ulusal acil tıp kongresi

316 Pages·2015·3.33 MB·English

11.
ULUSAL
ACİL TIP KONGRESİ
Rixos Sungate Hotel / Antalya
16-19 Nisan 2015
2
Intercontinental
nd
Emergency Medicine Congress
International
Critical Care and Emergency Medicine Congress
16-19 April 2015
BİLDİRİ ÖZETLERİ www.acil2015.org
BİLİMSEL SEKRETERYA ORGANİZASYON SEKRETERYASI
KONGRE VE ORGANİZASYON
ACİL TIP UZMANLARI DERNEĞİ İcadiye Cad. No: 3 Kuzguncuk 34674, İstanbul
Yukarı Ayrancı Güleryüz Sk. No: 26/19 Çankaya / Ankara T: [phone] F: [phone]
T: [phone] F: [phone] [email protected] / www.genx.com.tr
[email protected] / www.atuder.org.tr facebook.com/GENXKONGRE twitter.com/GENX_KONGRE

SÖZLÜ BİLDİRİLER
ORAL PRESENTATIONS
SÖZLÜ BİLDİRİLER
SS-001 Cerrahi Aciller (Genel Cerrahi, Ortopedi, Beyin Cerrahi, Kalp Damar, Anestezi, KBB, Kadın Doğum, Göz, vb.)
İnitial evaluation of hearing loss: Application – solution audiological evaluation application
Serhan Derin1, Osman Cam2, Murat Sahan1, Halil Beydilli3, Ethem Acar3
1Department of Otorhinolaryngology, School of Medicine, Mugla Sitki Kocman University, Mugla, Turkey.
2Department of Otorhinolaryngology, Delta hospital istanbul,Turkey
3Department of Emergency Medicine, School of Medicine, Mugla Sitki Kocman University, Mugla, Turkey.
OBjECTİvE: The aim of this study is to compare iOS based hearing test mobile appliaciton with convansional audiometry and to determine its accuracy and reliability.
MATERİALS-METhODS: 32 patients with the diagnosis of hearing loss were included in the study. Firstly they were evaluated with convensional audimetry and the degree of hearing loss
detected. Latter a smartphone based mobile application test was performed to these patients and the data were compared via Cohen’s Kappa analysis.
RESuLTS: The mean age was 53,59 ± 18,01 ranging from 19 to 85 years old.16 patients were male and 16 patients were female. Among the 64 ears 52 of them were diagnosed with hearing
loss consisiting of 28 right and 24 left ears. The kappa coefficient value were statically significant for right and left ears.
CONCLuSİON: Ear Trumpet v1.0.2 is a compact and easy mobile application that can measure hearing loss with reliable results on iphone 5.
KEywORDS: smartphone application, hearing loss, audiometry, emergency medicine.
SS-002 Cerrahi Aciller (Genel Cerrahi, Ortopedi, Beyin Cerrahi, Kalp Damar, Anestezi, KBB, Kadın Doğum, Göz, vb.)
Foley Catheter use On Nasal Bleeding
Onur Tokocin, Necmettin Sutasir, Ibrahim Ikizceli
Department of Emergency Medicine, Sisli Hamidiye Etfal Traning and Research Hospital, Istanbul, Trukey
BACKROuND: Nasal bleeding (epistaxis) has been frequently reported in the general population. Most affected persons do not need any medical care and almost 90% of epistaxis incidents
are minor and/or self-limited. Rarely, massive nasal bleeding may require emergency care and even more rarely can cause death.
Nasal bleeding usually responds to first-aid measures such as compression. When epistaxis does not respond to simple measures, the source of the bleeding should be located and treated
appropriately. Treatments to be considered include topical vasoconstriction, chemical cautery, electrocautery, nasal packing (nasal tampon or gauze impregnated with petroleum jelly),
posterior gauze packing, use of a balloon system (including a modified Foley catheter), and arterial ligation or embolization.
In our case we’ve used Foley catheter to stop nasal bleeding.
CASE: A 29-year-old male with no previous medical problem was admitted to the emergency service with a complaint of nasal bleeding with stage 3 shock. The patient’s blood pressure was
51/28 mmHg, tachycardia about 135/min was confused. Other general physical examination was normal, except for massive nasal bleeding in the right nasal cavity on anterior rhinoscopic
examination.
