A Rare Diagnosis in the Emergency Department: Renal Infarction

Objective: Renal infarction (RI), which is caused by sudden cessation of renal blood flow, is a rare disease. In this study, we planned to investigate the demographic and clinical characteristics and outcomes of patients diagnosed with renal infarction in the emergency department. Material and Methods: Patients over the age of 18 who presented to the emergency department with abdominal/flank pain, nausea, and vomiting between 2010 and 2021 and were diagnosed with acute renal infarction in contrast-enhanced abdominal computed tomography were included in the study. The data of the patients were reviewed retrospectively. Demographic and clinical characteristics, as well as laboratory results of the patients, were recorded. Results: A total of 38 patients were included in the study. The mean age of the patients was 61.8±18 years and 63.2% (n=24) were male. The most common complaints of the patients were abdominal pain (84.2%), flank pain (68.4%), and nausea-vomiting (50%). More rarely, patients complained about chest pain, dyspnea, and fever. Acute renal failure developed in 4 patients (10.5%). While only three (7.9%) of the patients had no known disease, the others had comorbidities such as hypertension (31.6%), ischemic heart disease (31.6%), previous thromboembolic events (31.6%), diabetes (26.3%), cancer (23.7%), heart failure (21.1%), and atrial fibrillation (18.4%). The most common cause of RI was cardioembolic events (44.7%), followed by hypercoagulability (28.9%), renal artery damage (15.8%), and idiopathic causes (10.5%). Conclusion: Acute RI is a disease that is rarely detected in the emergency department. Because there is a lack of specific clinical findings, it is often overlooked or diagnosed late. Delay in diagnosis can significantly cause morbidity and mortality. The diagnosis of acute RI should be considered especially in patients with a high risk of thromboembolism and who present to the emergency department with complaints of unexplained abdominal or flank pain

Organophosphate Poisoning and Intermediate Syndrome

Akut organofosfat zehirlenmesinden sonra oluşan toksik etki; akut kolinerjik kriz, intermediate sendrom ve gecikmiş polinöropati olarak üç fazda oluşmaktadır. Organofosfat zehirlenmesinde klinik belirti ve bulgular asetilkolinin sinir kavşaklarında birikiminine bağlıdır. Muskarinik bulgular, Nikotinik bulgular ve santral sinir sistemi bulgularından oluşan akut kolinerjik kriz, organofosfat zehirlenmesinde zehirlenmeden 24-96 saat sonra kolinerjik bulguların tekrarlaması ya da fasikülasyon olmadan kas zayıflığının meydana geldiği intermediate sendrom ve genellikle organik fosfor bileşiğine akut maruz kalınmasından sonraki birkaç gün veya hafta sonrasında meydana gelebilen gecikmiş tip polinöropati olarak üç temel klinik bulguya neden olmaktadır. Bu derlemede geç komplikasyonlardan olan intermediate sendromu gözden geçirilmiştirToxic effects that occur after acute organophosphate poisoning can manifest three phases, namely, acute cholinergic crisis, intermediate syndrome and delayed-type polyneuropathy. Clinical signs and symptoms of organophosphate poisoning depend on the accumulation of acetylcholine at the nerve junction. Organophosphate poisoning causes three main clinical findings; acute cholinergic crisis consisting of muscarinic, nicotinic and central nervous system symptoms, intermediate syndrome with recurrence of cholinergic symptoms or muscle weakness without fasciculation 24-96 hours after poisoning and delayed-type polyneuropathy that can usually occur several days or weeks after acute exposure to organic phosphorus compounds. In this article, intermediate syndrome, which is a late complication, has been reviewe