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Levofloxacin-Induced Hepatotoxicity and Death

Drug-induced hepatotoxicity is a major cause of hepatocellular injury in patients admitting to emergency services with acute liver failure. Hepatic necrosis may be at varying degrees from mild elevations in transaminases to fulminant hepatitis, and even death. The case of a 53-year-old female patient with toxic hepatitis due to levofloxacin and multiple organ failure secondary to toxic hepatitis is presented. Patient suffered itching, redness, and rash after receiving a single dose of 750 mg of levofloxacin tablets for pulmonary infection 10 days ago. Skin lesions had regressed within 3 days, but desquamation formed all over the body. After the fifth day of drug intake, complaints of abdominal pain, vomiting, and yellowing in skin color had started. The patient was referred to our emergency department with these complaints 10 days after drug intake. Patient was thought as a candidate for liver transplant, but cardiopulmonary arrest occurred, and the patient died before she could be referred to a transplant center. This case is important because hepatotoxicity and death due to levofloxacin is uncommon in the literature.

Etomidate Versus Ketamine: Effective Use in Emergency Procedural Sedation for Pediatric Orthopedic Injuries.

Objectives The aim of this study was to compare the induction and recovery times, postsedation observation durations, and adverse effects of etomidate and ketamine in pediatric patients with fractures and/or dislocations requiring closed reduction in the emergency department. Methods Forty-four healthy children aged 7 to 18 years were included. The patients were randomly divided into 2 groups. Group 1 (24 patients) received etomidate and fentanyl, and group 2 (20 patients) received ketamine intravenously. The Ramsay Sedation Scale and American Pediatric Association discharge criteria were used to evaluate the patients. Results There were 70 fractured bones and 3 joint dislocations. Except in 1 case (2.3%), all of the injuries were reducted successfully. The mean amount of drugs used to provide adequate sedation and analgesia were 0.25 mg/kg of etomidate and 1.30 &mgr;g/kg of fentanyl in group 1 and 1.25 mg/kg of ketamine in group 2. Fourteen patients (31.8%) reported adverse effects, and none required hospitalization. There was no difference between the groups in the recovery times, occurrence of adverse effects, and postsedation observation durations (P > 0.05). The mean (SD) induction time for the patients in group 1 was 4.3 (1.0) minutes, whereas it was 2.2 (1.6) minutes in group 2 (P < 0.001). Conclusions Etomidate induces effective and adequate sedation in the pediatric emergency department for painful orthopedic procedures. Ketamine, which has longer action times, might be preferred for reductions because orthopedic procedures could be lengthy.

Detection of the awareness rate of abuse in pediatric patients admitted to emergency medicine department with injury

Objective It was aimed to investigate whether neglected and abused pediatric patients are properly recognized and reported by emergency physicians in the emergency department (ED). Methods This prospective study was conducted on patients between 0 and 6 years of age presenting with trauma to ED. Patients were examined again by an emergency medicine specialist independent from the physician who did the first intervention during clinical follow-up phase after notification of patients presenting with trauma to emergency physician. Asked radiological examinations and clinical follow-up were performed. The suspected abuse evaluation form, consisting 12 items, which was formed by considering the forms used in previous studies was used to examine the awareness of physicians in cases of abuse suspicion. Results A total of 126 patients were included in our study. 54% of cases (n = 68) were male and mean age was determined to be 31.3 ± 18.9 months. It was found that no judicial records were written to 35.7% (n = 45) of our patients and that 11.1% (n = 5) of these patients were hospitalized. In 51.1% (n = 23) of patients without judicial records, multiple suspected abuse findings were identified. According to evaluation of first physician, it was found that 75.9% (n = 41) of discharged patients had no judicial records and was not considered as neglect and abuse. Conclusion We conclude that detection rates of abuse can be increased by developing child abuse screening forms and ensuring the continuity of the necessary training programs.

Acute intoxication with doxazosin

Experience with overdosage and toxicity with the alphaadrenoreceptor antagonists remains very limited in the literature. In this paper, the second case in the literature with doxazosin overdosage is reported. Supportive treatment was given to the patient and the patient was discharged 48 hours after admission to the emergency department.