The patient did not display petechia, ecchymosis or general bleeding pathologies, hepatosplenomegaly and lymphadenopathy. The patient received a blood transfusion and intravenous
hydration. At admission, hemoglobin was 7 mg/dL, platelets were 227,000/mcL and leucocytes were 8,300. PT, aPTT and INR were also within normal ranges. All biochemical tests were also
normal. Bilateral anterior packing with foley catheter were placed in both nostrils to apply extra pressure and to stop recurrent bleeding. The bleeding was stopped, we had consulted him
with ear nose any throat clinic. We found blood pressure 110/68 mmHg, heart rate 85/min and he was cooperated. Massive nasal bleeding occurred during the first 2 hours of hospitalization
and the hemoglobin level decreased to 12.8 mg/dL. The patient has transferred to otorhinolaryngology clinic.
DISCuSSION: Epistaxis is classified as anterior or posterior on the basis of the location of the primary bleeding site. Hemorrhage is most commonly anterior, originating from the nasal
septum. Intracavernous internal carotid artery aneurysms constitute 1-2% of all intracranial aneurysms and can be divided into traumatic or non traumatic types. Traumatic intracavernous
ICA aneurysm causing fatal epistaxis are sometimes encountered. However’ massive epistaxis from a non traumatic ICA aneurysm are rare Our case had posterior hemorrhage. Foley catheter
that can be obtained from cheap and easy, should be noted in bleeding.
KEywORDS: nasal bleeding, foley catheter, epistaxis
SS-003 Cerrahi Aciller (Genel Cerrahi, Ortopedi, Beyin Cerrahi, Kalp Damar, Anestezi, KBB, Kadın Doğum, Göz, vb.)
Analysis of 175 cases underwent operation after applying to hospital at the late period of abdominal injury by firearms
Yusuf Yucel1, Hasan Buyukaslan2, Samil Gunay3, Ahmet Seker1, Abdullah Ozgonul1, Alpaslan Terzi1, Orhan Gozeneli1, Ali Uzunkoy1
1Assoc. Prof. Harran University Medical Faculty Department of General Surgery, 63100, Sanliurfa, Turkey.
2Assoc. Prof. Harran University Medical Faculty Emergency Department, 63100, Sanliurfa, Turkey
3Harran University Department Of Thoracic, 63100, Sanliurfa, Turkey
AIM: We aimed at analysing the patients, who underwent surgical treatment in our hospital after having abdominal wounding by firearm in the war at Syria, retrospectively.
MATERIALS-METhODS: The files of Syrian patients, who applied to Emergency Service of Harran University Medical Faculty because of gunshot wounds and had operation after being
hospitalized in General Surgery Clinic due to abdominal injuries between the years of 2011 and 2014, were analysed retrospectively.
RESuLTS: 175 Syrian patients, who had abdominal injuries by firearms, underwent operation in our general surgery clinic. 99.4% (n=174) of the patients were male, and 0.6% (n=1) were
female. Trauma-admission to hospital times of all cases were ≥ 6 hours. 62.8% (n=110) of the patients had isolated abdominal injuries, and 37.2% (n=65) had two or more system injuries.
The most frequent injured intra-abdominal organs were colon, small bowel and liver. The frequency of more than one organ injuries in abdominal region was 44.5% (n=78) and the most
frequent complication was wound infection. Negative laparotomy was 1.1% (n=2), support for intensive care was 48.5% (n=85), average duration of intensive care unit stay was 5.57 days
and mortality was 9.7% (n=17).
CONCLuSIONS: In our study, it was seen that infectious morbidity and mortality increased for the patients, who applied to our hospital because of abdominal injuries by firearm, particularly
the ones with gastrointestinal perforation, if trauma-admission to hospital times were ≥ 6 hours. And this shows us that the early intervention to injuries that perforate gastrointestinal tract
was an important factor for decreasing morbidity and mortality.
KEywORDS: Gunshot wound, Abdominal injury, Mortality, Morbidity
SS-004 Cerrahi Aciller (Genel Cerrahi, Ortopedi, Beyin Cerrahi, Kalp Damar, Anestezi, KBB, Kadın Doğum, Göz, vb.)
Mean Platelet volume is Reduced in Acute Appendicitis
Egemen Küçük1, Irfan Küçük2
1Department of Emergency Medicine, Sakarya University Training and Research Hospital, Sakarya Turkey
2Department of Gastroenterology, Diyarbakir Military Hospital, Diyarbakir Turkey
OBjECTIvES: Acute appendicitis (AA) is the most common indication for emergency abdominal surgery, although it remains difficult to diagnose. In this study, we investigated the the clinical
utility of mean platelet volume in the diagnosis of acute appendicitis.
