NİLÜFER ELDEŞ HACIFAZLIOĞLU, Gonca ÜSTÜNDAĞ, Ebru KUTSAL, Cumhur AYDEMİR, Tunç TUNÇER, Emine AMİROVA

Karbonmonoksit zehirlenmesinin geç nörolojik bulguları: Bir vaka sunumu

Karbonmonoksit; akut ya da kronik zehirlenmeye neden olabilen renksiz, kokusuz bir gazdır. Karbon monoksit zehirlenmesine bağlı beklenmeyen ölümler özellikle kış aylarında artmaktadır. Karbon monoksit dokulara oksijen sunumunu azaltır. Zehirlenmeden günler veya haftalar sonra görülen geç nörolojik bulgular karbonmonoksit zehirlenmesinin en önemli komplikasyonlarıdır. On üç yaşında kız çocuğu ajitasyon, gözlerde sola kayma, kol ve bacaklarında istemsiz hareketler, idrar kaçırma şikâyetleri ile çocuk acil polikliniğine başvurdu. Öyküsünden, beş gün önce şofbenden zehirlendiği öğrenildi. Yapılan ayrıntılı değerlendirmeler sonucu karbon monoksit zehirlenmesinin geç komplikasyonu olarak değerlendirilen hastanın bulguları uygun destek tedavisinden sonra düzeldi.

Anahtar Kelimeler:

Mannitol, Ergen, Karbonmonoksit zehirlenmesi, Deksametazon, Kadın, Tedavi sonucu

Late neurologic symptoms of carbonmonoxide intoxication: A case report

Carbon monoxide is colourless, odourless gas that can cause acute or chronic intoxication. Carbonmonoxide reduces oxygen delivery of tissues. Late neurologic symptoms of carbonmonoxide intoxication can occur days or even weeks after the patient has made a seemingly good recovery from the acute poisoning. The patient, a 13-years old female girl admitted to hospital with disorientation, hemiparesis, choreoathetosis. From her history, we learned that she was poisoned from geyser five days ago. On detailed evaluation the patient is diagnosed as the late neurological signs of carbonmonoxide intoxication. Symptoms of patient is improved after appropriate supportive management.

Keywords:

Mannitol, Adolescent, Carbon Monoxide Poisoning, Dexamethasone, Female, Treatment Outcome,

___

1. Wright J. Chronic and occult carbon monoxide poisoning: we don't know what we're missing. Emerg Med J 2002; 19: 386-90.
2. Hawkins M. Carbonmonoxide poisoning. A review. Eur J Anaesthesiology 1999; 16:585-9.
3. Menkes JH. Toxic and nutritional disorders. In: Menkes JH, Sam at HB, eds. Child Neurology. Philedelphia: Lippincott Williams, 2000: 749-50.
4.Ersanlı D, Yıldız S, Togrol E, et al. Visual loss as a late complication of carbonmonoxide poisoning and its successful treatment with hyperbaric oxygen therapy. Swiss Med Wkly 2004; 134: 650-5.
5.Lee ACW, Ou Y, Lam SY, So KT, Kam CW. Non-accidental carbon monoxide poisoning from burning charcoal in attempted combined homicide-suicide. J Paediatr Child Health 2002; 38:465-8.
6. Anane D, Chevret S, Jars-Guincestre M, et al. Prognostic Factors in unintentional mild carbonmonoxide poisoning. Intensive Care Med 2001; 27:1776-81.
7. Mark PD. Carbonmonoxide poisoning: Areview. S.P.U.M.S.J 1992; 22:127-35.
8. Choi IS. Parkinsonism after carbonmonoxide poisoning. Eur Neurol 2002; 48:30-3.
9. Park S, Choi IS. Chorea following acute carbon monoxide poisoning. Yonsei Med J 2004; 45:363-6.
10. Raphael JC, Bailey M, Myles PS, et al. Trial of normobaric and hyperbaric oxygen for acute carbonmonoxide poisoning: Lancet 1989; 2:414-9.
11. Scheinkestel CD, Bailey M, Myles Ps, et al. Hyperbaric and normobaric oxygen for acute carbonmonoxide poisoning: a randomized controlled clinical trial. Med J Aust 1999; 170:203-10.
12. Weaver LK, Hopkins RO, Larson-Lohr V, et al. Double blind, controlled, prospective, randomized trial (RCT) in patients with acute carbonmonoxide (CO) poisoning: outcome of patients treated with normobaric oxygen or hyperbaric oxygen (HBO')-an in term report. Undersea Hyperb Med 1995, abstract.
13. Ducasse JL, Celsis P, Marc Vergnes JP. Non comatose patients with acute carbonmonoxide poisoning: hyperbaric and normobaric oxygenation. Undersea Hyperb Med 1995; 22:9-15.
14. Thorn SR, Taber RL, Mendiguren II, et al. Delayed neuropsychologic sequelae after carbonmonoxide poisoning: prevention by treatment with hyperbaric oxygen. Ann Emerg Med 1995, 254:474-80.