2021]; Erişim adresi: http://www.sciencedirect.com/science/article/pii/S0735675720300449
• 6. Mintegi S, Fernández A, Alustiza J, Canduela V, Mongil I, Caubet I, vd. Emergency Visits for Childhood Poisoning: A 2-Year Prospective Multicenter Survey in Spain. Pediatr Emerg Care. Mayıs 2006;22(5):334-8.
• 7. Burillo-Putze G, Munne P, Dueñas A, Pinillos MA, Naveiro JM, Cobo J, vd. National multicentre study of acute intoxication in emergency departments of Spain. Eur J Emerg Med. Haziran 2003;10(2):101-4.
• 8. Lee J, Fan N-C, Yao T-C, Hsia S-H, Lee E-P, Huang J-L, vd. Clinical spectrum of acute poisoning in children admitted to the pediatric emergency department. Pediatr Neonatol. 01 Şubat 2019;60(1):59-67.
• 9. Lamireau T, Llanas B, Kennedy A, Fayon M, Penouil F, Favarell-Garrigues J-C, vd. Epidemiology of poisoning in children: A 7-year survey in a paediatric emergency care unit. Eur J Emerg Med. 2002;9(1):9-14.
• 10. Lin Y-R, Wu T-K, Liu T-A, Chou C-C, Wu H-P. Poison exposure and outcome of children admitted to a pediatric emergency department. World J Pediatr. 01 Mayıs 2011;7(2):143-9.
• 11. Kline JN, Badolato GM, Goyal MK. Trends in Pediatric Poisoning-Related Emergency Department Visits: 2001–2011. Pediatr Emerg Care. Ocak 2021;37(1):e7.
• 12. Tay EY, Tan GF, Yeo AWC, Tham EH. Intentional Poisoning in Pediatric Patients: Examining the Risk Factors. Pediatr Emerg Care [Internet]. 16 Nisan 2020 [a.yer 24 Ocak 2021];Publish Ahead of Print. Erişim adresi: https://journals.lww.com/10.1097/PEC.0000000000002101
• 13. Gonzalez-Urdiales P, Kuppermann N, Dalziel SR, Prego J, Benito J, Mintegi S. Pediatric Intentional Self-poisoning Evaluated in the Emergency Department: An International Study. Pediatr Emerg Care [Internet]. 19 Ocak 2021 [a.yer 24 Ocak 2021];Publish Ahead of Print. Erişim adresi: https://journals.lww.com/pec-online/Abstract/9000/Pediatric_Intentional_Self_poisoning_Evaluated_in.97875.aspx
• 14. Kara H, Bayir A, Degirmenci S, Kayis SA, Akinci M, Ak A, vd. Causes of poisoning in patients evaluated in a hospital emergency department in Konya, Turkey. J Pak Med Assoc. 2014;64(9):7.
• 15. Demorest R, Posner J, Osterhoudt K, et al. Poisoning prevention education during emergency department visits for childhood poisoning. Pediatr Emerg Care. 2004;20:281-284.
• 16. Agarwal G, Bithu KS, Agarwal R. An epidemiological study of acute poisoning in children in a tertiary care hospital of western Rajasthan, India. Int J Contemp Pediatr. 22 Aralık 2016;3(4):1249-51.
• 17. Coronavirus disease (COVID-19) – World Health Organization [Internet]. [a.yer 01 Şubat 2021]. Erişim adresi: https://www.who.int/emergencies/diseases/novel-coronavirus-2019
• 18. Lin Y-R, Liu T-H, Liu T-A, Chang Y-J, Chou C-C, Wu H-P. Pharmaceutical Poisoning Exposure and Outcome Analysis in Children Admitted to the Pediatric Emergency Department. Pediatr Neonatol. 01 Şubat 2011;52(1):11-7.
• 19. Lacroix J, Gaudreault P, Gauthier M. Admission to a pediatric intensive care unit for poisoning: a review of 105 cases. Crit Care Med. Ağustos 1989;17(8):748-50.
• 20. Tenenbein M. Recent advancements in pediatric toxicology. Pediatr Clin North Am. Aralık 1999;46(6):1179-88, vii.
• 21. Mintegi S, Dalziel SR, Azkunaga B, Prego J, Arana-Arri E, Acedo Y, vd. International Variability in Gastrointestinal Decontamination With Acute Poisonings. Pediatrics. Ağustos 2017;140(2):e20170006.
• 22. Krenzelok E.P, McGuigan M., Lheur P. Position statement: ipecac syrup, American Academy of Clinical Toxicology; European Association of Poisons Centres and Clinical Toxicologists. J Toxicol Clin Toxicol. 1997; 35: 699-709
• 23. Niedzielski A, Schwartz SG, Partycka-Pietrzyk K, Mielnik-Niedzielska G. Çocuklarda Kostik Ajanlar Yutulması: 51 Yıllık Retrospektif Kohort Çalışması. Ear Nose Throat J. 01 Ocak 2020;99(1):52-7.
