Ülkü Sabuncu, R. Abdullayev, M. Duran, Abuzer Güler, H. Kuşderci
Tricyclic antidepressants (TADs) are widely used drugs for different indications such as depression, neuropathic pain, nocturnal enuresis, obsessive-compulsive, panic and attention deficit hyperactivity disorders. These agents are the most prescribed drugs following selective serotonin reuptake inhibitors for depression (1). Taken in high doses either on purpose or accidentally they can result in serious morbidity and mortality. Data of 2008 from Turkey’s National Poison Consultation Center reveals that amitriptyline ranks 3rd, after paracetamol and combined upper respiratory tract infection treatment drugs, according to the classification made by reference active ingredient (2). Amitriptyline increases noradrenaline and serotonin levels by inhibiting their reuptake from the synaptic cleft (3). It also blocks adrenergic, histaminergic, central and peripheral cholinergic receptors. Toxicity symptoms are the results of the effects of amitriptyline in different systems. Dryness and metallic taste in the mouth, mydriasis, constipation, urinary retention, respiratory depression, and decreased cognitive functions and tachycardia occur due to the cholinergic receptor blockade. Weight gain, sedation and depression ABSTRACT Tricyclic antidepressants are widely used drugs for treatment of depression despite serious mortality and morbidity in higher doses. They can cause severe cardiac arrhythmias, hypotension and central nervous system depression. Some patients may remain unresponsive in spite of conventional therapies such as gastric lavage and activated charcoal administration, benzodiazepines, volume replacement, lidocaine and sodium bicarbonate infusion. In this paper we report a 20-year-old female patient who had severe amitriptyline intoxication with a Glasgow Coma Scale score 4 and severe cardiac arrhythmias and was treated with hemodiafiltration. Conventional therapy was inadequate and hemodiafiltration was applied to the patient for 36 hours. At the end of the 36-hours the patient was conscious and became stabilized in terms of hemodynamics. In case of serious intoxication that does not respond to conventional therapy, approaches like hemodialysis, plasmapheresis, hemoperfusion and hemodiafiltration can be a rescue therapy and they should be considered.
{"title":"Hemodiafiltration Practice in a Patient with Severe Amitriptyline Intoxication","authors":"Ülkü Sabuncu, R. Abdullayev, M. Duran, Abuzer Güler, H. Kuşderci","doi":"10.4274/tybd.32559","DOIUrl":"https://doi.org/10.4274/tybd.32559","url":null,"abstract":"Tricyclic antidepressants (TADs) are widely used drugs for different indications such as depression, neuropathic pain, nocturnal enuresis, obsessive-compulsive, panic and attention deficit hyperactivity disorders. These agents are the most prescribed drugs following selective serotonin reuptake inhibitors for depression (1). Taken in high doses either on purpose or accidentally they can result in serious morbidity and mortality. Data of 2008 from Turkey’s National Poison Consultation Center reveals that amitriptyline ranks 3rd, after paracetamol and combined upper respiratory tract infection treatment drugs, according to the classification made by reference active ingredient (2). Amitriptyline increases noradrenaline and serotonin levels by inhibiting their reuptake from the synaptic cleft (3). It also blocks adrenergic, histaminergic, central and peripheral cholinergic receptors. Toxicity symptoms are the results of the effects of amitriptyline in different systems. Dryness and metallic taste in the mouth, mydriasis, constipation, urinary retention, respiratory depression, and decreased cognitive functions and tachycardia occur due to the cholinergic receptor blockade. Weight gain, sedation and depression ABSTRACT Tricyclic antidepressants are widely used drugs for treatment of depression despite serious mortality and morbidity in higher doses. They can cause severe cardiac arrhythmias, hypotension and central nervous system depression. Some patients may remain unresponsive in spite of conventional therapies such as gastric lavage and activated charcoal administration, benzodiazepines, volume replacement, lidocaine and sodium bicarbonate infusion. In this paper we report a 20-year-old female patient who had severe amitriptyline intoxication with a Glasgow Coma Scale score 4 and severe cardiac arrhythmias and was treated with hemodiafiltration. Conventional therapy was inadequate