Pulmonary Toxicity Secondary to Amiodarone Use

Amiodarone is an antiarrhythmic medication used for the treatment of ventricular tachycardia. In addition to unwanted effects in many tissues, one of the most important side effects of the drug is pulmonary toxicity. Toxicity may develop at any time after administration to the drug, and the risk increases depending on the dose and duration of the treatment. Clinical and laboratory findings are non-specific. In treatment, amiodarone is discontinued. In severe cases, corticosteroid therapy can be started. Here, we present the case of a patient who was followed up for two years for hypertrophic cardiomyopathy and presented to the pediatric emergency department with hemoptysis, dizziness clouding of consciousness and numb tongue. Amiodarone was used for two years to treat ventricular arrhythmia. The findings of the patient at presentation were thought to be due to amiodarone pulmonary toxicity. Amiodarone was stopped and corticosteroid therapy was initiated. Non-invasive mechanical ventilation was applied for 3 days. On the 8th day of hospitalization, the patient was transferred to the ward. The aim of this case report was to draw attention to pulmonary toxicity due to amiodarone administration

Evaluation of nutritional status in pediatric intensive care unit patients: The results of a multicenter, prospective study in Turkey

IntroductionMalnutrition is defined as a pathological condition arising from deficient or imbalanced intake of nutritional elements. Factors such as increasing metabolic demands during the disease course in the hospitalized patients and inadequate calorie intake increase the risk of malnutrition. The aim of the present study is to evaluate nutritional status of patients admitted to pediatric intensive care units (PICU) in Turkey, examine the effect of nutrition on the treatment process and draw attention to the need for regulating nutritional support of patients while continuing existing therapies.Material and MethodIn this prospective multicenter study, the data was collected over a period of one month from PICUs participating in the PICU Nutrition Study Group in Turkey. Anthropometric data of the patients, calorie intake, 90-day mortality, need for mechanical ventilation, length of hospital stay and length of stay in intensive care unit were recorded and the relationship between these parameters was examined.ResultsOf the 614 patients included in the study, malnutrition was detected in 45.4% of the patients. Enteral feeding was initiated in 40.6% (n = 249) of the patients at day one upon admission to the intensive care unit. In the first 48 h, 86.82% (n = 533) of the patients achieved the target calorie intake, and 81.65% (n = 307) of the 376 patients remaining in the intensive care unit achieved the target calorie intake at the end of one week. The risk of mortality decreased with increasing upper mid-arm circumference and triceps skin fold thickness Z-score (OR = 0.871/0.894; p = 0.027/0.024). The risk of mortality was 2.723 times higher in patients who did not achieve the target calorie intake at first 48 h (p = 0.006) and the risk was 3.829 times higher in patients who did not achieve the target calorie intake at the end of one week (p = 0.001). The risk of mortality decreased with increasing triceps skin fold thickness Z-score (OR = 0.894; p = 0.024).ConclusionTimely and appropriate nutritional support in critically ill patients favorably affects the clinical course. The results of the present study suggest that mortality rate is higher in patients who fail to achieve the target calorie intake at first 48 h and day seven of admission to the intensive care unit. The risk of mortality decreases with increasing triceps skin fold thickness Z-score

Parsiyel epilepsili çocuk hastalarda klinik, elektroensefalografi (EEG), bilgisayarlı beyin tomografisi (BBT), manyetik rezonans görüntüleme (MRG), single photon emission tomografi (SPECT) ilişkisi

TEZ1973Tez (Uzmanlık) -- Çukurova Üniversitesi, Adana, 1998.Kaynakça (s. 47-50) var.50 s. : rnk. res. ; 30 cm.