METhODS: The medical records of 241 patients who had undergone appendectomy between June 2013 and March 2014 were investigated retrospectively. Sixty patients who had undergone
4
ORAL PRESENTATIONS
at least one complete blood count during preoperative hospital admission and who had no other active inflammatory conditions at the time the sample was taken were included in the study.
Mean platelet volume and leukocyte count values were determined in each patient at previous hospital admission and during active acute appendicitis. Age, sex, mean platelet volume and
leukocyte counts were recorded for each patient.
RESuLTS:The mean age of patients was 33.15±10.94 years and the male to female ratio was 1.5:1. The mean leukocyte count prior to acute appendicitis was 7.42±2.12×103/mm3. Mean
leukocyte count was significantly higher (13.14±2.99×103/mm3) in acute appendicitis. The optimal leukocyte count cutoff point for the diagnosis of acute appendicitis was 10.10×103/mm3,
with sensitivity of 94% and a specificity of 75%. The mean platelet volume prior to acute appendicitis was 7.58±1.11 fL. Mean platelet volume was significantly lower (7.03±0.8 fL) in acute
appendicitis. The optimal mean platelet volume cutoff point for the diagnosis of AA was 6.10 fL, with a sensitivity of 83% and a specificity of 42%. Area under the curve for leukocyte count
diagnosis was 0.67 and 0.69 for the diagnosis of AA by mean platelet volume.
CONCLuSIONS: Mean platelet volume was significantly decreased in acute appendicitis. Mean platelet volumecan be used as a supportive diagnostic parameter in the diagnosis of acute
appendicitis.
KEywORDS: Acute appendicitis; diagnosis; mean platelet volume
SS-005 Cerrahi Aciller (Genel Cerrahi, Ortopedi, Beyin Cerrahi, Kalp Damar, Anestezi, KBB, Kadın Doğum, Göz, vb.)
The Change of Red Cell Distribution width in Acute Appendicitis
Egemen Küçük
Department of Emergency Medicine, Sakarya University Training and Research Hospital, Sakarya Turkey
INTRODuCTION: Acute appendicitis is the most common cause of emergent abdominal surgery, and diagnosis is quite difficult. We aimed to investigate the supporting diagnostic role of
red cell distribution width in acute appendicitis.
METhODS: Sixty patients who had undergone at least one complete blood count during preoperative hospital admission and who had no other active inflammatory conditions at the time the
sample was taken, were included in the study between June 2013 and March 2014. Red cell distribution width and leukocyte count values were determined in each patient at prior hospital
admission and during active acute appendicitis. Age, sex, red cell distribution width and leukocyte counts were recorded for each patient.
RESuLTS: The mean age of patients was 33.15±10.94 years and the male to female ratio was 1.5:1. The mean leukocyte count prior to acute appendicitis was 7.42±2.12x103/mm3. It was
significantly higher (13.14±2.99×103/mm3) in acute appendicitis. The red cell distribution width prior to operation was 15,53±1,58%. It was reduced (14,90±1,54%) in acute appendicitis
but not statistically significant.
CONCLuSION: Red cell distribution width is not a useful supportive parameter in the diagnosis of acute appendicitis.
KEywORDS: Red cell distribution width, Acute appendicitis, Diagnosis
SS-006 Cerrahi Aciller (Genel Cerrahi, Ortopedi, Beyin Cerrahi, Kalp Damar, Anestezi, KBB, Kadın Doğum, Göz, vb.)
The Change of Neutrophil Lymphocyte Ratio in Acute Appendicitis
Egemen Küçük
Department of Emergency Medicine, Sakarya University Training and Research Hospital, Sakarya, Turkey
AIM: Acute appendicitis is the most common indication for emergency abdominal surgery, although it remains difficult to diagnose. Aim of this study is to investigate the supporting role of
neutrophil/lymphocyte ratio in diagnosis of acute appendicitis.
METhOD: The medical records of 241 patients who had undergone appendectomy between June 2013 and March 2014 were investigated retrospectively. Sixty patients who had undergone
at least one complete blood count during preoperative hospital admission and who had no other active inflammatory conditions at the time the sample was taken were included in the study.
Neutrophil/lymphocyte ratio and leukocyte count values were determined in each patient at hospital admission and during active acute appendicitis. Age, sex, neutrophil/lymphocyte ratio
and leukocyte counts were recorded for each patient.
