Isoniazid intoxication: Three case reports

Son yıllarda görülme sıklığı yeniden artan tüberküloz, ülkemiz için halen önemli bir toplum sağlığı sorunudur. İzoniazid, ucuz ve etkin olması nedeniyle en sık kullanılan antitüberküloz ilaçlardan biridir. Yüksek dozlarda alındığında konvülsiyon, metabolik asidoz, laktik asidoz, rabdomiyoliz, koma ve hatta ölümle sonuçlanabilir. Temel tedavi alınan izoniazide eş dozda verilen parenteral piridoksin uygulamasıdır. Burada konvülsiyon geçirdiği için getirilen üç olgu sunulmuş olup, izoniazid zehirlenmesinin klinik ve metabolik bulguları ile tedavi yaklaşımının tartışılması amaçlanmıştır.Tuberculosis is still an important health problem in our country as its prevalence has increased in recent years. Isoniazid is one of the most commonly used antituberculous drugs because it is cheap and efficacious. When administered at high doses; it can cause convulsions, metabolic acidosis, lactic acidosis, rhabdomyolisis, coma, and even death. The basis of therapy consists of parenteral pyridoxine administration in a dose equivalent to that of the ingested isoniazid. Here we reported three cases of acute isoniazid intoxication presenting with convulsions and aimed to discuss the clinical signs, pathophysiology, and treatment of isoniazid intoxication

Our patients followed up with a diagnosis of neurogenic pulmonary edema

Nörojenik pulmoner ödem, merkezi sinir sistemi hasarı sonucu gelişen klinik bir durumdur. Çocukluk çağında nadir görülür. Nörojenik pulmoner ödem, klinik bir tanıdır. Patogenezi tam anlaşılmamış olmakla birlikte pulmoner intertisyel ve alveolar sıvıda artış oluşur. Nörojenik pulmoner ödem tedavisindeki ana prensip akut sıkıntılı solunum sendromundaki gibi destek tedavisi ve intrakraniyal basıncı düşürmektir. Bu makalede merkezi sinir sistemi hasarlanması sonucu gelişen nörojenik pulmoner ödem tanısı alan iki olgumuzun klinik özellikleri sunulmuşturNeurogenic pulmonary edema is a clinical situation which developes as a result of central nervous system injury. It is rare in the childhood. Neurogenic pulmonary edema is a clinical diagnosis. Although the pathogenesis is not elucidated well, there is increase in pulmonary interstitial and alveolar fluid. The main principle in treatment of neurogenic pulmonary edema is supportive treatment and decreasing intracranial pressure as in acute respiratory distress syndrome. In this article, clinical properties of our two patients diagnosed with neurogenic pulmonary edema developed as a result of central nervous system injury are presente

Chylous ascites: an unusual complication of peritoneal dialysis in an infant with congenital nephrotic syndrome

Şilöz asit; periton diyalizi yapılan hastalarda nadir görülen fakat önemli bir non-enfeksiyöz komplikasyondur. Konjenial nefrotik sendromlu 1,5 aylık erkek hasta genel durumunda kötüleşme, diffüz ödematöz görünüm ve solunum sıkıntısı nedeni ile çocuk yoğun bakım ünitesine kabul edildi. Yatışının üçüncü gününde periton diyaliz kateteri takılarak periton diyalizi uygulanmaya başlandı. Periton diyaliz kateteri takıldıktan beş gün sonra (yatışının sekizinci gününde) diyaliz sıvısı süt görünümü almaya başladı. Süt görünümündeki sıvının biyokimyasal analizi şilöz asit karakteri gösteriyordu: trigliserit 468 mg/dl. Şilöz asit kısa zincirli yağ asitlerinden zengin düşük lipidli diyet ve somatostatin anoloğu (octreotid) infüzyonu ile tedavinin 5. gününde düzeldi ve hasta tedavinin devamı için pediatri servisine transfer edildi.Chylous ascites is a rare but important non-infectious complication in patients undergoing peritoneal dialysis. A male infant of 1.5-month-old with congenital nephrotic syndrome admitted to our pediatric intensive care unit becasue of deterioration in general appearence, diffuse edematous appearance and respiratory distress. Peritoneal catheter insertion and peritoneal dialysis was performed in the 3rd day of hospitalization. Five days after peritoneal dialysis catheter insertion (on the 8th day of hospitalization) the peritoneal dialysis effluent had a milky appearance. The chemical analysis of the milky effluent showed characteristics of chylous ascites: triglycerides 468 mg/dl. The chylous ascites resolved at the 5th day of our treatment with a low fat diet with medium chain triglycerides and intravenous infusion of somatostatin analogue (octreotide) and the patient was transferred to the pediatric service for maintenance of the treatment

