Intrapleural and Intraperitoneal Free Fluid in Calcium Channel Blocker Overdose

Aim: Toxicity findings affecting many systems, particularly the cardiovascular system, are observed in calcium channel blocker (CCB) overdose. Here, we aimed to present the incidence of CCB overdose patients with intraperitoneal and intrapleural free fluids detected by abdominal ultrasonography (USG). Materials and Methods: CCB overdose patients admitted to the emergency room in a 2-year period were prospectively included. All patients with CCB overdose were evaluated by bedside abdominal USG in terms of the presence of pleural and peritoneal fluid. Results: A total of 14 patients with CCB poisoning were included in our study. Six (42.8%) patients had taken verapamil, 7 (50%) patients amlodipine, and 1 (7.2%) patient nifedipine. The mean age of the patients was 27.2±15.9 years (range: 18–65 years). The median time from drug intake to arrival at the hospital was 3.0 h (IQR: 1.75–5). Nine (64.28%) of these patients were detected to have intraperitoneal and intrapleural free fluid by bedside USG. The mean arterial pressure of patients with intraabdominal and intrapleural fluid was lower than that of patients without the detected fluid, i.e., 56.8 (IQR: 54.8–61.8) vs. 65.6 (IQR: 64.2–66.8), respectively (p<0.001). Conclusion: Besides the cardiovascular findings, intraperitoneal and intrapleural free fluid is also a common feature in CCB overdose. Bedside USG may help to identify these patients. (Eurasian J Emerg Med 2016; 15: 82-5)Aim: Toxicity findings affecting many systems, particularly the cardiovascular system, are observed in calcium channel blocker (CCB) overdose. Here, we aimed to present the incidence of CCB overdose patients with intraperitoneal and intrapleural free fluids detected by abdominal ultrasonography (USG). Materials and Methods: CCB overdose patients admitted to the emergency room in a 2-year period were prospectively included. All patients with CCB overdose were evaluated by bedside abdominal USG in terms of the presence of pleural and peritoneal fluid. Results: A total of 14 patients with CCB poisoning were included in our study. Six (42.8%) patients had taken verapamil, 7 (50%) patients amlodipine, and 1 (7.2%) patient nifedipine. The mean age of the patients was 27.2±15.9 years (range: 18–65 years). The median time from drug intake to arrival at the hospital was 3.0 h (IQR: 1.75–5). Nine (64.28%) of these patients were detected to have intraperitoneal and intrapleural free fluid by bedside USG. The mean arterial pressure of patients with intraabdominal and intrapleural fluid was lower than that of patients without the detected fluid, i.e., 56.8 (IQR: 54.8–61.8) vs. 65.6 (IQR: 64.2–66.8), respectively (p<0.001). Conclusion: Besides the cardiovascular findings, intraperitoneal and intrapleural free fluid is also a common feature in CCB overdose. Bedside USG may help to identify these patients. (Eurasian J Emerg Med 2016; 15: 82-5

Relationship between mortality and acute inflammatory markers, erythrocyte cholinesterase, serum cholinesterase levels in the acute organic phosphorus intoxication

