Alcohol Withdrawal Mimicking Organophosphate Poisoning

Organophosphates, which can cause occupational poisoning due to inappropriate personal protective measures, are widely used insecticides in agricultural regions of southern Turkey. Therefore, the classical clinical findings of this cholinergic poisoning are myosis, excessive secretions, bradicardia and fasciculations are easy to be recognized by local medical stuff. Diseases and conditions related to alcoholism such as mental and social impairments, coma, toxicity, withdrawal, and delirium are frequent causes of emergency visits of chronic alcoholic patients. Here we present a case diagnosed and treated as organophosphate poisoning although it was an alcohol withdrawal in the beginning and became delirium tremens, due to similar symptoms

Utilization of plasmapheresis for organophosphate intoxication: A case report

Organophosphate (OP) compounds are extremely toxic chemicals that may be absorbed via skin, conjunctiva, gastrointestinal and respiratory systems. Treatment of OP poisoning is a critical and aggressive process which includes decontamination, antidote administration (atropin and oximes), mechanical ventilation support and extracorporeal elimination procedures if needed. Here we present a young female patient who was unintentionally poisoned by an OP (trichlorfon) after using it to moisture her skin. The importance of this patient is the dermal disease that makes her unprotective to dermal exposure of chemicals and application of plasmapheresis to treat her poisoning. Keywords: Organophosphate, Intoxication, Plasmapheresis, Dermal exposure, Ichthyosi

Therapeutic Hypothermia

It is agreed that early application of therapetic hypotehermia to cardiac arrest patients prevents the chemical reactions occured with reperfusion injury and contributes and prevents the neurologic injury. In this review we tried to discuss the thepeutic hypothermia using areas in the emergency department and intensive care under the light of the last literatures. [Archives Medical Review Journal 2011; 20(1.000): 20-35

Comparison of Single-Dose Pralidoxime and Pralidoxime Infusions for the Treatment of Organophosphate Poisoning

WOS: 000305320400025Objective: Organic phosphates (OP) bind covalently to acetylcholinesterase (AChE) and acetylcholine (Ach) accumulates in the synaptic cleft. Administering oximes before aging process causes breakage of the covalent bond between OP-AChE, and allows reactivation of AChE. Pralidoxime (PAM) is the most commonly used oxime. The purpose of this study is to determine the best PAM regimen for the length of hospitalization, the need for mechanical ventilation and reduction of the duration of mechanical ventilation in patients presenting with OP poisoning. Material and Methods: Thirty four patients included in this study were organized according to the order of enrollment, randomized and divided into two groups. Seventeen patients in the group I were given a single dose of 2 g/20 min PAM infusion (bolus dose), while 17 patients in group II were administered a dose of 2 g/20 min followed by 6 g/24 hours PAM infusion (bolus and infusion). Clinical signs and symptoms as well as the serum butyrylcholinesterase (BCHE) levels were used to verify the patients' diagnoses. Results: There were no significant differences between the groups. Conclusion: We suggest that PAM bolus plus infusion therapy does not have any advantage over a single dose of bolus PAM therapy the in treatment of OP poisoning

Role of intravenous lipid emulsions in the management of calcium channel blocker and beta-blocker overdose: 3 years experience of a university hospital

WOS: 000353453200001PubMed ID: 25684131Objectives: The objective of this study was to assess the efficacy of lipid emulsion as antidotal therapy in severe calcium channel blocker (CCB) and beta-blocker (BB) intoxications. Patients and methods: This is a retrospective study in which we have summarized data of patients who were admitted to a university-based emergency department in a period of 3 years and were given intravenous lipid emulsion (ILE) to manage cardiogenic shock due to CCB and BB overdose. Results: We identified 15 patients who received ILE therapy for CCB and BB toxicity. Hospitalization durations variated between 3 and 33 days (mean 7.46 perpendicular to 7.41 days). Drug exposures included CCBs (n = 8, 53.3%), CCBs and paracetamol (n = 1, 6.6%), and BBs (n = 6, 40%). ILE therapy was effective in 12 patients (80%). Three patients (20%) had resistant hypotension, one of whom progressed to pulmonary edema. Adverse effects of ILE therapy were seen in three patients (20%). Two patients underwent mechanical ventilation. Two patients developed hypoxic ischemic encephalopathy, one patient died, and 14 patients (93.3%) were discharged from hospital. Conclusion: There was 93.3% survival in patients receiving ILE for drug-induced cardiovascular collapse. Clinically significant adverse effects were uncommon. We suggest ILE administration for the treatment of cardiogenic shock due to CCB and BB overdose

Vitamin D levels in Cukurova Region

WOS: 000406284600016Purpose: The aim of ths study was to evaluate the increase in the request of plasma 25-hydroxy vitamin D level assay tests in Balcali Hospital of the Cukurova University during last 13 years and levels of 25-hydroxy vitamin D to determine the frequency of deficiency among the regional adult population admitting this hospital. Material and Methods: This study was performed by using pre-recorded electronic files and laboratory results of patients admitted to Balcali Hospital of the Cukurova University between 2003 and 2015. The number of 25-hydroxy vitamin D tests assayed of all ages between 20032015 and the diagnoses, age, gender, sampling, request, acceptance, confirmation times of tests, plasma 25-hydroxy vitamin D were evaluated. Results: The number of 25-hydroxy vitamin D tests assayed in the last 13 years was 77,569. When compared between years 2003-2013, number of 25-hydroxy vitamin D tests was increased 6785%. Mean plasma 25-hydroxy vitamin D levels were found to be higher in men (52.95 +/- 0.92 nmol/L) than women (48.42 +/- 0.54 nmol/L) (p<0.001). Among 6,198 patients included, 24.65% had 25-hydroxy vitamin D insufficiency and 35.95% had 25-hydroxy vitamin D deficiency. Only 15.62% of patients had optimal 25-hydroxy vitamin D levels. Conclusion: Although it is an extremely sunny environment, vitamin D insufficiency is a common and public health problem in Cukurova region. Many diseases may be prevented by education of how to benefit from sunrays and dietery supplements of vitamin D in risky population