Konjenital nefrotik sendromlu bir infantta periton diyalizine bağlı olarak görülen nadir bir komplikasyon olarak şiloz asit

Chylous ascites is a rare but important non-infectious complication in patients undergoing peritoneal dialysis. A male infant of 1.5-month-old with congenital nephrotic syndrome admitted to our pediatric intensive care unit becasue of deterioration in general appearence, diffuse edematous appearance and respiratory distress. Peritoneal catheter insertion and peritoneal dialysis was performed in the 3rd day of hospitalization. Five days after peritoneal dialysis catheter insertion (on the 8th day of hospitalization) the peritoneal dialysis effluent had a milky appearance. The chemical analysis of the milky effluent showed characteristics of chylous ascites: triglycerides 468 mg/dl. The chylous ascites resolved at the 5th day of our treatment with a low fat diet with medium chain triglycerides and intravenous infusion of somatostatin analogue (octreotide) and the patient was transferred to the pediatric service for maintenance of the treatment.Şilöz asit; periton diyalizi yapılan hastalarda nadir görülen fakat önemli bir non-enfeksiyöz komplikasyondur. Konjenial nefrotik sendromlu 1,5 aylık erkek hasta genel durumunda kötüleşme, diffüz ödematöz görünüm ve solunum sıkıntısı nedeni ile çocuk yoğun bakım ünitesine kabul edildi. Yatışının üçüncü gününde periton diyaliz kateteri takılarak periton diyalizi uygulanmaya başlandı. Periton diyaliz kateteri takıldıktan beş gün sonra (yatışının sekizinci gününde) diyaliz sıvısı süt görünümü almaya başladı. Süt görünümündeki sıvının biyokimyasal analizi şilöz asit karakteri gösteriyordu: trigliserit 468 mg/dl. Şilöz asit kısa zincirli yağ asitlerinden zengin düşük lipidli diyet ve somatostatin anoloğu (octreotid) infüzyonu ile tedavinin 5. gününde düzeldi ve hasta tedavinin devamı için pediatri servisine transfer edildi

Uncontrolled Agitation and Flushed Face Due to Tropicamide: A Missed Diagnosis

Introduction: Topical ophthalmic drugs that are not used in appropriate doses may lead to overdose symptoms. Case Report: A 2-month-old boy presented to the emergency department with extreme agitation, flushed face, mydriasis, cataract in the left eye, dry oral mucosa, spasticity in all extremities, and wheezing. It was learned that the patient had been receiving eye drops containing tropicamide at repeated doses before ophthalmologic evaluation. Pheniramine maleate and methylprednisolone were given to counter the drug-related side-effects or allergic reactions to the eye drop. At the follow-up, his symptoms and findings had become exacerbated, and he was admitted to the pediatric intensive care unit due to shock and drug-related anticholinergic toxicity. Conclusion: This case illustrates the importance of recognizing toxidromes at differential diagnosis and is the first reported pediatric case with tropicamide-induced anticholinergic syndrome

Evaluation of poisoned children with calcium channel blockers or beta blockers drugs