Amaç: Çalışmada organik fosfor zehirlenmesi olan hastalarda serum ve eritrosit kolinesteraz düzeyi, akut inflamatuvar belirteçler ile mortalite arasındaki ilişkinin araştırılması amaçlanmıştır. Materyal ve Metod : Gereç ve Yöntemler: Acil servise organik fosfor zehirlenmesi ile başvuran 19 kadın, 20 erkek toplam 39 olgu retrospektif olarak değerlendirilmiş olup bu hastalrada serum fibrinojen, ferritin, C reaktif protein, tümör nekroz faktör-alfa, interlökin 1, interlökin 6, interlökin 10, eritrosit ve serum kolinesteraz düzeyleri yanı sıra beyaz küre ve trombosit sayıları gözden geçirilmiştir. Herediter kolinesteraz eksikliği, karaciğer fonksiyon bozukluğu, malnutrisyon, anemi, kokain, morfin, kodein ve süksinilkolin gibi ilaç kullanımı olan olgular çalışmaya alınmamaıştır. Veriler SPSS 18,0 paket programı kullanılarak analiz edilmiştir. Bulgular: Organik fosfor zehirlenmesi nedeniyle ölen hastalarla taburcu edilen hastaların laboratuvar verileri karşılaştırıldığında; ölen hastalarda acile ilk başvuruda alınan ortalama serum kolinesteraz düzeyi düşük (p=0,006), fibrinojen düzeyi yüksek bulunmuştur (p=0,011), Benzer şeklide trombosit sayısı düşük (p=0,031) bulundu. Ancak eritrosit kolinesteraz, IL-1, IL-6, IL-10, TNF-?, CRP, ferritin ve beyaz küre düzeyleri arasında her iki grup arasında istatistiksel olarak anlamlı bir fark bulunamadı. Bun karşın eksitus olan ve taburcu edilen hastaların fibrinojen, eritrosit kolinesteraz (p=0,013) ve serum kolinesteraz (p=0,029) düzeyleri arasında istatistiksel olarak anlamlı bir ilişki saptandı. Sonuç: Organik fosfor zehirlenmesinde serum kolinesteraz düzeyi ve trombosit sayısı düşüklüğü, fibrinojen düzeyi yüksekliğinin mortalite üzerinde etkili faktörler olduğu belirlendi. Acile orgonik fosfor intoksikasyon bulguları ile başvuran olgularda yukarıda sıralanan belirteçler mortalitenin daha önceden öngörülmesi açısından önemli olup daha geniş serilerde yapılacak çalışmalarla bu veriler desteklenmelidir.Purpose: In our study, we aimed to investigate the relationship between the mortality and acute inflammatory markers, serum and erythrocyte cholinesterase levels in patients with organophosphorus poisoning. Material and Methods: We included 19 female and 20 male patients who applied to emergency department with organic phosphorus poisoning retrospectively. Standard data entry form has been created. White blood cell (WBC) and platelet counts, fibrinogen, ferritin, C-reactive protein (CRP), tumor necrosis factor-alpha (TNF-&amp;#945;), interleukin-1 (IL-1), interleukin 6 (IL-6), interleukin 10 (IL-10), erythrocyte and serum cholinesterase levels were determined. Patients with hereditary cholinesterase deficiency, liver disorders, malnourished, anemia, abusing cocaine, morphine, codeine, and medications such as succinylcholine were excluded from the study. SPSS 18.0 software was used for statistical analysis. Results: The laboratory data of patients who died at our hospital due to organophosphorus poisoning were compared with the patients discharged; the mean serum cholinesterase levels of the patients died were statistically low (p = 0.006), platelet counts were also low (p = 0.031), fibrinogen levels were high (p = 0.011). However, there was no statistically significant differences between erythrocyte cholinesterase (p = 0.984), IL-1 (p = 0.139), IL-6 (p = 0.513), IL-10 (p = 0.089), TNF-&amp;#945; (p = 0.074), CRP (p = 0.081), ferritin (p = 0.275), and WBC (p = 0.272) levels of the patients who died or discharged. There was a statistically significant relationship between fibrinogen levels, erythrocyte cholinesterase (p = 0.013), and serum cholinesterase (p = 0.029) levels of the patients who discharged or died. Conclusion: Low serum cholinesterase levels, low platelet count and high fibrinogen levels were found to be significant factors for the high mortality rate of organic phosphorus poisoning. This study will be valuable for emergency physicians to be able to predict mortality of organic phosphorus poisoning thereby contribute more to clinical experiences. These laboratory tests can be used as prognostic markers after more detailed studies

The relationship between electrocardiographic changes, cholinesterase levels and mortality in acute organophosphate poisoning