Venous blood gases: is it useful in COPD?

Abstract Introduction The present study aims to investigate whether values of venous blood gas sampling can be used instead of arterial blood gas values in the evaluation of blood gas for the emergency service patients with acute exacerbation of chronic obstructive pulmonary disease (COPD). Methods Patients diagnosed COPD and identified to have acute exacerbation of COPD based on acute exacerbation of COPD criteria participated in the study. Data from arterial and venous samples were compared using Spearman and Pearson correlation and Bland-Altman analysis. Results Ninety patients were included in this study. The results indicated statistically significant correlations between venous blood gas pH, pO2, pCO2 and HCO3 values and arterial pH, pO2, pCO2 and HCO3 values of the patients. The correlation for pH, pCO2 and HCO3 values were found to be significantly important (p<0.0001). Discussion and conclusion The findings of the study suggest that some formulations can be used to estimate pH and pCO2 values when evaluating the lung functions of the emergency service patients with acute exacerbation of COPD. Özet Amaç Bu çalışmanın amacı, acil servise kronik obstruktif akciğer hastalığı akut alevlenme ile gelen hastaların kan gazı değerlendirmesinde arteriyel kan gazı değerleri yerine venöz kan gazı örneklemesi yaparak elde edilecek değerlerin kullanılıp kullanılamayacağını araştırmaktır. Metot KOAH tanısı almış ve akut alevlenme olarak tanımlanan hastalar çalışmaya dahil edildi. Arter ve venöz örneklemelerden elde edilen veriler Spearman and Pearson Correlation ve Bland-Altman kullanılarak analiz edildi. Bulgular Toplam 90 hasta çalışmaya dahil edildi. Hastalara ait venöz kan gazı pH, pO2, pCO2 ve HCO3 değerleri ile arteriyel pH, pO2, pCO2 ve HCO3 değerleri arasında istatistiksel olarak anlamlı derecede korelasyon bulundu. Özelikle pH, pCO2 ve HCO3 değerleri arasında yüksek derecede korelasyon olduğu saptandı (p<0.0001). Sonuç Bu yazıda elde edilen sonuçlara göre acil servise KOAH akut alevlenme nedeniyle gelen hastaların akciğer fonksiyonlarını değerlendirmek için pH ve pCO2 değerlerini tahmin etmede bazı formüller kullanılabilir.

Subaraknoid Kanama Mortalitesini Etkileyenler Factors Affecting Mortality in Subarachnoid Hemorrhage

Factors affecting mortality in subarachnoid hemorrhage Objective: Subarachnoid hemorrhage (SAH) is an important emergency that should be early diagnosed and treated. It can be spontaneous or traumatic; has severe complications and high mortality and morbidity rates. In our study, we aimed to establish whether is there a relationship in between duration of hospitalization and mortality rate with risk factors, medical history, etiological properties and hematologic parameters at patients whose was diagnosed spontaneous or traumatic SAH at our emergency service. Material and Method: In our research, we included 150 patients who come or referred to Adana Numune Education and Research Hospital, Emergency Medicine Clinic between 1 August 2014 and 1 August 2016, above the age of 18 and diagnosed spontaneous or traumatic SAH. Results: Overall 150 SAH diagnosed patient were analyzed retrospectively. In our research %70 (n=105) of 150 cases were spontaneous SAH, %30 (n=45) were traumatic SAH, %60 (n=90) were male, %40 (n=60) were female. Average age of all patients was 54.5±15.7. In the group of died patients in our study, we detected that; age, medical drug using, rate of positive feature at medical history, sudden change of mental status, hemiparesis, abnormal electrocardiographic (ECG) features, Fisher and Hunt-Hess scores were seen significantly higher