Amaç: Kalsiyum kanal blokeri ve beta bloker ilaçlar çoğunlukla hipertansiyon tedavisinde kullanılmaktadır. Çocuklarda bazen yanlışlıkla, bazen de özkıyım amaçlı doz aşımı meydana gelebilmektedir. Bu tip zehirlenmelerde hastalık ve ölüm diğer zehirlenmelere kıyasla daha fazla olmaktadır. Bu çalışmada, kalsiyum kanal blokeri veya beta bloker ilaçlar ile oluşan zehirlenme olguları, literatür bilgileri ışığında tartışılmıştır. Gereç ve Yöntem: Ocak 2011 ile Temmuz 2012 ayları arasında Çocuk Yoğun Bakım Birimi’nde izlenen 590 ilaç zehirlenmesi olgusundan kalsiyum kanal blokeri veya beta bloker ilaçlar ile zehirlenen 16 olgu değerlendirmeye alındı. Hastaların 11'i (%68,8) kız, beşi (%31,2) erkekti. Hastaların ortalama yaşı 11,8±5,94 (2,5-18) yıl idi. Bulgular: Kalsiyum kanal bloker ilaç zehirlenmesi hastalarında en sık klinik bulgu hipotansiyon idi. İki hasta ise bulgusuzdu. Elektrokardiyografide dört hastada QT uzaması, iki hastada AV blok ve bir hastada ST çökmesi saptandı. Beta bloker ilaç zehirlenmesi hastalarında, bulantı, kusma, hipotansiyon, uykuya eğilim ve ellerde titreme en sık gözlenen klinik bulgulardı. Yedi hastada elektrokardiyografi normal iken; bir hastada QT uzaması ve bir hastada da Wolff–Parkinson–White sendromu vardı. İki kalsiyum kanal bloker ilaç zehirlenmesi hastasına sadece dopamin, birine dopamin ve dobutamin, birine de dopamin, dobutamin, adrenalin, noradrenalin, glükagon ve insülin verilmişti. Hiçbir beta bloker ilaç zehirlenmesi hastasına inotrop verilmemişti. Bulgusuz olan iki hasta dışında, tüm kalsiyum kanal bloker ilaç zehirlenmesi hastalarına damardan Ca-glükonat destek tedavisi verilmişti. On beş hasta şifa ile taburcu edilmiş iken; bir kalsiyum kanal bloker zehirlenmesi kaybedilmişti. Çıkarımlar: Kalsiyum kanal blokeri veya beta bloker ilaçlarla oluşan zehirlenmeler, çok ağır seyredebilen zehirlenmeler olduğundan, bu hastalar tam donanımlı çocuk yoğun bakım birimlerinde izlenmelidir.Aim: Calcium channel blockers (CCB) and beta blockers (BB) are primarily used to treat hypertension. Overdose of these medications can occur by accidental ingestion or ingestion for suicide attempt. Morbidity and mortality are higher in these poisonings compared to other poisonings. In this study, BB or CCB drug poisoning cases are discussed and the literature is reviewed. Material and Method: Between January 2011 and July 2012, 590 cases of drug poisoning were admitted in the Pediatric Intensive Care Unit. In this study, 16 of these 590 subjects who were poisoned with calcium channel blockers or beta blockers were evaluated. 11 (68.8%) patients were female and 5 (31.2%) were male. Mean age of the patients was 11.8±5.94 (2.5-18) years. Results: Hypotension was the most common clinical sign in CCB poisoning. Two patients were asymptomatic. On ECG, QT prolongation was found in four patients, AV block was found in two patients and ST depression was found in one patient. Nausea, vomiting, hypotension, lethargy and tremor were the most common clinical findings in patients with BB intoxication. Although seven patients had normal ECG, one patient had QT prolongation and one patient had Wolff-Parkinson-White syndrome. Only dopamine was given to two patients with CCB poisoning, dopamine and dobutamine were given to one patient and dopamine, dobutamine, epinephrine, norepinephrine, glucagon and insulin were given to another patient. Inotropic drugs were not given to any patient with BB poisoning. IV Ca-gluconate was given to all patients with CCB poisoning except two patients who were asymptomatic. 15 patients were discharged, while one patient with CCB poisoning was lost. Conclusions: Because the prognosis of CCB or BB poisoning may be very severe, these patients should be followed up in a fully- equipped pediatric intensive care unit

Aluminium Phosphide Poisoning: Two Pediatric Patients and Two Different Clinical Outcomes