Giriş: Çalışmamızda akut organofosfat zehirlenmesine bağlı elektrokardiyografik (EKG) değişiklikler ile kolinesteraz düzeylerinin mortaliteye etkilerini araştırmayı amaçladık. Materyal ve Metod: Prospektif, randomize olarak 2 yıl süresince, 01.08.2009 – 31.08.2011 tarihleri arasında acil tıp kliniği’ne organik fosfat zehirlenmesi ile gelen hastaların alınmasının planlandığı çalışmaya Etik Kurul’dan onay alındıktan sonra başlandı. Acile başvuru sonrası, tedavi (atropin ve pralidoksim uygulaması) öncesinde çalışmada kullanılmak üzere EKG çekildi ve kan örneği alınarak, serum ve eritrosit kolinesteraz düzeyleri hastanemiz laboratuvarı’nda çalışıldı. Hastaların EKG bulguları, kolinesteraz değerleri, sonlanım durumu standart veri giriş formuna kayıt edildi. Verilerin istatistiksel analizinde SPSS 18.0 paket programı kullanıldı. Bulgular: Çalışmaya alınan 39 hastanın 5’i (% 12.8) tedavileri sırasında eksitus oldu. Hastalarda görülen elektrokardiyografik bulgular sıklık sırasına göre; sinüs taşikardisi (% 48.7), uzamış QT mesafesi (% 20.5) ve sağ dal bloğu (% 20.5), ST-T dalga değişikliği (% 12.8), atriyal fibrilasyon (% 7.7), sağ aks sapması (% 5.1), uzamış PR mesafesi (% 2.5) idi. Eksitus ve taburcu edilen hastaların acile ilk başvurusu sonrasında çekilen EKG bulguları karşılaştırıldığında gruplar arasında istatistiksel olarak fark olmadığı tespit edildi (p ? 0.05). Eksitus olan hastaların ilk geliş anında bakılan ortalama serum kolinesteraz düzeyleri ortalaması taburcu edilen hastalara göre düşüktü ve aralarında istatistiksel olarak anlamlı bir fark mevcuttu (p=0.006). Ancak eksitus ve taburcu edilen hastaların eritrosit kolinesteraz düzeyleri arasında anlamlı farklılık yoktu (p= 0.984). Sonuç: Organofosfat zehirlenmesinin şiddeti ile EKG bulguları arasında mortalite açısından anlamlı bir ilişki olmadığı, şiddetli zehirlenmelerde serum kolinesteraz düzeyi düşüklüğü ile mortalite arasında istatistiksel olarak anlamlı bir ilişki olduğu belirlendi. Organofosfat zehirlenmelerinde görülebilecek EKG bulguları ve mortaliteye etkileri hakkında acil hekimlerine fikir vermesi, klinik deneyimlerine katkıda bulunması açısından bu çalışmanın faydası olacaktır. Ancak bu konuda yapılacak daha detaylı çalışmalara ihtiyaç vardır.Purpose: In our study we aimed to investigate the relationship between electrocardiographic (ECG) changes, cholinesterase levels and mortality due to acute organophosphate poisoning. Material and Methods: We planned to take patients who administered to emergency department with organic phosphorus poisoning randomized and prospectively for 2 years between 01.08.2009 – 31.08.2011 after approval by the Ethics Committee. The electrocardiograms of the patients were taken after admission to the emergency department, before the treatment (atropine and pralidoxime application). Blood samples were taken and serum - erythrocyte cholinesterase levels were studied in the laboratory of our hospital. ECG findings, cholinesterase values and the final situation of the patients were recorded at the standard data entry form. SPSS 18.0 package program was used for statistical analysis of data. The statistical significance level of all tests was p < 0.05. Results: The five of thirty nine patients (12.8 %) included in the study have died during the treatment. The electrocardiographic findings seen in patients in order of frequency; sinus tachycardia (48.7 %), prolonged QT interval (20.5 %), and right bundle branch block (20.5 %), ST-T wave changes (12.8 %), atrial fibrillation (7.7 %), right axis deviation (5.1 %), prolonged PR (2.5 %). There was no statistically significant difference between the ECG findings of the patient groups who died or discharged (p &amp;#8805; 0.05). The mean serum cholinesterase levels of the patients who died were statistically lower than the discharged patients (p = 0.006). Conclusion: There is not a significant relationship between ECG findings and the severity of organophosphate poisoning. There is a statistically significant relationship between mortality and low levels of serum cholinesterase due to severe poisoning. ECG findings and their effects to the mortality in organophosphate poisoning can give an opinion to the emergency physicians and contribute to their clinical experiences. However, more detailed studies are needed in this matter