Mekanik ventilatör kullanımı ile ilişkili izole bir pnömoperitonyum olgusu

Periton kavitesinde serbest havanın bulunması olarak tanımlanan pnömoperitonyuma gastrointestinal perforasyon, mekanik ventilator tedavisi, kardiyopulmoner resusitasyon, pnömotoraks, trakea rüptürü, median sternotomi ve maske balon uygulaması neden olabilir. Çocuk Yoğun Bakım Ünitesine büyük damar transpozisyonu, ventriküler septal defekt, pnömoni ve sepsis nedeni ile yatırılan ve ventilatörde yüksek basınç ile solunum desteğine başlanan iki aylık hastada yatışının 3.gününde ani batın distansiyonu gelişti. Batın grafisinde diyafragma altında yaygın serbest hava görünümü vardı. Gastrointestinal sistemde perforasyon düşünülerek operasyona alınan hastada perforasyon saptanmadı ve penröz diren konuldu. 24 saat sonra çekilen grafide batın içi serbest havanın tamamen absorbe olduğu gözlendi. Hastada pnömoperitonyumun mekanik ventilator tedavisinin bir komplikasyonu sonucu geliştiği düşünüldü. Sonuç olarak ventilatörde izlenen ve pnömoperitonyum gelişen bir hastada cerrahi problemler yanısıra akla ventilator tedavi komplikasyonları da gelmelidir.Pneumoperitoneum is defined as the presence of free air in periton cavity and can be caused by gastrointestinal perforation, mechanical ventilator treatment, cardiopulmonary resuscitation, pneumothorax, tracheal rupture, median sternotomy and mask and bag ventilation. Two months old bay girl was admitted to Pediatric Intensive Care Unit for pneumonia, sepsis and transposition of great arteries and Ventricular Septal Defect. She was supported by high pressure ventilation and at third days of admission our unit, acute abdominal distention was observed. In abdominal X-ray there was free air below diahragma. She was operated for suspicious gastrointestinal perforation but no perforation was detected. Penrous drainage was performed and 24 hours later, air was completely absorbed. Pneumoperitoneum was possibly a complication of mechanical ventilatory support. In conclusion complication of ventilatory therapy must be concluded in the etiology of pneumoperitoneum

Hiperamonemili Üç Yenidoğan Bebekte Devamlı Venovenöz Hemodiafiltrasyon

Yenidoğan bebeklerde hiperamonemi, hipotoni, letarji, nöbetler ve koma ile karakterize ensefalopati tablosuna yol açabilir. Akut dekompanse olmuş hiperamonemi tedavisinde devamlı venovenöz hemodiafiltrasyon tedavi seçeneği olabilir. Burada hipotoni, konvülziyon ve hiperamonemi olan üç yenidoğan olgusu sunulmuştur.yaşamlarının ilk üç gününde amonyak değerleri 4609, 1023, 1949 microgram/ml idi. Devamlı venovenöz hemodiafiltrasyon ile başarılı bir şekilde tedavi edilerek tedavinin ilk 24 saatinde amonyak değerleri 268, 164 65 microgram/ml'ye azaltıldı.hafif hipotermi ve anemi komplikasyon olarak saptandı.In newborns, hyperammonemia leads to encephalopathy which is usually characterized by vomiting, hypotonia, lethargy, seizures and coma. Continuous venovenous hemodiafiltration (CVVHDF) is a modality choice to treat acute decompensation in hyperammonemia. Here we report three newborn patients with hypotonia, convulsion and hyperammonaemia. In the first three days of life, their serum ammonia levels were 4609, 1023 and 1949 mg/ml. They were successfully treated with CVVHDF and serum ammonia levels subsequently decreased to 268, 164 and 65 mg/ml in the first 24 hours of treatment. The complications were mild hypothermia and anemia

