NAMIK NEBİ ÖZCAN, Müge TÜRKOĞLU, Bülent BALTACI, Çetin KAYMAK, Hülya BAŞAR

Metanol zehirlenmesi sonrasında gelişen akut böbrek yetmezliği

Giriş: Metil alkol (metanol), karbonmonoksitin katalitik redaksiyonu ile sentetik olarak elde edilen toksik bir alkoldür. Metanol zehirlenmesinde, akut böbrek yetmezliği terminal bir komplikasyon olarak tanımlanır. Bu çalışmada, metanol zehirlenmesi sonrasında akut böbrek yetmezliği gelişen bir olgunun sunulması amaçlanmıştır. Olgu: Otuzdört yaşında erkek hasta, içeriği bilinmeyen, alkol alımından 10 saat sonra hastanemiz acil servisine başvurdu. Hastanın arteriyel kan gazında (AKG) Pa02: 111 mm Hg, PaC02: 22 mmHg, pH: 7.00, HC03: 6 mmol L' ve derin anyon açığının da olması üzerine acil hemodiyaliz planlandı. Hemodiyaliz sonrası AKG'de Pa02: 80 mm Hg, PaC02: 21 mmHg, pH: 7.36, HC03:11 mmol L' olarak bulundu. Ancak kan metanol düzeyinin halen 30 mg dL' olması üzerine hastaya fomepizol tedavisi başlandı. Yatışının 5. günü AKG'de Pa02: 74 mmHg, PaC02: 26 mmHg, pH: 7.43, HC03:17 mmol L1 olan ve genel durumu düzelen hastanın biyokimyasal değerlerinde üre: 149 mg dL'1, kreatinin: 4.6 mg dL', ürik asit: 10.4 mg dL'1 olarak en yüksek değerlerine ulaştı. Hemodiyaliz yapılmadan takip edilen hastanın yatışının 14. gününde üre: 24 mg dL'1, kreatinin: 1.36 mg dL'1, ürik asit: 5.2 mg dL1 olması üzerine taburcu edilmesine karar verildi. Sonuç: Metanol zehirlenmelerinde akut böbrek yetmezliği gelişebilir. Erken hemodiyaliz uygulamalarıyla akut böbrek yetmezliği gelişiminin önlenebilmesi mümkündür.

Acute renal failure following methanol poisoning

Introduction: Methyl alcohol (methanol), is a toxic alcohol synthesized by catalytic reduction of carbon monoxide. Acute renal failure is defined as a terminal complication in methanol poisoning. Presentation of a case who developed acute renal failure following methanol poisoning is aimed in recent study. Case: Thirty four years old male was referred to our hospitals emergency service 10 hours after ingestion of alcohol with unidentified ingredient. Because ofPa02: 111 mm Hg, PaC02: 22 mmHg, pH: 7.00, HC03: 6 mmol L1 in arterial blood and with high anion gap, urgent hemodialysis was planned. Pa02: 80 mm Hg, PaC02: 21 mmHg, pH: 7.36, HC03: 11 mmol L' after hemodialysis. Since the blood methanol level was still 30 mg dL'1 fomepizol therapy is initiated. At the fifth day of admittance blood gas analysis revealed Pa02: 74 mmHg, PaC02: 26 mmHg, pH: 7.43, HC03:17 mmol L' and renal function tests reached peak values as; urea: 149 mg dL'1, ere: 4.6 mg dL1, uric acid: 10.4 mg dL'1. Until the 14th day of admittance patient was followed up without hemodialysis and since kidney function tests were urea: 24 mg dL'1, ere: 1.36 mg dL'1, uric acid: 5.2 mg dL' decision was made to discharge from hospital. Conclusion: Acute renal failure may develop following methanol intoxication. It is possible to prevent development of acute renal failure with early hemodialysis interventions.

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