and hemodiafiltration was applied to the patient for 36 hours. At the end of the 36-hours the patient was conscious and became stabilized in terms of hemodynamics. In case of serious intoxication that does not respond to conventional therapy, approaches like hemodialysis, plasmapheresis, hemoperfusion and hemodiafiltration can be a rescue therapy and they should be considered.","PeriodicalId":392452,"journal":{"name":"Türk Yoğun Bakım Dergisi","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129986952","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"The Evaluation of the Effects of Erythrocyte Transfusion on Central Venous Oximetry in Major Surgery Patients","authors":"E. Gasimov, Ahmet K Koltka, N. Sivrikoz, A. Çamcı","doi":"10.4274/TYBD.95914","DOIUrl":"https://doi.org/10.4274/TYBD.95914","url":null,"abstract":"","PeriodicalId":392452,"journal":{"name":"Türk Yoğun Bakım Dergisi","volume":"94 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129232081","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Acute Renal Failure Due to Metformin Intoxication: Case Report","authors":"Ç. Kocaoğlu, A. Ozel","doi":"10.4274/TYBD.26818","DOIUrl":"https://doi.org/10.4274/TYBD.26818","url":null,"abstract":"","PeriodicalId":392452,"journal":{"name":"Türk Yoğun Bakım Dergisi","volume":"16 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127688650","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Helin Şahintürk, A. Ozdemirkan, F. Kilic, Onur Ozalp, H. Arslan, P. Zeyneloğlu, A. Pirat
Objective: The aim of the study was to assess the outcomes of intensive care unit acquired extensively drug-resistant (XDR) bacterial infections in a surgical patient cohort. Materials and Methods: The data of patients with XDR bacteria isolated at Başkent University Hospital, Anesthesia and Surgical Intensive Care Unit between January 2016 and December 2016 were reviewed retrospectively. Adult patients over 18 years of age who had undergone surgery within the first 24 hours and who developed intensive care unit infection 48 hours after admission to intensive care unit were included in the study. Results: All of the 341 patients who admitted to the surgical intensive care unit during the study period were underwent surgery within the first 24 hours. XDR bacterial infections were isolated in 30 out (9%) of these 341 patients. The mean APACHE II score was calculated as 18.5±5.3, and expected mean mortality rate of 35±17.1. The mean length of intensive care unit stay was 27.0±27.4 days, while the mean hospital stay was 49.0±34.3 days. The hospital mortality rate was found to be 57% (n=7). Conclusion: As a conclusion of our study, we found that XDR bacterial infections were common (9%) among intensive care surgical patients and their mortality rate was higher than their expected mortality rate according to their APACHE II scores calculated during intensive care unit admission (57% vs. 35%, respectively).
{"title":"The Effect of Extensively Drug-resistant Infections on Mortality in Surgical Intensive Care Patients","authors":"Helin Şahintürk, A. Ozdemirkan, F. Kilic, Onur Ozalp, H. Arslan, P. Zeyneloğlu, A. Pirat","doi":"10.4274/TYBD.73636","DOIUrl":"https://doi.org/10.4274/TYBD.73636","url":null,"abstract":"Objective: The aim of the study was to assess the outcomes of intensive care unit acquired extensively drug-resistant (XDR) bacterial infections in a surgical patient cohort. Materials and Methods: The data of patients with XDR bacteria isolated at Başkent University Hospital, Anesthesia and Surgical Intensive Care Unit between January 2016 and December 2016 were reviewed retrospectively. Adult patients over 18 years of age who had undergone surgery within the first 24 hours and who developed intensive care unit infection 48 hours after admission to intensive care unit were included in the study. Results: All of the 341 patients who admitted to the surgical intensive care unit during the study period were underwent surgery within the first 24 hours. XDR bacterial infections were isolated in 30 out (9%) of these 341 patients. The mean APACHE II score was calculated as 18.5±5.3, and expected mean mortality rate of 35±17.1. The mean length of intensive care unit stay was 27.0±27.4 days, while the mean hospital stay was 49.0±34.3 days. The hospital mortality rate was found to be 57% (n=7). Conclusion: As a conclusion of our study, we found that XDR bacterial infections were common (9%) among intensive care surgical patients and their mortality rate was higher than their expected mortality rate according to their APACHE II scores calculated during intensive care unit admission (57% vs. 35%, respectively).","PeriodicalId":392452,"journal":{"name":"Türk Yoğun Bakım Dergisi","volume":"23 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128251307","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ayşe Güsün Halitoğlu, Mukaddes Saba Saygılı, A. Kaya, M. Tercan