Acil Serviste Vertigoya Yaklaşım

Vertigo acil servislere sik basvuru nedenlerinden biridir. Basvuruda vertigo ve sersemlik hissi ayirt edilmelidir. Sersemlik hissinin, vertigoya gore daha cok vital bulgu anormalligi yapabilecegi ve altta yatan ciddi bir problemi yansitacagi bilinmelidir. Ilac tedavisinin sadece semptomlari azalttigi ve vestibuler testlerin ise tedavinin temeli oldugu bilinmektedir. Bu derlemede periferik ve santral vertigo ayirici tanisi yapilarak, basit manevra onerileri ile acilden taburcu edilebilecek hastalarla daha ileri tetkik ve tedavi gerektirecek hastalara genel yaklasimin aktarilmasi amaclanmistir.

The relationship of oxidative stress parameters with infarct volume and National Institutes of Health Stroke Scale in ischemic stroke / İskemik inmede oksidatif stres parametrelerinin infarkt volümü ve National Institutes of Health Stroke Scale ile ilişkisi

Abstract Objective: What we know about the relationship between oxidative stress parameters and ischemic stroke is still limited and controversial. Our study aimed to investigate the relationships among ischemic lesion volume, National Institutes of Health Stroke Scale (NIHSS) values, and oxidant and antioxidant levels to determine whether oxidative stress paramaters is effective on stroke severity in ischemic stroke patients. Methods: The study included 34 patients with ischemic stroke and 34 volunteers with no active diseases. Total Oxidant Status (TOS), Total Antioxidant Status (TAS), thiol, paraoxonase, stimulated paraoxonase (stparaoxonase) and arylesterase were measured in blood samples collected on admission from patients diagnosed with ischemic stroke. The Oxidative Stress Index (OSI) was calculated. The same oxidative stress parameters were measured in the control group and compared with the patient group. Correlation between the oxidative stress parameters, the infarct volume and the NIHSS was studied. NIHSS was calculated when patients were admitted to the emergency department. The infarct volume was calculated using diffusion-weighted magnetic resonance imaging performed in the first 72-96 hours. Results: TOS and OSI values were significantly higher in the case group than the control group. Paraoxonase, arylesterase, and thiol values were significantly lower in the case group than the control group. TAS and stparaoxonase values weren’t differed significantly between the case and control groups. There were significant negative correlations between the NIHSS value and both the paraoxonase value and stparaoxonase value. There were no significant correlations between the NIHSS value and the infarct volume and the TAS, TOS, OSI, arylesterase, and thiol values. Conclusion: We concluded that change in oxidative stress balance in favor of oxidants could be a cause in the pathogenesis of ischemic stroke but oxidative stress alone can’t be sufficient in predicting the severity of stroke. Özet Amac: İskemik inme ile oksidatif stress parametreleri arasındaki ilişki hala sınırlı ve tartışmalıdır. Calışmamızda iskemik inmeli hastalarda oksidatif stress parametrelerinin inme şiddetini tahmin etmede etkisinin olup olmadığını tespit etmek icin iskemik lezyon volumu, National Institutes of Health Stroke Scale (NIHSS), oksidan seviyeleri ve antioksidan seviyeleri arasındaki ilişkiyi araştırmayı amacladık. Metod: Calışmaya 34 iskemik inmeli hasta ile aktif hastalığı bulunmayan 34 gonullu dahil edildi. İskemik inme tanısı konulan hastalardan başvuru anında alınan kanlarda Total Oksidan Seviyesi (TOS), Total Antioksidan Seviyesi (TAS), tiyol, paraoksonaz, stimule paraoksonaz ve arilesteraz calışıldı. Oksidatif Stres İndeksi (OSİ) hesaplandı. Kontrol grubundan alınan kanlarda da aynı oksidatif stres parametreleri calışılarak hasta grubuyla karşılaştırıldı. Oksidatif stres parametreleri ile NIHSS ve enfarkt volumu arasındaki korelasyon incelendi. NIHSS hastaların acil servise başvuru anında hesaplandı. Enfarkt volumu ilk 72-96 saat icerisinde cekilen difizyon ağırlıklı MR’da hesaplandı. Bulgular: Hasta grubunda TOS ve OSI değeri kontrol grubundan anlamlı olarak daha yuksekti. Hasta grubunda paraoksinaz, arilesteraz, tiyol değerleri kontrol grubundan anlamlı olarak daha duşuktu. Hasta ve kontrol grubunda TAS ve stparaoksinaz değeri anlamlı farklılık gostermedi. NIHSS ile paraoksinaz ve stparaoksonaz değerleri arasında anlamlı negatif korelasyon mevcuttu. NIHSS değeri ile TAS, TOS, OSI, arilesteraz, tiyol değerleri arasında anlamlı korelasyon yoktu. Enfarkt hacmi ile TAS, TOS, OSI, arilesteraz, tiyol, paraoksinaz ve stparaoksinaz değerleri arasında anlamlı korelasyon saptanmadı. Sonuc: Oksidatif stres dengesinin oksidan lehine bozulmasının iskemik inme patogenezinde etkili olabileceğini fakat oksidatif stresin tek başına inmenin şiddetini tahmin etmede yeterli olmayabileceğini duşunmekteyiz.

