Lithium poisoning: Is the lithium level a guide?

Objective: The aim of the study was to analyze the lithium levels relation with clinical findings and treatment selection in lithium poisonings that were admitted to Department of Emergency Medicine in Dokuz Eylul University Hospital (EMDEU). Methods: The lithium poisoning cases distribution, epidemiologic characteristics, clinical findings, methods of management, length of hospital stay admitted to EMDEU between January 1993 and January 2010 scanned retrospectively from the patient charts. Results: The mean age of the 18 patients diagnosed by lithium poisoning was 34.6 +/- 18.2, female/ male ratio was 2.6. Suicide (50.0%), overdose use (22.2%), accidental (5.6%) and the unknown exposures (11.1%) were the masons of poisonings. Of the eight patients (38.9%) were exposed only lithium, 10 (55.6%) of them were exposed multidrug. The 38.9% (n=7) of the poisoning were chronic, 27.8% (n=5) of them were acute poisonings. Suicide was common under 40 years (chi(2)=8.42, p=0.001). The admission reason in all of patients older than 40 years was chronic poisoning. There were non spesific ST-T alterations in 8 patients (44.4%). Lithium levels were toxic in 14 patients (77.8%). The treatments were gastric layage (GL) and supportive treatment in five patients (27.8%), GL and activated charcoal in two patients (11.1%), hemodialysis and supportive treatment in three patients (16.7%) and only supportive treatment in nine patients (50.0%). Fourteen patients (77.8%) were discharged after observation in emergency service. Although the treatment with hemodialysis and supportive treatment in intensive care, 52 years old man was died. Conclusion: There isn't significant interaction between the lithium levels and clinical findings in every lithium poisoning cases. But older patients have chonic lithium poisonings show frequent neurologic symptoms. Treatment must arrange according to clinical findings besides lithium levels in existence of multidrug use, other diseases and renal function disorders. (Anatolian Journal of Psychiatry 2011; 12:198-203

Evaluation of the radiocontrast nephropathy development due to the contrast-enhanced CT applications in emergency department

Aim: We aimed to determine the incidence of post-contrast acute kidney injury (PC-AKI), the demographic characteristics of patients, and the reasons that facilitate the development of PC-AKI in patients who were admitted to the emergency department and underwent computed tomography (CT) with intravascular contrast media. Material and Methods: This study is a retrospective, cross-sectional and analytical study. Patients over the age of 18 who underwent CT with intravascular contrast media and were hospitalized for at least 48 hours were included in this study. The development of PC-AKI and the clinical and demographic characteristics of the patients were evaluated.Results: A total of 816 patients were included in the study. Thirty-six (4.4%) patients developed PC-AKI. We found that the average length of hospital stay was 22.2 +/- 41.7 days. Patients with a history of hypertension (HT) and diabetes mellitus (DM) and who had hypotension on admission to the emergency department were found to have a higher risk of developing PC-AKI (p<0.05 for all of them). The development of PC-AKI was significantly higher in patients receiving ACE inhibitors (p=0.004). When the clinical outcomes of the patients with PC-AKI were evaluated, it was observed that 47.2% (n=17) of them died. Mortality was statistically significantly higher in patients with PC-AKI than in the patients without PC-AKI (p<0.0001). Discussion: PC-AKI led to an increase in the length of hospital stay of patients. The patients with PC-AKI had a higher mortality rate compared with the patients without PC-AKI

The value of serum acetylcholinesterase level for clinical and mortality in patients with organophosphate toxicitiy

Objectives The aim of study is to evaluate the relationship between theserum acetylcholinesterase (AChE) level and the clinical course andmortality in patients who presented to the university hospitalemergency department with organophosphate and carbamate toxicitybetween June 1993 and June 2007.Methods All patients who presented to the hospital emergencydepartment with organophosphate and carbamate toxicity betweenJune 1993 and June 2007 were included in this retrospective analyticstudy. Demographic characteristics, type of toxic agent, route and reasonfor the exposure, clinical signs and findings, serum AChE levels,mechanical ventilation requirements, complications that developed andoutcome of the patients were analyzed.Results A total of 108 patients were included in this study. Themean age was 34.1 ± 18.6 and the male/female ratio was 1.57. The meanserum AChE level was 3167 ± 3503 IU/l. (31–13685 IU/l) The meanserum AChE level in the patients who required mechanical ventilationwas significantly lower according to the patients who did not(1103.90 ± 1718.92, 3843.55 ± 3680.44 IU/l, P &lt; 0.01, respectively).The leading cause of complication was pneumonia which was detectedin 12 patients. The mean serum AChE level in the patients whodeveloped complications was significantly lower according to thepatients who did not (735.66 ± 985.81, 3589.95 ± 3613.61 IU/l,&nbsp;P &lt; 0.01, respectively). In this study 6 of our patients have died (%5.6).The mean serum AChE level of the patients who died was significantlylower according to the survival group (637.50 ± 502.55, 3369.46 ±3562.56 IU/l, P &lt; 0.01, respectively).Conclusion Our results indicate that lower serum AChE levels areassociated with higher risk of in-hospital mortality and complicatedclinical course in organophosphate and carbamate toxicity. The serumAChE level may be used as a valuable parameter in risk assessment inorganophosphate and carbamate intoxication.</p