RESuLTS: The mean age of the patients was 33.15±10.94 years, male to female ratio was 1.5:1. Mean leukocyte count was significantly higher in acute appendicitis group (13.14±2.99×103/
mm3) than control group (7.42±2.12×103/mm3) (p=0.01). The best cutoff point for leukocyte count was 10.10×103/mm3, with sensitivity of 94% and a specificity of 75%. Mean neutrophil/
lymphocyte ratio was significantly higher in acute appendicitis group (5.47±3.24) than control group (1.99±1.11) (p=0.02). The best cutoff point for neutrophil/lymphocyte ratio was 1.73,
with sensitivity of 97% and a specificity of 87%. Area under receiver operating characteristic curve was 0.67 for leukocyte count and 0.60 for neutrophil/lymphocyte ratio.
CONCLuSION: Neutrophil/lymphocyte ratio was significantly higher in acute appendicitis and can be used as a supportive diagnostic parameter in the diagnosis of acute appendicitis.
KEywORDS: Acute appendicitis, Neutrophil/lymphocyte ratio, Diagnosis
SS-007 Cerrahi Aciller (Genel Cerrahi, Ortopedi, Beyin Cerrahi, Kalp Damar, Anestezi, KBB, Kadın Doğum, Göz, vb.)
An Extremely Rare Case - Rectal Perforation with Semi-Rigid wire Guide Foley Catheter
Binnur Eşfer, Selim İnan, Burak Demirci, İrfan Kala, Metin Özdemir, Fatma Yorulmaz, Muhittin Serkan Yılmaz, Muhammed Evvah Karakılıç
Ankara Numune Training and Research Hospital,Emergency Medicine,Ankara,Turkey
INTRODuCTION: Urinary bladder catheters are used for urinary drainage or as a means to collect urine for measurement. It may be used for diagnostic purposes to help determine the
etiology of various genitourinary conditions or therapeutically (to relieve urinary retention, instill medication, or provide irrigation). Patients of all ages may require urethral catheterization,
but patients who are elderly or chronically ill are more likely to require indwelling catheters, which carry their own independent risks.Most common complications are Infections including
urethritis, cystitis, pyelonephritis, and transient bacteremia, paraphimosis, caused by failure to reduce the foreskin after catheterization Creation of false passages urethral strictures bleeding
and rarely urethral perforation. We will report an extremely rare case; uretral and rectal perforation with semi-rigid wire guide foley catheter.
CASE: 86-year-old male patient was brought to the emergency department with confusion. He had a history of of diabetes, hypertension, Parkinson’s diseases and benign prostatic hyperp-
lasia.He had been used madopar, comtan,ecopirin, humulin. Patients had oral intake disorders for 1 week and on admission day they admitted to hospital after the patient’s consciousness
began to change after insulin injection. Initial vital signs were: pulse, 84 beats per minute; respirations 22 cycles per minute; temperature, 37.4°C; and blood pressure 90/60 mmHg, fingertip
blood glucose was 40mg/dl. We began the treatment with dextrose infusion. He was monitored and taken to the observation room.We tried to insert a foley catheter for input-output follow
up.But we failed because of benign prostatic hyperplasia. We request urology consultation for urinary catheterization.Urology department insert the foley catheter with semi-rigid wire guide.4
hours after catheterization no urine came. We have irrigated foley catheter for probability of obstruction. With irrigation bad smelly, brown, stool containing discharge came. Abdomen ct was
taken and balloon catheter was seen in the rectum. Patients were operated on by general surgeon and urology because of rectal and uretral perforation.
CONCLuSION: There are lots of complications of urinary catheterization.Most common of these are infections, paraphimosis, urethral strictures,bleeding and rarely urethral perforation. In
our case we saw uretral and rectal perforation. That is a very rare condition.So we want to report this extremely rare case report.
KEywORDS: Foley Catheter,Rectal Perforation,Urinary Catheterization
5
SÖZLÜ BİLDİRİLER
SS-008 Cerrahi Aciller (Genel Cerrahi, Ortopedi, Beyin Cerrahi, Kalp Damar, Anestezi, KBB, Kadın Doğum, Göz, vb.)
