Karbon Monoksit Zehirlenmelerinde, Serum Laktat Düzeyleri ve Tedavinin Etkinliğinin Belirlenmesinde Laktat Klirenslerinin Kullanılması

Öz

Amaç: Bu çalışmanın konusu karbon monoksit (CO) zehirlenmelerinde, başvuru anındaki laktat düzeylerinin ölçülmesi ve 6 saat sonra alınan laktat düzeylerine göre laktat klirens hızına bakarak tedavide metabolik cevabı değerlendirilmesindeki kullanılabilirliğini belirlemektir.

Gereç ve Yöntemler: Ankara Eğitim ve Araştırma Hastanesi Acil servise, Kasım 2010- Şubat 2011 tarihleri arası CO zehirlenmesi nedeniyle başvuran 18 yaş üstü hastalar dâhil edildi. Geliş laktatı (laktat 1) ve 6. saatteki laktat (laktat 2) sonuçlarından laktat klirensi hesaplandı. Laktat> 1.7 mmol/lt ve üzeri pozitif kabul edildi.

Bulgular: Çalışmaya 100 hasta dâhil edilmiştir. Hastaların %62'si kadın, %38'i erkektir. Hastaların %94’ünde hastaneye başvuru anlarındaki laktat oranları yüksekti. Hastaların laktat düzeyleri ile CO seviyelerine bakıldığında, laktat düzeyi yüksek olan grupta, normal olan gruba göre CO düzeyi anlamlı olarak daha büyüktü. Standart oksijen tedavisi alan grupta laktat klirensi %52 iken hiperbarik alan grupta %64 idi ve bu durum hiperbarik oksijen tedavisi alan grupta laktatın ortadan kaldırılması daha hızlı olduğunu göstermektedir.

Sonuç: Bizim çalışmamıza göre CO zehirlenmelerinde laktat yükselmektedir ve düzeyleri karboksi hemoglobin (COHb) düzeyleri ile koreledir. Tedavi etkinliğini değerlendirmede laktatklirens hızı kullanılabilir. Özellikle belirgin laktat yüksekliği ve metabolikasidozu olan hastalar erken dönemde hiperbarik oksijen tedavisine gönderilmelidir.

Anahtar Kelimeler

• Laktat,laktat klirensi,karbon monoksit zehirlenmesi

USE OF LACTATE CLEARANCE IN DETERMINING SERUM LACTATE LEVELS AND EFFECTIVENESS OF TREATMENT IN CARBON MONOXIDE POISONINGS

Öz

Objective: This study aims to determine the feasibility of using the rate of lactate clearance to evaluate the metabolic response to treatment in patients with carbon monoxide (CO) poisoning after their lactate levels were measured on initial presentation to the emergency department (ED).

Material and Methods: Patients older than 18, who presented with CO poisoning to the ED of Ankara Training and Research Hospital between November 2010 and February 2011 were enrolled in the study. Lactate levels upon admission (Lactate-1) and after 6 hours of treatment (Lactate-2) were compared to calculate the lactate clearance rate. Lactate levels of 1.7 mmol/l or greater were considered as positive.

Results: A total of 100 patients were enrolled in the study (62 females and 38 males). We found that 94% of patients had elevated lactate levels on admission to the ED. When lactate levels and CO values were compared, the CO values were found to be significantly higher in the elevated lactate level group compared to non-elevated patients. The rate of lactate clearance was 52% in the standard oxygen therapy group compared to 64% in the hyperbaric oxygen therapy (HOT) group, which suggests a faster removal of lactate with this treatment modality.

Conclusion: We conclude that lactate levels increase in patients with CO poisoning, and that those levels are correlated with carboxyhemoglobin (COHb) levels. The rate of lactate clearance can be used to evaluate the effectiveness of therapy. Patients with metabolic acidosis and significantly increased lactate should be referred for HOT in early phases of management.

Anahtar Kelimeler

• Lactate,lactate clearance,carbon monoxide poisoning

Kaynakça

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