A Rare Reason of Hyperammonemia: Valproic Acid Poisoning

Introduction: Valproic acid (VA) is a broad-spectrum antiepileptic drug that is widely used in the treatment of epilepsy and bipolar affective disorder and also in the prophylaxis of migraine. High doses can cause central nervous system depression ranging from lethargy to coma, respiratory failure, renal failure, acute pancreatitis, hepatotoxicity, and bone marrow depression. Case Report: In this paper, we attempted to examine a case of acute encephalopathy with hyperammonemia caused by high doses of VA and treated with L-carnitine based on the recent literature. Conclusion: In patients with hyperammonemia associated with the severe toxicity symptoms of poisoning, L-carnitine administration is a treatment approach to keep in mind based on the rare types of poisoning observed at emergency services.

The Role of Oxidative Stress Markers in the Pathophysiology of Migraine and After Treatment

Introduction:In this study, we investigated whether oxidant and antioxidant levels have a role in the pathophysiology of migraine and whether these measurements can be used effectively in the follow-up treatment. Materials and Methods:Thirty-one patients were admitted to the emergency department because of migraine attack and 30 healthy volunteers were enrolled in the study. The treatment was initiated with metoclopramide, and total antioxidant status (TAS), thiol, paraoxonase (PON), stimulated paraoxonase (St PON), arylesterase (ARE), and total oxidant status (TOS) were evaluated with the samples that were collected at the time of admission and at 30th and 60th minutes. Oxidative Stress Index (OSI) was calculated. Intensity of pain was assessed by the Visual Analogue Scale (VAS), simultaneously with sample collection. The results of patients were compared with those of healthy volunteers. Results:In the samples of patients collected at the time of admission, thiol and ARE levels were significantly low (226.6±29 vs. 170.2±52.2, P=0.000 and 339.3±47.9 vs. 278.0±44.8, P=0.000) and TOS and OSI were significantly high (2.1±0.5 vs. 3.0±1.8, P=0.000 and 1.1±0.3 vs. 1.6±1.0, P=0.000) when compared with the control group. There was no significant change in the levels of TAS, PON, and St PON (1.9±0.3 vs. 1.8±0.3, P=0153 and 210.5±135.9 vs. 164.5±101.6, P=0139 and 512.5±353.3 vs. 419.8±276.5, P=0.262). VAS scores at 30th and 60th minutes were significantly decreased when compared with those at the time of admission. However, there was no correlation between the decrease in VAS score and TAS, thiol, PON, St PON, ARE, and TOS and OSI levels (P>0.05). Conclusions:The effect of oxidative stress in the pathophysiology of migraine is more likely to be an oxidant. These parameters alone are not sufficient to explain the pathophysiology of migraine because no significant changes were observed in either of antioxidant and oxidant levels, whereas a significant improvement in pain was achieved after the treatment of patients. Therefore, these results suggest that there are more than one mechanism in the pathophysiology of migraine.