Alüminyum fosfit, ağızdan alındığı zaman mide sıvıları ile temas edip oldukça toksik bir gaz olan fosfin gazına dönüşen bir insektisittir. Alüminyum fosfit zehirlenmesi şiddetli metabolik asidoz, akut respiratuvar distress sendromu ve kardiyojenik şok ile birlikte çoğul organ yetersizliğine neden olmaktadır. Birinci olgumuz; 18 yaşında kız hasta özkıyım amacıyla 500 mg alüminyum fosfit içeren tabletten bir tane aldıktan iki saat sonra hastanemiz acil servisine başvurdu. İnotrop tedavileri başlandıktan bir saat sonra hastaya veno-arteryel ekstra-korporeal membran oksijenizasyonu uygulanmaya başlandı. Takibinin 12. saatinden sonra aritmileri gelişen hasta hemodinamisi düzelmesine rağmen devam eden direngen aritmi nedeni ile takibinin 22. saatinde eks oldu. İkinci olgumuz ise alüminyum fosfit 500 mg tabletten bir adet ağzında parçalanmış şekilde görülmesi nedeni ile hastanemiz acil servisine getirilen iki yaşında bir kız hastaydı. Takiplerinde yaşamsal bulguları dengede seyretti. İzleminde herhangi bir sorun yaşanmayan hasta 48. saatte taburcu edildi.Aluminium phosphide is an insecticide that turns into a quite toxic gas called phosphine when contacts with gastric fluids. Aluminium phosphide poisoning causes severe metabolic acidosis, acute respiratory distress syndrome and multi-organ failure with cardiogenic shock. Our first case was an-18-year-old girl admitted to our emergency department two hours after ingestion of one tablet containing 500 mg aluminium phosphide in a suicide attempt. Venoarterial extracorporeal membrane oxygenation was started one hour after initiation of inotropic agents. Despite improvement in hemodynamic status, she developed refractory arrhythmias at the12th hour and she died 22 hours after admission. The second case was a two-year-old girl who was admitted to our emergency department because of observing a piece of aluminum phosphide 500 mg tablet broken in her mouth. Her vital signs were stable in the follow-up. The patient who had no problems in the follow-up was discharged at 48 hours

Burnout of Nurses Working in a University Hospital and the Effect of Social Support

Amaç: Bu çalışmada; Çukurova Üniversitesi Tıp Fakültesi'nde çalışan hemşirelerin tükenmişlik düzeyleri ile algılanan sosyal destek sistemleri ve tükenmişliği etkileyen faktörlerin incelenmesi amaçlanmıştır. Materyal ve Metod: Bu çalışmada Sosyodemografik veri toplama formu, Maslach Tükenmişlik Ölçeği, Çok Boyutlu Algılanan Sosyal Destek Ölçeği 403 hemşireye uygulanmıştır. Bulgular: Elde edilen sonuçlara göre hemşirelerin sosyal destek sistemlerinin yeterli olduğu ancak orta düzeyde duygusal tükenme (DT) ve duyarsızlaşma (D) yaşadıkları belirlenmiştir. Kişisel başarı yönünden ise; yüksek düzeyde tükenmişlik yaşadıkları sonucuna ulaşılmıştır. Hemşirelerin çalışma şekline ait veri değerlendirildiğinde gece çalışan hemşirelerin DT ve D puan ortalamaları diğer gruplardan daha yüksek bulunmuştur ve istatistiksel açıdan anlamlıdır (p=0,001). Sonuç: Sonuç olarak; hemşirelerin algıladığı sosyal desteğin, tükenmişliği etkilediği bulunmuştur.Özellikle arkadaş desteğinin tükenmişliği etkileyen en önemli sosyal destek alt grubu olduğu belirlenmiştir.Purpose: In this study, levels of burnout in nurses working in Çukurova University Faculty of Medicine and perceived social support systems and to examine the factors that affect burnout. Material and Methods: Socio-demographic data collection form for this purpose, Maslach Burnout Inventory, Multidimensional Scale of Perceived Social Support 403 nurses applied. Results: According to the results obtained from the nurses' social support systems are adequate but moderate emotional exhaustion (EE) and depersonalization (D) were live. In terms of personal achievement, it is concluded their high levels of burnout. Nurses working in night mode of operation of the data evaluated EE and D were higher mean scores than the other groups, and statistically significant (p = 0.001). Conclusion: As a result, nurses' perceived social support, burnout was found to affect. In particular sub-group of friend support and burnout was determined that the most important social support

