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

Yıl 2021, Cilt: 3 Sayı: 1, 5 - 15, 30.03.2021

Hacer Efnan Melek Arsoy Fatih Güneysu

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

Öz

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. 

Anahtar Kelimeler

zehirlenme, çocuk acil, İnflamatuar, NLR

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

Öz

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.

Anahtar Kelimeler

poisoning, pediatric emergency, Inflammatory, NLR

Kaynakça

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