Yoğun Bakımda Takip Edilen Alkol Zehirlenmelerinin Retrospektif İncelenmesi

Öz

Amaç: Alkolle ilişkili ölümlerin büyük bir kısmı akut alkol tüketiminden kaynaklanmaktadır. Alkol toksisitesinin prognozunu etkileyen birçok faktör vardır. Bu faktörlerin belirlenmesi ile erken tanı konulup tedaviye erken başlanarak mortalite oranlarının azaltılabileceği bildirilmiştir. Bu çalışmada akut alkol zehirlenmesi nedeni ile yoğun bakımda takip edilen hastaların klinik durumu ve laboratuvar faktörleri değerlendirilerek prognozun belirlenmesi amaçlanmıştır. Gereç ve Yöntemler: Çalışmaya 2013-2021 yılları arasında hastanemiz yoğun bakım ünitesine(YBÜ) takip edilen ve akut alkol intoksikasyonu tanısı alan 21 hasta dahil edildi. Hastaların laboratuvar parametreleri, demografik özellikleri ve klinik durumları kaydedildi. Hastalar hem eksitus olanlar ve hayatta kalanlar olmak üzere hem de tüketilen alkol tipine (etanol ve metanol) göre gruplara ayrıldı. Bulgular: Olguların tümü erkek hastalardan oluşuyordu ve yaş ortalaması 40.10 ± 15.9 yıl olarak tespit edildi. Başvuruların %52.4’ü ethanol, %47.6’sı metanol zehirlenmesiydi. Mortalite oranı %33.3 tü. Metanol zehirlenmesinde semptomların, etanol zehirlenmesine kıyasla geç dönemde ortaya çıktığı gözlendi (p<0.001). Etanol ve metanol grupları karşılaştırıldığında Grup M'de pH, HCO3- düzeyleri daha düşük, laktat ve kreatinin değerleri ise daha yüksek bulundu. İleri yaş, düşük Glaskow koma skalası (GKS) ve Akut Fizyoloji ve Kronik Sağlık Değerlendirmesi (APACHE II) skoru, yüksek nötrofil/lenfosit oranı (NLO), laktat, anyon açığı, kreatin, osmolarite ve düşük pH, HCO3- mortalite ile ilişkiliydi (p<0.05). Sonuç: Bu çalışmada, akut alkol zehirlenmesinde ileri yaş, düşük GKS ve APACHE skoru, laboratuvar bulgularında yüksek anyon açığı ile seyreden metabolik asidoz, artmış NLO, laktat düzeyi ve kreatin yüksekliği mortalite ile ilişkili bulunmuştur. YBÜ yatışı sırasında bu bulgulara sahip hastaların yakından takip edilmesi gerektiğini düşünüyoruz.

Anahtar Kelimeler

• Etanol
• Metanol
• İntoksikasyon
• Mortalite

Retrospective Investigation of Alcohol Intoxications Followed in Intensive Care Unit

Öz

Aim: The majority of alcohol-related deaths are due to acute alcohol consumption. There are many factors affecting the prognosis of alcohol toxicity. It has been reported that by determining these factors, mortality rates can be reduced by early diagnosis and early initiation of treatment. In this study, we aimed to determine the prognosis by evaluating the clinical status and laboratory factors of patients followed up in intensive care unit (ICU) due to acute alcohol intoxication. Materials and Methods: The study included 21 patients with acute alcohol intoxication who were followed up in the ICU of our hospital between 2013-2021.Laboratory parameters, demographic characteristics and clinical status of the patients were recorded. Patients were divided into both exitus and survivors and according to the type of alcohol consumed (ethanol and methanol). Results: All patients were male with a mean age of 40.10 ± 15.9 years. 52.4% of the admissions were ethanol poisoning and 47.6% were methanol poisoning. Mortality rate was 33.3%. It was observed that symptoms appeared later in methanol intoxication compared to ethanol intoxication (p<0.001). When ethanol and methanol groups were compared, pH and HCO3- levels were lower and lactate and creatinine levels were higher in Group M. Advanced age, low Glasgow coma scale (GCS) and Acute Physiology and Chronic Health Evaluation (APACHE II) scores, high neutrophil/lymphocyte ratio (NLR), lactate, anion gap, creatinine, osmolarity and low pH, HCO3- were associated with mortality (p<0.05). Conclusion: In this study, advanced age, low GCS and APACHE scores, metabolic acidosis with high anion gap in laboratory findings, increased NLR, lactate level and creatine elevation were found to be associated with mortality in acute alcohol intoxication. We think that patients with these findings should be followed closely.

Anahtar Kelimeler

• Ethanol
• Methanol
• Intoxication
• Mortality

Kaynakça

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