Acute aortic dissection presenting as recurrent transient ischemic attack episodes
Ozcan Yavasi1, Adnan Yamanoglu2, Nalan Gokce Celebi Yamanoglu3, Korhan Erkanlı4, Kamil Kayayurt1
1Department of Emergency Medicine, Recep Tayyip Erdogan University Research and Training Hospital, Rize, Turkey
2Department of Emergency Medicine, Haseki Research and Training Hospital, Istanbul, Turkey
3Department of Emergency Medicine, Beykoz State Hospital, Istanbul, Turkey
4Department of Cardiovascular Surgery, Mehmet Akif Ersoy Research and Training Hospital, Istanbul, Turkey
INTRODuCTION: Emergency physicians (EPs) encounter various medical emergent conditions, some of which present with atypical symptoms and signs as written in textbooks. We report
an interesting case of acute aortic dissection (AD) who presented with recurrent transient ischemic attacks (TIA). We aim to focus on EP-performed bedside US in evaluation of patients with
neurological symptoms.
CASE REPORT: A previously healthy 57-year-old man was transferred to our emergency department from another hospital with the diagnosis of acute ischemic stroke. After a syncope
attack at home, he was unable to use his left hand and could not walk without help. He was transferred to a hospital where he was diagnosed as acute ischemic stroke with a normal cranial
computed tomography. At presentation to our emergency department he was conscious and alert and able to use his left extremities. He had a blood pressure of 130/80 mmHg on right arm,
a heart rate of 55 beats/min, a respiratory rate 14 breaths/min, and an oxygen saturation of 97% on room air. He was considered to have a transient ischemic attack. Following examination
he became aphasic. He was re-evaluated for neurological examination. He had 1/5 motor deficit on left arm and 3/5 motor deficit on left leg. EP performed bedside Doppler US of right and
left common carotid arteries (CCA). There was a flap and a thrombus in right CCA behind it, that narrows the true lumen. Bedside transthoracic echocardiography revealed dilated aortic root
(59 mm) in parasternal long axis and there was a dissecting flap at aortic root. He was again fully conscious and left hemiparesia resolved within almost 10 minutes. Computed tomography
angiography (CTA) revealed type I aortic dissection extending to the right CCA. The patient then was transferred to operating room. He had a successfull operation and course without any
neurological sequela.
CONCLuSİON: Although, pain character of acute AD is classically described as a sudden onset of severe chest, back, or abdominal pain that is characterized as ripping or tearing in nature,
pain is not an obligatory symptom. 10% of ADs are painless and half of these, present with either permanent or transient neurological symptoms only. High index of suspicion is the key
in the diagnosis. Aortic dissection should be considered in the differential diagnosis of patients who present with hemiplegia of acute onset, regardless of whether they complain of pain.
KEywORDS: aortic dissection, emergency department, transient ischemic attack, ultrasonography
SS-009 Cerrahi Aciller (Genel Cerrahi, Ortopedi, Beyin Cerrahi, Kalp Damar, Anestezi, KBB, Kadın Doğum, Göz, vb.)
Near infrared spectrophotometry in predicting mesenteric ischemia; an experimental study
Özlem Bilir1, Gökhan Ersunan1, Asım Kalkan1, Yıldıray Kalkan2, Deniz Özel Erkan4, Özcan Yavaşi1, Ender Özer3
1Recep Tayyip Erdoğan Üniveritesi Tıp Fakültesi Acil Tıp Anabilim Dalı
2Recep Tayyip Erdoğan Üniversitesi Tıp Fakültesi Histoloji ve Embriyoloji Anabilim Dalı.
3Recep Tayyip Erdoğan Üniveritesi Tıp Fakültesi Genel Cerrahi Anabilim Dalı
4Akdeniz Üniversitesi Tıp Fakültesi Biyoistatistik ve Tıbbi Bilişim Anabilim Dalı
ThİS STuDy İNvESTİGATED ABDOMİNAL SATuRATİON İN RATS wİTh İNDuCED MESENTERİC İSChEMİA uSİNG NEAR İNFRARED SPECTROPhOTOMETRy (NIRS). ThE PuRPOSE wAS
TO ASSESS ThE EFFECTİvENESS OF NIRS İN DİAGNOSİNG MESENTERİC İSChEMİA.
MATERIALS-METhODS: This was a randomized, controlled, non-blinded interventional animal study. Twenty-eight male Sprague Dawley rats were randomly divided into four groups.