Presented of acute abdominal pain of a case with acute transverse myelitis

Akut transvers miyelit duyu kaybı, sfinkter kusuru ve ekstremi-telerde ilerleyici güçsüzlük ile karakterize bir hastalıktır. Ateş, miyalji, sırt ağrısı, bacak ağrısı, parestezi ve güçsüzlük yakınmaları en sık görülen başvuru nedenleridir. Biz bu makalede karın ağrısı ile başvuran ve akut transvers miyelit semptomları gelişen 13 yaşındaki bir kız çocuğunu sunuyoruz. Plazmaferez, intravenöz immünglobulin ve pulse steroid tedavisinin uygulanmasının ardından semptomları azaldı. Bu olgu bilindiği kadarıyla akut batın tablosu ile başvuran ve akut transvers miyelit saptanan ilk olgudur.Acute transverse myelitis is characterized by paresthesia, sphincter dysfunction, and progressive weakness in the all extremities. Fever, miyalgia, back pain, lower limb pain, parapa-resia, and weakness were the most common clinical presentations. We report 13-year-old girl with transverse myelitis who presented with acute abdominal pain. Sphincter dysfunction and weakness improved more slowly than plasmapheresis, intravenous immunglobuline, and methylprednisone pulse therapy were performed. This is the first report, to our knowledge, first presented of acute abdominal pain of a pediatric patient with transverse myelitis

Brucellosis case with thrombocytopenia

Brusellozisde hematolojk komplikasyonlar görülür ve bunlardan biri de trombositopenidir. Biz burada hepatomegali, splenomegali, lenfadenopati, periferik yaymada dev trombositler ve kemik iliği incelemesinde megakaryositer seride artış olan trombositopeni ile seyreden bir Brusella olgusu sunduk.Heametologic complications of brucellosis is seen and thromboyctopenia is the one. Here, we report a brucellosis one with trombocytopenia who had hepatosplenomegaly, lympadenopaty and peripheral blood smear contained giant platelets, examination of bone marrow showed elevating numbers of megakaryocytes

A Pediatric Case of Post Traumatic Pulmonary Thromboembolism

Düşme sonrası sol alt ekstremite lateralinde yumuşak doku hasarı meydana gelen 10 yaşındaki erkek hasta, iki gün sonra gelişen yan ağrısı, göğüs ağrısı, solunum sıkıntısı ve ateş yakınmasıyla acil servise başvurdu. Yapılan fizik muayene, laboratuvar, Doppler ultrasonografi ve bilgisayarlı tomografi incelemeleri sonucu derin ven trombozu ve pulmoner tromboemboli tanısı kondu. Hastaya 6 saatlik doku plazminojen aktivatörü infüzyonu başlandı, daha sonra damar içi fraksiyone olmayan düşük molekül ağırlıklı heparin tedavisi verildi. Takibinde solunum sıkıntısı gerileyen hasta servise devredildi. Travma geçiren çocuklarda, çocukluk çağında oldukça nadir görülen fakat mortalitesi yüksek olan derin ven trombozu ve pulmoner tromboemboli gelişimi açısından dikkat edilmelidir.A 10-year-old male patient with a fall-related soft tissue injury of the lateral lower left extremity was admitted to the emergency room with the complaints of flank pain, chest pain, respiratory distress and fever developing two days later. The patient was diagnosed with deep vein thrombosis and pulmonary embolism after physical examination, findings of laboratory tests, Doppler ultrasonography and computed tomography. The treatment was initiated with the infusion of tissue plasminogen activator for 6 hours, and continued with intravenous unfractionated low-molecular-weight heparin. After the respiratory distress was improved, the patient was transferred to the pediatric hematology ward. Care should be taken in these quite rare, yet highly fatal conditions known as deep vein thrombosis and pulmonary embolism in traumatized children

A Pediatric Case of Post Traumatic Pulmonary Thromboembolism

A 10-year-old male patient with a fall-related soft tissue injury of the lateral lower left extremity was admitted to the emergency room with the complaints of flank pain, chest pain, respiratory distress and fever developing two days later. The patient was diagnosed with deep vein thrombosis and pulmonary embolism after physical examination, findings of laboratory tests, Doppler ultrasonography and computed tomography. The treatment was initiated with the infusion of tissue plasminogen activator for 6 hours, and continued with intravenous unfractionated low-molecular-weight heparin. After the respiratory distress was improved, the patient was transferred to the pediatric hematology ward. Care should be taken in these quite rare, yet highly fatal conditions known as deep vein thrombosis and pulmonary embolism in traumatized children

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