• 24. Mu H-W, Chen C-H, Yang K-W, Pan C-S, Lin C-L, Hung D-Z. The prevalence of esophageal cancer after caustic and pesticide ingestion: A nationwide cohort study. PLOS ONE. 29 Aralık 2020;15(12):e0243922.
• 25. Rafeey M, Ghojazadeh M, Sheikhi S, Vahedi L. Caustic Ingestion in Children: a Systematic Review and Meta-Analysis. J Caring Sci. 01 Eylül 2016;5(3):251-65.
• 26. Tagwireyi D, Ball DE, Nhachi CFB. Toxicoepidemiology in Zimbabwe: Pesticide Poisoning Admissions to Major Hospitals. Clin Toxicol. 01 Ocak 2006;44(1):59-66.
• 27. Lin-Jye Lin Mee-Sun Tsai, Tzeng-Jih Lin. The Patients Presented in Emergency Department with Poisoning Exposure, 1995-2002. J Emerg Med Taiwan. 2003;5(4):181-9.
• 28. Burillo-Putze G, Mintegui S, Munne P. Changes in pediatric toxic dose of acetaminophen. Am J Emerg Med. 01 Temmuz 2004;22(4):323.
• 29. van Hoving DJ, Veale DJH, Müller GF. Clinical Review: Emergency management of acute poisoning. Afr J Emerg Med. 01 Haziran 2011;1(2):69-78.
• 30. Wu AHB, McKay C, Broussard LA, Hoffman RS, Kwong TC, Moyer TP, vd. National Academy of Clinical Biochemistry Laboratory Medicine Practice Guidelines: Recommendations for the Use of Laboratory Tests to Support Poisoned Patients Who Present to the Emergency Department. Clin Chem. 01 Mart 2003;49(3):357-79.
• 31. Ghonem M, El Sharaby RM. Leucocytes’ Parameters for Prediction of the Complications of Acute Corrosive Toxicity. Mansoura J Forensic Med Clin Toxicol. 01 Ocak 2018;26(1):77-86.
• 32. Lee JH, Lee YH, Park YH, Kim YH, Hong CK, Cho KW, vd. The difference in C-reactive protein value between initial and 24 hours follow-up (D-CRP) data as a predictor of mortality in organophosphate poisoned patients. Clin Toxicol. 01 Ocak 2013;51(1):29-34.
• 33. Nacaroglu HT, İsgüder R, Bent S, Erdem Bahceci S, Ceylan G, Korkmaz HA, vd. Can neutrophil/lymphocyte ratio be a novel biomarker of inflammation in children with asthma? Eur J Inflamm. 01 Ağustos 2016;14(2):109-12.
• 34. Nayak A, McDowell DT, Kellie SJ, Karpelowsky J. Elevated Preoperative Neutrophil–Lymphocyte Ratio is Predictive of a Poorer Prognosis for Pediatric Patients with Solid Tumors. Ann Surg Oncol. 01 Ekim 2017;24(11):3456-62.
• 35. Elawady EH, Tawfik HM. EVALUATION OF THE EARLY PROGNOSTIC VALUE OF NEUTROPHIL-LYMPHOCYTE RATIO (NLR) AND PLATELET-LYMPHOCYTE RATIO (PLR) IN SNAKEBITE POISONED PATIENTS. Egypt J Forensic Sci Appl Toxicol. 01 Aralık 2019;16(Supplement):1-16.
• 36. Dundar ZD, Ergin M, Koylu R, Ozer R, Cander B, Gunaydin YK. Neutrophil-Lymphocyte Ratio in Patients with Pesticide Poisoning. J Emerg Med. 01 Eylül 2014;47(3):286-93.
• 37. Bhat T, Teli S, Rijal J, Bhat H, Raza M, Khoueiry G, vd. Neutrophil to lymphocyte ratio and cardiovascular diseases: a review. Expert Rev Cardiovasc Ther. 01 Ocak 2013;11(1):55-9.
• 38. Yy H, Y W, Gq Z, Jl Y, L W, Wz W. [Relationship between neutrophil-to-lymphocyte ratio and myocardial injury induced by acute carbon monoxide poisoning]. Zhonghua Lao Dong Wei Sheng Zhi Ye Bing Za Zhi Zhonghua Laodong Weisheng Zhiyebing Zazhi Chin J Ind Hyg Occup Dis. 01 Mayıs 2018;36(5):362-4.
• 39. Yurtseven S, Arslan A, Eryigit U, Gunaydin M, Tatli O, Ozsahin F, vd. Analysis of patients presenting to the emergency department with carbon monoxide intoxication. Turk J Emerg Med. 01 Aralık 2015;15(4):159-62.