ARİF KURTDEDE, M. Çağrı KARAKURUM, Murat GÜZEL, ALİ HAYDAR KIRMIZIGÜL, M. Sinan AKTAŞ

Bir köpekte yüksek dozda aspirine bağlı hematemeziz

Bu olgunun materyalini 5 yaşlı 6 kg ağırlığında dişi Terrier ırkı bir köpek oluşturdu. Anamnezde köpeğe kliniğe getirilmeden iki gün önce iki adet 500 mg'lık aspirin verildiği, Aspirin verildikten sonra kusma başladığı, çıkarılan mide içeriğinin önce açık renkte ve köpüklü, daha sonra koyu renkte ve kahve telvesi görünümünde olduğu öğrenildi. Klinik muayenede 40,l°C ateş, aşırı depresif görünüm, karın bölgesinin palpasyonunda ağrı, mide içeriğinin kahverenkli olduğu saptandı. Laboratuar muayenelerinde pH 7,3, pCO2 42,6 mm Hg, pO2 20,3 mm Hg, baz açığı -3,9 mmol/L, hematokrit %28, Hb 9,4g/dl, Na+ 151,8 mmol/L, K+ 2,07 mmol/L, Cl 100 mmol/L ve idrar pH'ı 5 olarak belirlendi. Olguda hematemezis bulgusundan başka hematokrit ve hemoglobin değerlerindeki düşüş kanamaya, potasyum düzeyindeki azalma ise aspirinin toksik etkisine bağlandı. Olguya sağaltımda alkali diürez sağlama amacı ile 500 mi %5 dekstroz + %0,9 NaCl içerisinde 30 mEq sodyum bikarbonat ve 20 mEq potasyum klorür, ranitidin 4 mg/kg/8 saat, metoklopromid-HCl 1 mg/kg IV ve sukralfat 1 g/6 saat sonda ile uygulandı. Sağaltımdan 8 saat sonra genel durumun düzelmesi nedeniyle hasta taburcu edildi. İkinci gün yapılan klinik muayenede kusmanın sıklığının azaldığı ve mide içeriğinin renginin açıldığı belirlendi. Hastaya 120 ml Ringer laktat deri altı, ranitidin deri altı ve sukralfat oral uygulandı. Sağaltımın üçüncü gününden itibaren kusma azaldı ve genel durumun daha iyi olduğu belirlendi. Ranitidin ve sukralfat uygulamasına 10 gün devam edildi. Bu olguda 166 mg/kg dozda aspirinin bir defada alınmasının hematemezise neden olabileceğinin ve sağaltımın etkinliğinin vurgulanması amaçlandı.

Anahtar Kelimeler:

yan etkiler, aspirin, olgu sunumları, klinik görünüm, ilaç tedavisi, ilaç toksisitesi, sıvı tedavisi, kusma, köpek

A year old, 6 kg weighting, female Terier constitued the material of the present case. According to the anamnes, 2 days before referral 1000 mg aspirin was prescribed once, which was then emesis was noticed with formerly whitish foamed gastric content turned to dark colored coffee consistency. At clinical examination 40.1°C body temperature, severely depressive appearence, pain on abdominal palpation and dark brown-colored gastric content were detected. Laboratory examination revealed pH 7.3, PCO2 42.6 mmHg, P02 20.3 mmHg, base excess 3.9 mmol/L, hematocrit 28%, Hb 9.4g/dl, Na+ 151.8 mmol/L, K+ 207 mmol/L, Cl" 100 mmol/L, and urinary PH as 5. In the present case other than hematemesis, the decrease in hematocrit and hemoglobine levels was considered as a result of bleeding, and the decrease in potassium level was considered to the toxic effects of the aspirine. As therapy included 30 m Eq sodium bicarbonat added in 500 ml dexrose 5%+ 0.9% NaCl, Sodium bicarbonat 8.4% molar amp., and 20 mEq potassium clorur, ranitidin 4 mg/kg/8 hours, metoclopramid HC1 1 mg/kg IV and sucralfat 1 g/6 hours administered with gastric tub. Following 8 hours after initial therapy, the patient was discharged because of the recovery of the general condition . At the clinical examination on 2nd day the frequency öf the emesis was detected to cease and gastric content was detected to change color 120 ml lactated Ringer solution and ranitidine subcutaneusly and sucralfate orally was administered. Following 3rd Day of the therapy, emesis ceased and the general condition was detected as better. Ranitidin and sucralfate, administration was continued for 10 .days In this clinical case the aim was to emphasize aspirin administration at a dosage of 166 mg/kg once could cause hematemesis and the efficacy of therapy

Keywords:

adverse effects, aspirin, case reports, clinical aspects, drug therapy, drug toxicity, fluid therapy, vomiting, dogs,

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