Bir acil servisin kullanım özellikleri ve başvuran hastaların aciliyetinin hekim ve hasta açısından değerlendirilmesi

Objectives: Many patients present to emergency departments (ED) with nonurgent complaints. Inappropiate visits may contribute to emergency department overcrowding. This study aims to investigate the causes of inappropriate visits and to assess urgency from the patient and physician point of view. Materials and Methods: All consecutive adult patients referred to the ED during a 28-day period were enrolled in this cross sectional study. Demographic and socioeconomic variables and reasons for the visits were record;not;ed. NRS (Numeric Rating Scale) was used to rate perceptions regarding urgency of the current visit. Resident physicians taking care of the patients also rated their opinions of appropriateness of ED utilization on NRS. All patients were categorized as to their appropriateness for ED care. Results: 2.351 (92,8%) out of 2.533 patients provided complete data sets. 67.8% of visits were catagorized as appropriate for ED care by the resident. Lower NRS scores were encountered younger patients, women, single, with higher levels of educated and those who visited the ED for institutional reputation. Availability of health insurance did not contribute to a statistically significant difference with regarding appropriateness of visits. Patient and physician perceptions of appropriateness were significantly correlated. Conclusion: Our results show that there is agreement between patient and physician perception of urgency regarding ED visits. Availability of health insurance was not associated with less ;quot;inappropriate;quot; ED utilization. Single, female, educated patients with a higher socioeconomic standing visited the ED inappropriately more frequently. Future studies are required to futher investigate issues related to inappropriate visits.Giriş: Kesintisiz hizmet veren acil servislere herhangi bir yakınma ile çok sayıda hasta başvurmaktadır. Bu hastalar incelendiğinde başvuru nedeni acil olmayanların bulunduğu görülmektedir. Acil olmayan başvurular yoğun olan acil servislerin işleyişini olumsuz etkilemektedirler. Bu çalışma ile amaçlanan başvuruların aciliyetini irdelemek olduğu kadar başvuruların aciliyetinin hasta ve hekim bakış açısıyla nasıl algılandığını ortaya koymaktır. Gereç ve Yöntem: Bu çalışma bir analitik kesitsel çalışmadır. Yirmi sekiz günlük zaman dilimi içinde acil servise başvuran tüm hastaların demografik bilgileri, sosyoekonomik durumları yakınmaları ve yapılan inceleme ve girişimler hakkında bilgi toplandı. Ayrıca her hastadan aciliyetlerine yönelik olarak kendi düşüncelerini yansıtan puanları NRS (Numeric Rating Scale) ölçeği üzerinde belirtmeleri istendi. Hastadan sorumlu kıdemli ve kıdemsiz asistanlar da hastanın aciliyetine yönelik görüşlerini NRS ölçeği üzerinde bildirdiler. Çalışma sonunda her hasta için doldurulan formlar kategorilere göre değerlendirilerek incelendi. Hastaların başvurularının aciliyet yönünden uygunluğu, bir Acil Tıp Uzmanı tarafından belirlendi. Bulgular: Çalışma dönemi boyunca acil servise başvuran 2.533 hastanın 2.351'inden (%92,8) yeterli veri edinildi. Kullanılan kategori sınıflaması ve uzman kararı sonrasında başvuruların %67,8'i aciliyet açısından uygun bulundu. Gençlerin (17-39 yaş), kadınların, bekarların, eğitim düzeyi yüksek olanların ve acil servise güvendiği için başvuran hastaların aciliyet uygunluğunun daha düşük olduğu saptandı. Sosyal güvence grupları arasında ve gelir grupları arasında aciliyetin uygunluğu açısından anlamlı fark saptanmadı. Acil servisin en çok tercih sebebi güvenilir bulunmasıdır. Hastaların aciliyet algıları ile hekimlerinin değerlendirmeleri arasında istatistiksel olarak anlamlı fark saptandı. Sonuç: Uygun olmayan başvurular incelendiğinde genelde sosyoekonomik düzeyi yüksek olan hastaların acil servisi uygunsuz kullanımı gözlendi. Bu grup hastalar daha hızlı ve kaliteli hizmet talep etmeleriyle ilişkili olabilir. Acil servis hizmetlerinin güvenle sürdürülebilmesi için birinci basamak sağlık hizmetlerinin güçlendirilmesi gereklidir. Ülkemizde hastaların acil servisleri kullanımı konusunda ileri çalışmalara ihtiyaç olduğunu düşünmekteyiz