İLK DOZ PERİNDOPRİL KULLANIMINDAN SONRA GELİŞEN LİNGUAL ÖDEM SONUCU MEKANİK VENTİLATÖR İHTİYACI NEDENİYLE ENTÜBE EDİLEN HASTA

Öz

Anjiyotensin dönüştürücü enzim inhibitörlerinin (ACEİ) lingual ödem yan etkisi nadir karşılaşılan ve ciddi hayatı tehdit eden bir durumdur. Bu olguda ilk doz perindopril alımı sonrasında yoğun bakım ünitesinde entübe olarak takip edilen bir hastanın klinik sonuçları sunulmuştur. Anjiyotensin dönüştürücü enzim inhibitörlerinin tetiklediği durum, inaktif metabolitlere ayrıştırılamayan bradikinin birikimi ile ilişkilidir. En yüksek anjiyoödem insidansı tedavinin ilk ayında saptanmış olup bizim vakamızda ilk doz sonrası görüldü. Kadınlar, sigara içenler, daha önce anjiyoödem öyküsü olan hastalarda anjiyoödem gelişme riski daha yüksektir. Öncü bulgular saptandığında ilaç hemen kesilmeli antihistaminikler ve steroidler başlanmalıdır. Hastanın durumu kötüleşirse bu müdahalelere rağmen trakeal entübasyon gerekebilir. Bradikinin aracılı anjiyoödemde dikkate alınması gereken diğer önemli nokta bradikinin birikimi yapabilecek diğer ilaçlardan da kaçınılması gerektiğidir. Erken tanı ve müdahale hastalığın hayatı tehdit edici hale gelmesini önleyebileceği için her hekimin bu konuda dikkatli olması gerekmektedir.

Anahtar Kelimeler

• Anjioödem
• Bradikinin
• Perindopril
• Yoğun Bakım

THE PATIENT WAS INTUBATED DUE TO THE NEED FOR A MECHANICAL VENTILATOR AS A RESULT OF LINGUAL EDEMA DEVELOPING AFTER THE USE OF THE FIRST DOSE OF PERINDOPRIL

Öz

Lingual edema is a rare and seriously life-threatening side effect of angiotensin-converting enzyme inhibitors (ACEI). In this case, the clinical results of a patient who was followed up intubated in the intensive care unit after receiving the first dose of perindopril are presented. The condition triggered by angiotensin-converting enzyme inhibitors is associated with the accumulation of bradykinin, which cannot be degraded into inactive metabolites. The highest incidence of angioedema was detected in the first month of treatment, and in our case, it was observed after the first dose. Women, smokers, and patients with a previous history of angioedema have a higher risk of developing angioedema. When preliminary symptoms are detected, the drug should be stopped immediately, and antihistamines and steroids should be started. If the patient's condition worsens, tracheal intubation may be required despite these interventions. Another important point to consider in bradykinin-mediated angioedema is that other drugs that may accumulate bradykinin should be avoided. Since early diagnosis and intervention can prevent the disease from becoming life-threatening, every physician should be careful in this regard.

Anahtar Kelimeler

• Angioedema
• Bradykinin
• Perindopril
• Intensive Care

Kaynakça

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