MyD 88 Polymorphisms in Children Diagnosed with Sepsis

Background: Myeloid differentiation primary response gene 88 (MyD 88) is an intracellular adapter protein that mediates the early immune response to pathogens. Toll-like receptors (except TLR-3) induce the immune response through a MyD 88-dependent signal pathway. Aims: We aimed to investigate the MyD 88 polymorphisms that play important roles in the immune response in septic children and to evaluate whether or not they were risk factors in the development of sepsis. Study Design: Case-control study. Methods: Sixty-five patients diagnosed with sepsis in the Pediatric Intensive Care Unit during the period from April 2010 to January 2012 were included as the study group. Sixty-five children without sepsis were included as controls. After DNA was obtained from blood samples in the study and control groups, MyD 88 polymorphisms were analyzed. According to the genotype and allele frequencies, the distributions of MyD 88 polymorphisms [Single nucleotide polymorphism (SNP) - 938 C/A (rs4988453), MyD 88 SNP 1944 C/G (rs4988457)] were analyzed in both the study and control groups. Results: The C/C genotype of MyD 88 SNP -938 was significantly more common than the C/A genotype in the patient group (p=0.002). No statistically significant difference in the frequency of the MyD 88 SNP 1944 genotype was found between the study and control groups (p=0.272). Conclusion: Gene polymorphism studies could elucidate our understanding of sepsis in terms of prevalence and the managementof treatment. It was shown in this study that children with the MyD 88 SNP -938 C/C genotype had a greater tendency toward sepsis. However, additional studies should be performed

MyD 88 Polymorphisms in Children Diagnosed with Sepsis

Background: Myeloid differentiation primary response gene 88 (MyD 88) is an intracellular adapter protein that mediates the early immune response to pathogens. Toll-like receptors (except TLR-3) induce the immune response through a MyD 88-dependent signal pathway. Aims: We aimed to investigate the MyD 88 polymorphisms that play important roles in the immune response in septic children and to evaluate whether or not they were risk factors in the development of sepsis. Study Design: Case-control study. Methods: Sixty-five patients diagnosed with sepsis in the Pediatric Intensive Care Unit during the period from April 2010 to January 2012 were included as the study group. Sixty-five children without sepsis were included as controls. After DNA was obtained from blood samples in the study and control groups, MyD 88 polymorphisms were analyzed. According to the genotype and allele frequencies, the distributions of MyD 88 polymorphisms [Single nucleotide polymorphism (SNP) - 938 C/A (rs4988453), MyD 88 SNP 1944 C/G (rs4988457)] were analyzed in both the study and control groups. Results: The C/C genotype of MyD 88 SNP -938 was significantly more common than the C/A genotype in the patient group (p=0.002). No statistically significant difference in the frequency of the MyD 88 SNP 1944 genotype was found between the study and control groups (p=0.272). Conclusion: Gene polymorphism studies could elucidate our understanding of sepsis in terms of prevalence and the managementof treatment. It was shown in this study that children with the MyD 88 SNP -938 C/C genotype had a greater tendency toward sepsis. However, additional studies should be performed.Background: Myeloid differentiation primary response gene 88 (MyD 88) is an intracellular adapter protein that mediates the early immune response to pathogens. Toll-like receptors (except TLR-3) induce the immune response through a MyD 88-dependent signal pathway. Aims: We aimed to investigate the MyD 88 polymorphisms that play important roles in the immune response in septic children and to evaluate whether or not they were risk factors in the development of sepsis. Study Design: Case-control study. Methods: Sixty-five patients diagnosed with sepsis in the Pediatric Intensive Care Unit during the period from April 2010 to January 2012 were included as the study group. Sixty-five children without sepsis were included as controls. After DNA was obtained from blood samples in the study and control groups, MyD 88 polymorphisms were analyzed. According to the genotype and allele frequencies, the distributions of MyD 88 polymorphisms [Single nucleotide polymorphism (SNP) - 938 C/A (rs4988453), MyD 88 SNP 1944 C/G (rs4988457)] were analyzed in both the study and control groups. Results: The C/C genotype of MyD 88 SNP -938 was significantly more common than the C/A genotype in the patient group (p=0.002). No statistically significant difference in the frequency of the MyD 88 SNP 1944 genotype was found between the study and control groups (p=0.272). Conclusion: Gene polymorphism studies could elucidate our understanding of sepsis in terms of prevalence and the managementof treatment. It was shown in this study that children with the MyD 88 SNP -938 C/C genotype had a greater tendency toward sepsis. However, additional studies should be performed