Hiperaktif Deliryum ve Kısa Dönem Ketiapin Tedavisi: Bir Pediatrik Vaka

Öz

Çocuklarda deliryum yetişkinlerden farklı klinik tabloyla karşımıza çıkabilmekte ve ilaç/ madde toksikasyonu (benzodiazepinler, kannabis, kokain, dekstrometorfan), otoimmün hastalıklar nörolojik hastalıklar, enfeksiyonlar, ciddi travma, ilaç/madde etkisi, çoklu organ yetmezliği, kardiyak ve resprituvar hastalık, otoimmün hastalıklara bağlı görülebilmektedir. Çocuk ve ergenlik dönemindeki deliryum vakalarının gözden kaçırılma olasılığının yüksek olması ve ülkemizde yapılan çalışmalar incelendiğinde literatürde sınırlılıklar nedeniyle bu olgu takdiminin önemli olabileceği düşünülmüştür. 17 yaşındaki erkek hasta, operasyon sonrası aniden başlayan, uykuda azalma, sinirlilik, görsel halüsinasyonlar, ajitasyon şikayetleri sebebiyle tarafımıza konsülte edilmiştir. Şüphe sanrıları, görsel halüsinasyonları, irritabilitesi, hastaneden kaçmaya çalışma davranışlarının bir hafta önce geçirdiği ameliyatından beş gün sonra başladığı, ameliyat sonrası ağrı kontrolü ve sedasyon için midozolam ve morfin başlandığı, midozolam 265mg/G tedavisinin üç gün kullanılıp kesildiği öğrenildi. Hasta, başvuru sırasında çocuk yoğun bakım servisinde piperasilin/tazobaktam 16 mg/G, teikoplanin 800 mg/G, terlipressin 2 mg/G, morfin 7.5 mg/G, K1 vitamini 10mg/G ve intravenöz hidrasyon tedavisi alıyordu. Yapılan laboratuar tetkikleri, WBC: 13.4 bin/uL, lenfosit%: 11.6, Nötrofil%: 80.2, CRP:225, sodyum: 130 olarak sonuçlanmıştı. Hasta ile ilk görüşmede yapılan Deliryum Değerlendirme Ölçeği’nden 23 puan almıştı. Bir hafta sonra gerçekleşen kontrol değerlendirilmesinde semptomlarının azaldığı ve yapılan Deliryum Değerlendirme Ölçeği’nden 6 puan aldığı görülmüştür. Hasta çoğul etyolojiye bağlı hiperaktif deliryum olarak değerlendirilerek ketiapin 25mg/gün tedavisi başlanmış ve tedricen 50 mg/gün artırılabileceği önerilmiştir. Altta yatabilecek nedenlere yönelik tedavi düzenlenmesi ve deliryum açısından alınacak önlemler tedavi ekibine ve aileye anlatılmıştır. Pediyatrik deliryum tanısı için klinisyenlerin çocuk ve ergenlerdeki akut mental durum değişikliği ve etiyoloji açısından dikkatli olunması ve ketiapinin özellikle hiperaktif ve hiponatremik hastalar için uygun bir tedavi seçeneği olabileceği ve görece düşük doz (25mg-50mg) tedavinin etkili olabileceği söylenebilir.

Anahtar Kelimeler

• deliryum
• ketiapin
• pediatrik hastalar

Hyperactive Delirium and Short-Term Quetiapine Treatment: A Pediatric Case

Öz

Delirium in children may present with a different clinical picture than in adults and may be seen due to drug/substance toxicity (benzodiazepines, cannabis, cocaine, dextromethorphan), autoimmune diseases, neurological diseases, infections, serious trauma, drug/substance effects, multiple organ failure, cardiac and respiratory diseases, autoimmune diseases. Due to the high probability of missing delirium cases in children and adolescents and the limited literature when the studies conducted in our country are examined, it was thought that this case report may be important. A 17-year-old male patient was consulted to us due to complaints of sudden onset of sleep loss, irritability, visual hallucinations, and agitation after surgery. It was learned that his suspicious delusions, visual hallucinations, irritability, and behaviors of trying to escape from the hospital started five days after his surgery one week ago, midozolam and morphine were started for postoperative pain control and sedation, and midozolam 265mg/G treatment was used for three days and then stopped. At the time of admission, the patient was receiving piperacillin/tazobactam 16 mg/G, teicoplanin 800 mg/G, terlipressin 2 mg/G, morphine 7.5 mg/G, vitamin K1 10mg/G, and intravenous hydration treatment in the pediatric intensive care unit. Laboratory tests revealed WBC: 13.4 thousand/uL, lymphocyte%: 11.6, Neutrophil%: 80.2, CRP: 225, and sodium: 130. The patient scored 23 on the Delirium Assessment Scale administered during the first interview. In the follow-up evaluation one week later, it was observed that his symptoms had decreased and he received 6 points on the Delirium Assessment Scale.

Anahtar Kelimeler

• delirium
• qeutiapin
• pediatric patients

Kaynakça

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