Successful Treatment of Aluminum Phosphide Poisoning with Continuous Veno-venous Hemofiltration: A Case Report

WOS: 000381858100005Introduction: We aim to discuss the case of a patient with aluminum phosphide (AP) poisoning in a suicide attempt and who was successfully treated with continuous veno-venous hemofiltration (CVVH). Case Report: A-24-year old lady was admitted to a hospital with the complaints of dizziness, numbness in the face, and nausea and vomiting after taking two tablets of AP. She was transferred to our emergency clinic 10 h later because of persistent hypotension and metabolic acidosis. Her Glasgow Coma Scale score was 13 on admission. Her vital signs were as follows: blood pressure, 80/50 mmHg; pulse rate, 128/min; pulse oximetry, 90%; and respiration rate, 26/min. Her laboratory tests revealed the following: pH, 7.13; bicarbonate level, 10.1 mmol/L; and serum lactate level, 10.2 mmol/L. Other blood test results were normal. CVVH (Prismaflex hemofiltration set M150) was started in the intensive care unit because hypotension and metabolic acidosis were persistent; oliguria was added despite fluid resuscitation and inotrope infusion. Hemofiltration was continued until the 32nd hour when blood pressure and blood gas levels returned to normal. She was discharged healthy on the 4th day of hospitalization. Conclusion: We suggest the utilization of CVVH in the early stages of AP poisoning before the development of multiple organ failure because AP causes metabolic acidosis and hypotension resistant to medical treatment

A Comparison of Effectiveness of Sodium Bicarbonate in Patients Intoxicated by Tricyclic Antidepressants and Anticholinergic Drugs Other Than Tricyclic Antidepressants which Affected the Heart

WOS: 000309698500006Objective: Anticholinergic drug poisoning is among the life threatening poisonings frequently seen in emergency services. These drugs have serious side effects on heart like heart rate alterations, arrhythmias and conduction delays. The purpose of our study is to determine whether the other negative impacts of intoxication with tricyclic antidepressants (TCA) and anticholinergic drugs other than TCAs on heart are similar in nature in patients with QTc >= 45, and to compare the effectiveness of the standard NaHCO3 treatment on prolongation of QTc as well as QRS complex widening in patients intoxicated by anticholinergic drugs. Material and Methods: This prospective case-control study was planned to enroll patients who admitted to emergency service of Cukurova University Medical Faculty between June 06, 2005 and November 30, 2006 due to poisoning with TCA or anticholinergic drugs other than TCAs, and having a QTc interval >= 0.45 on the electrocardiogram (ECG) taken at the time of admission. The patients were managed with a 2 rnEq/kg dose of NaHCO3 treatment. In both groups, changes in QTc and QRS distances, cardiac biochemical parameters and systolic blood pressure and heart rate changes were compared with respect to time and the groups. Biochemical parameters related to possible complications due to the given treatment were examined. Results: The patients' demographic, clinical, electrocardiographic and laboratory findings were recorded and analyzed. A total of 58 patients, 30 of whom were poisoned with TCA agents, and 28 were poisoned with other drugs with anticholinergic effects were enrolled in the study. All patients had prolonged QTc and tachycardia and in 64.9% of the patients (n=37) QRS was >= 0.1. When we compared the QRS and QTc values at admission and at the sixtieth minute of the therapy, we observed a statistically significant decrease in both groups. Hopwever this reduction did not differ significantly between the groups. No significant changes were observed in systolic blood pressures or cardiac biochemical parameters of the patients of during the time between admission and discharge. Treatment and follow-up of all patients were performed in the emergency observation unit. No mortality occurred among patients in both groups. Conclusion: The fact that NaHCO3 treatment completely improved signs and symptoms and no treatment-related complications like hypertension, metabolic alcalosis, hypernatremia, hypokalemia, hypocalcemia developed, we suppose that standard 2 meq/kg NaHCO3 treatment is valid, effective and reliable in anticholinergic drug poisonings

The efficacy of tow-dose antivenom therapy on morbidity and mortality in snakebite cases

WOS: 000255262000003PubMed ID: 18410806Similar to the cases seen around the world, snakebite causes mortality and morbidity in Turkey. The venom of different types of snake in the region of Cukurova causes serious systemic and local tissue damage. Methods: We performed this prospective study on 45 patients who complained of snakebite. We grouped the patients according to their clinical presentations to facilitate treatment and follow-up period procedures. Results: Whereas the patients with grade I envenomation did not receive any antivenom, grades 2 and 3 patients received 2.70 +/- 0.77 and 4.88 +/- 1.65 vials of antivenom, respectively. One of our patients had to undergo finger amputation but there were no deaths. Allergic reactions developed after antivenom therapy in 8 patients (17.8%). Conclusions: When we considered the cost and complications of the antivenom treatment, it was seen that low-dose antivenom treatment effectively treated the patients with venomous snakebite injuries in our region. (c) 2008 Elsevier Inc. All rights reserved