Objective: This study aims to determine the extent to which the timing of apnea test has influence on the organ donation of those patients diagnosed with the brain death (BD) at University of Health Sciences, Şanlıurfa Mehmet Akif İnan Training and Research Hospital between the years of 2006-2017. Materials and Methods: One hundred and five patients diagnosed with BD between the years of 2006-2017 were analyzed retrospectively. Since the sample is limited to the national population, 13 Syrian cases are excluded from the study. The demographic characteristics of the cases, their clinical diagnoses, elapsed time between intensive care hospitalization and apnea test, duration between apnea test and cardio-circulatory arrest, elapsed time between apnea test and BD council decision time, Glasgow coma scores at first visit, APACHE II scores were recorded. Results: Of the ninety two cases evaluated in the study, 33 (35.9%) were female and 59 (64.1%) were male. While the most frequent diagnosis during the admission to the intensive care unit was trauma with 52.2% (n=48), the rest was found as stroke with 35.9% (n=33), anoxic brain injury after cardiopulmonary resuscitation with 6.5% (n=6), and asphyxia with 5.4% (n=5) respectively. Among the patients who have been diagnosed with BD, 12% of the family accepted organ donation. In the cases who accept organ donation; the median time from the first hospitalization in the intensive care unit to the time that the apnea test was positive is 57 hours whereas the median time is 86.8 hours when the organ donation is rejected (p>0.05). Conclusion: Whereas the number of patients diagnosed with BD in our hospital increases over the years, the organ donation rate is insufficient compared to the western part of the country.
目的:本研究旨在确定2006-2017年健康科学大学Şanlıurfa Mehmet Akif İnan培训与研究医院的呼吸暂停测试时间对脑死亡(BD)患者器官捐赠的影响程度。材料与方法:回顾性分析2006-2017年间诊断为BD的105例患者。由于样本仅限于全国人口，13例叙利亚病例被排除在研究之外。记录病例的人口学特征、临床诊断、重症监护住院至呼吸暂停测试的间隔时间、呼吸暂停测试至心脏循环骤停的间隔时间、呼吸暂停测试至BD委员会决定时间的间隔时间、首次就诊时格拉斯哥昏迷评分、APACHE II评分。结果:本组92例患者中，女性33例(35.9%)，男性59例(64.1%)。重症监护病房入院时最常见的诊断是外伤，占52.2% (n=48)，其余分别为中风(35.9%)(n=33)、心肺复苏后缺氧脑损伤(6.5%)(n=6)和窒息(5.4%)(n=5)。在被诊断为双相障碍的患者中，12%的家庭接受了器官捐赠。接受器官捐献的;从首次入住重症监护病房到呼吸暂停试验阳性的中位数时间为57小时，而器官捐献被拒绝的中位数时间为86.8小时(p>0.05)。结论:我院BD患者逐年增加，但器官捐献率与西部地区相比仍显不足。
{"title":"Does Early Apnea Test Have an Effect on the Organ Donation?","authors":"Ayşe Güsün Halitoğlu, Mukaddes Saba Saygılı, A. Kaya, M. Tercan","doi":"10.4274/tybd.36854","DOIUrl":"https://doi.org/10.4274/tybd.36854","url":null,"abstract":"Objective: This study aims to determine the extent to which the timing of apnea test has influence on the organ donation of those patients diagnosed with the brain death (BD) at University of Health Sciences, Şanlıurfa Mehmet Akif İnan Training and Research Hospital between the years of 2006-2017. Materials and Methods: One hundred and five patients diagnosed with BD between the years of 2006-2017 were analyzed retrospectively. Since the sample is limited to the national population, 13 Syrian cases are excluded from the study. The demographic characteristics of the cases, their clinical diagnoses, elapsed time between intensive care hospitalization and apnea test, duration between apnea test and cardio-circulatory arrest, elapsed time between apnea test and BD council decision time, Glasgow coma scores at first visit, APACHE II scores were recorded. Results: Of the ninety two cases evaluated in the study, 33 (35.9%) were female and 59 (64.1%) were male. While the most frequent diagnosis during the admission to the intensive care unit was trauma with 52.2% (n=48), the rest was found as stroke with 35.9% (n=33), anoxic brain injury after cardiopulmonary resuscitation with 6.5% (n=6), and asphyxia with 5.4% (n=5) respectively. Among the patients who have been diagnosed with BD, 12% of the family accepted organ donation. In the cases who accept organ donation; the median time from the first hospitalization in the intensive care unit to the time that the apnea test was positive is 57 hours whereas the median time is 86.8 hours when the organ donation is rejected (p>0.05). Conclusion: Whereas the number of patients diagnosed with BD in our hospital increases over the years, the organ donation rate is insufficient compared to the western part of the country.","PeriodicalId":392452,"journal":{"name":"Türk Yoğun Bakım Dergisi","volume":"86 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127135727","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Despite improvements in medical and surgical treatment, aneurysmatic subarachnoid hemorrhage (SAH) remains one of the main causes of early mortality. Cardiac and pulmonary complications are the main causes of mortality. One of the most severe cardiac complications is neurogenic stress cardiomyopathy. Left ventricular dysfunction which is seen in neurogenic stress cardiomyopathy, although it is usually reversible within a few days, can cause severe hypotension, pulmonary edema and cardiogenic shock. Traditional treatment of heart failure after SAH is based on the use of noradrenaline, dobutamine and high volume of fluids. However, it is difficult to treat reduced cardiac output in SAH. Because, myocardial cells are already under stress due to increased adrenergic stimulation. The use of exogenous catecholamines may cause additional neurocardiogenic damage in myocardial cells, excessive calcium burden, decreased cerebral blood flow, and delayed cerebral ischemia. By reducing the use of exogenous catecholamines with levosimendan, the vicious circle of cardiotoxicity induced by catecholamines can be broken. Levosimendan is a nonadrenergic inotropic calcium sensitizer that allows rapid recovery of cardiac output and optimizes cerebral perfusion without increasing myocardial oxygen consumption. If we consider that reduction in left ventricular systolic function plays a role in the pathogenesis of delayed cerebral ischemia, the risk of developing neurological complications may be reduced by administration of levosimendan in these patients. Moreover, new evidence from experimental studies also indicates that levosimendan may have neuroprotective effects in the SAH. In this review, the use of levosimendan in the treatment of hemodynamic disorders which develops in the course of SAH has been discussed in company with current literature.
{"title":"Can Levosimendan Be a Treatment Option in Subarachnoid Hemorrhage?","authors":"T. Mengi, B. Yılmaz, A. N. Gokmen, U. Koca","doi":"10.4274/TYBD.05025","DOIUrl":"https://doi.org/10.4274/TYBD.05025","url":null,"abstract":"Despite improvements in medical and surgical treatment, aneurysmatic subarachnoid hemorrhage (SAH) remains one of the main causes of early mortality. Cardiac and pulmonary complications are the main causes of mortality. One of the most severe cardiac complications is neurogenic stress cardiomyopathy. Left ventricular dysfunction which is seen in neurogenic stress cardiomyopathy, although it is usually reversible within a few days, can cause severe hypotension, pulmonary edema and cardiogenic shock. Traditional treatment of heart failure after SAH is based on the use of noradrenaline, dobutamine and high volume of fluids. However, it is difficult to treat reduced cardiac output in SAH. Because, myocardial cells are already under stress due to increased adrenergic stimulation. The use of exogenous catecholamines may cause additional neurocardiogenic damage in myocardial cells, excessive calcium burden, decreased cerebral blood flow, and delayed cerebral ischemia. By reducing the use of exogenous catecholamines with levosimendan, the vicious circle of cardiotoxicity induced by catecholamines can be broken. Levosimendan is a nonadrenergic inotropic calcium sensitizer that allows rapid recovery of cardiac output and optimizes cerebral perfusion without increasing myocardial oxygen consumption. If we consider that reduction in left ventricular systolic function plays a role in the pathogenesis of delayed cerebral ischemia, the risk of developing neurological complications may be reduced by administration of levosimendan in these patients. Moreover, new evidence from experimental studies also indicates that levosimendan may have neuroprotective effects in the SAH. In this review, the use of levosimendan in the treatment of hemodynamic disorders which develops in the course of SAH has been discussed in company with current literature.","PeriodicalId":392452,"journal":{"name":"Türk Yoğun Bakım Dergisi","volume":"34 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121153012","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：