Yoğun bakım ünitesindeki metanol intoksikasyonlarının mortalitesi
Yoğun bakımımızdaki 10 metanol intoksikasyonu olgusu retrospektif olarak incelenmiştir. Hastalar; koma, stupor, metabolik asidoz, solunum yetmezliği ve hemodinamik bozukluk nedeniyle yoğun bakıma alınmışlardır. Bütün hastalarda derin metabolik asidoz, 20 mmol L-1 den daha fazla.anyon gap ve 247 mOsm kg-1 H2O'dan daha büyük ozmolalite bulunmaktaydı. Hastaların tedavisinde standart destek tedavi, metabolik asidozun düzeltilmesi, folik asit, etanol verilmesi ve hemodiyaliz uygulanmıştır. Hastaların dördü yaşamış, altısı kaybedilmiştir. Ölen grupta, Glascow Koma Skalası (GKS) 3, anyon gap 39.36 ± 6.14 mmol L-1 ve hastaneye geliş süreleri 24 saatten daha uzun zamanda olmuştur. Yaşayan grupta, GKS 14, anyon gap 27.45 ± 6.79 mmol L1 ve hastaneye geliş süreleri 4 saat içerisinde olmuştur. Erken tanı ve hemen tedavinin başlaması, 4 hastanın başarılı bir şekilde hayatının kurtulmasını sağlamıştır. Düşük GKS değeri ve geç hastaneye yatırmanın, mortalitede rol alan önemli faktörler olduğu düşünülmüştür.
Mortality of methanol introxication cases in the intensive care unit
In this report, a series of ten cases of methanol intoxication in our intensive care unit are presented. The patients were admitted to ICU because of conta, stupor, metabolic acidosis, respiratory insufficiency and hemodynamic instability. All oft he patients had profound metabolic acidosis, an anion gap greater than 20 mmol L-1 and osmolality greater than 247 mOsm kg-1 H2O. Standard supportive care, correction of metabolic acidosis, folic acid and ethanol administration, and hemodialysis were carried out for the management of these patients. Four patients recovered, but six patients died. Among the patients who died, Glascow Coma Scala (GCS) scores yere 3, the anion gap 39.36 ± 6.14 mmol L-1 and the time lapse before hospital admission was longer than 24 hours. Among the patients who survived GCS points were 14, the anion gap 27.45 ± 6.79 mmol L-1 and the time lapse for hospital admission was less than 4 hours. Early diagnosis and prompt initiation of treatment led to successful recovery in four of the patients. Low GCS scores and delayed hospitalization were thought to play an important role in the mortality of the other patients.
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