Çocuk Acile Karbonmonoksit Zehirlenmesi ile Başvuran Hastaların Değerlendirilmesi

Amaç: Karbonmonoksit zehirlenmeleri özellikle kış mevsiminde zehirlenme ile çocuk acil servisine başvuruların önemli nedenlerinden biridir. Bu çalışmanın birincil amacı çocuk acil servisine karbonmonoksit zehirlenmesi ile başvuran çocuk hastaların demografik özellikleri ile klinik ve laboratuvar bulgularını değerlendirmek, ikincil amacı ise karbonmonoksit zehirlenmesine bağlı bilinç değişikliği gelişen hastaların laboratuvar değerlerini incelemektir. Gereç ve Yöntemler: 2017 ve 2020 yılları arasında çocuk acil servisine karbonmonoksit zehirlenmesi nedeniyle başvurmuş olan 162 hastanın demografik ve klinik özellikleri ile laboratuvar değerleri geriye dönük olarak incelendi. Bilinç değişikliği semptomu olan ve olmayan hastaların laboratuvar parametreleri karşılaştırıldı. Bulgular: Hastaların ortalama yaşı 8,94±5,33 yıl idi ve cinsiyet dağılımları homojendi. En yüksek başvuru sıklığı kış mevsimindeydi. Bulantı, kusma ve baş ağrısı en sık görülen semptomlardı. Hastaların on beşinde bilinç değişikliği vardı. Hastaların laboratuvar değerleri genel olarak normal aralıklarda iken karboksihemoglobin, laktat ve troponin değerleri yüksek olan ve pH değeri düşük olan hastalar da olduğu tespit edildi. Bilinç değişikliği olan hastaların karboksihemoglobin ve laktat düzeyi, bilinç değişikliği olmayan hastalara göre anlamlı şekilde daha yüksek bulundu (sırasıyla p<0,001 ve p=0,019). Sonuç: Yüksek karboksihemoglobin ve laktat seviyesi bilinç değişikliği ile ilişkili bulunmuştur. Karboksihemoglobin düzeyi tanı ve klinik takip için önemli olmakla birlikte tek başına bir belirteç olarak kullanılmamalıdır. Yüksek laktat ve troponin değerleri ve düşük pH değeri de dikkate alınmalıdır.

Anahtar Kelimeler:

karbonmonoksit, çocuk, Bilinç değişikliği, zehirlenme

Evaluation of Patients Presenting to the Pediatric Emergency Department with Carbon Monoxide Poisoning

Aim: Carbon monoxide poisoning is one of the significant causes of intoxication and presentation to pediatric emergency departments, especially in winter. The primary aim of this study was to evaluate the demographic characteristics, and clinical and laboratory findings of pediatric patients who presented to the pediatric emergency department with carbon monoxide poisoning, and the secondary aim was to examine the laboratory values of the patients with impaired consciousness. Material and Methods: The demographic and clinical characteristics and laboratory values of 162 patients presented to the pediatric emergency department due to carbon monoxide poisoning between 2017 and 2020 were retrospectively analyzed. The laboratory parameters of the patients with and without symptoms of impaired consciousness were compared. Results: The mean age of the patients was 8.94±5.33 years, and the gender distribution was homogenous. The highest frequency of presentation was during winter. Nausea, vomiting, and headache were the most common symptoms. Fifteen of the patients had impaired consciousness. While the laboratory values of the patients were generally within normal ranges, patients with high carboxyhemoglobin, lactate, and troponin values, and low pH were encountered. The carboxyhemoglobin and lactate levels of patients with impaired consciousness were found to be significantly higher than the patients without impaired consciousness (p<0.001 and p=0.019, respectively). Conclusion: Elevated carboxyhemoglobin and lactate levels were associated with impaired consciousness. Although carboxyhemoglobin levels are important for diagnosis and clinical follow-up, they should not be used as the only marker. High lactate and troponin levels, and low pH should also be taken into account.

Keywords:

Carbon monoxide, children, impaired consciousness, poisoning,

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