Following administration of anesthesia, the fur was removed from the abdominal region in all groups and basal measurements were performed using an INVOS-5100c device. The abdomen
was entered through a 4-cm midline incision. Once the mesenteric arteries had been appropriately ligated, the rats were grouped on the basis of rSO2 measurement times. Animals were
divided into one group (sham group) in which the mesenteric artery was not ligated and groups in which measurements were performed at 30 min (2. group) and at 2 h (3. group) and 6 h
(4. group). Measurements were repeated using NIRS probes once the abdomens had been surgically closed. Following measurement, the abdomens were opened, and small intestine tissue
specimens were taken for histopathological examination. Initial and final NIRS measurements were then compared.
RESuLTS: No statistically significant difference was determined in the first group between basal rSO2 values (48.57 ± 2.82) and post-incision values (48.43± 3.31) (p=0.748). Pre-incision
basal rSO2 values in groups 2, 3 and 4 were 49 ± 6.38, 46.86 ± 7.01 and50.57 ± 4.24, respectively.rSO2values measured 30 min after ligation of the mesenteric artery in the rats in group
2 were 22.57 ± 640).rSO2values 2 h after ligation of the mesenteric artery in the rats in group 3 were21.86 ± 6.99. rSO2values after 6 h in the rats in group 4 were 18.14 ± 2.79. Significant
variation was determined between initial and final measurements in rats in groups 2, 3 and 4(p=0.018).
CONCLuSION: Although various radiological or biochemical markers are available for detecting mesenteric ischemia, we think that NIRS can be used as a good noninvasive method for early
diagnosis of acute mesenteric ischemia.
KEywORDS: NIRS,Mesenteric İschemia,experimental study
SS-010 Cerrahi Aciller (Genel Cerrahi, Ortopedi, Beyin Cerrahi, Kalp Damar, Anestezi, KBB, Kadın Doğum, Göz, vb.)
Clinical value of the platelet-to-lymphocyte ratio for diagnosing complicated acute appendicitis
Gülşen Çığşar1, Ali Cihat Yıldırım2, Turgut Anuk3, Elnara Günal1
1Department of Emergency Medicine,Kafkas University School of Medicine,Kars,Turkey
2General Surgery,Kars Harakani State Hospital,Kars, Turkey
3Department of General Surgery,Kafkas University School of Medicine,Kars,Turkey
BACKGROuND: Acute appendicitis is the most common acute surgical disease worldwide. Despite the use of preoperative advanced radiological instruments, preoperative determination of
complicated cases is still difficult and remains an important concern. The aim of this study is to evaluate the predictive value of the platelet-to-lymphocyte ratio and of the presence of elevated
white blood cells to discriminate between complicated and noncomplicated acute appendicitis.
MATERIALS-METhODS: All patients who were admitted to the emergency care unit and then underwent urgent laparatomy with acute appendicitis. The platelet-to-lymphocyte ratio and
white blood cell count were measured. Patients were divided into two groups. Group 1 was the noncomplicated group, and group 2 was the complicated group. White blood cell count and
platelet-to-lymphocyte ratio were compared between the two groups.
RESuLTS: There were 225 patients in group 1 and 33 patients in group 2. The gender distribution between groups was homogeneous (P=0.114); the mean age of group 2 was higher
than group 1 (P=0.012). The platelet-to-lymphocyte ratio was significantly higher in group 2, but there was not a significant difference in the white blood cell count (P=0.015 and P=0.223
respectively). The platelet-to-lymphocyte ratio was significantly higher in group 2, and it could predict complications independently of age and gender (P=0.029). The cutoff value of the
platelet-to-lymphocyte ratio was 143.6, giving a sensitivity of 54.5% and a specificity of 54.2%.
CONCLuSION: The platelet-to-lymphocyte ratio may be a valuable parameter for preoperatively distinguishing complicated from noncomplicated appendicitis.
KEywORDS: Acute appendicitis, platelet-to-lymphocyte ratio, white blood cells, complication
6
ORAL PRESENTATIONS
SS-011 Toksikoloji
Cade Oil; Arouses Senses But worsens your Pain
Sonay Ezgi Yıldırım, Hande Akbal Kahraman, Mustafa Varlık
Department of Emergency Medicine, Ümraniye Education and Research Hospital, İstanbul, Turkey
Cade oil ( Juniper tar), is an essential oil very rich in terpenes and phenols; extracted from the tree Juniperus oxycedrus by distillation of its branches and wood(1). We present you a case of
a young woman who ingested a cupfull of cade oil mixed with coffee to relieve her kidney pain. She presented to our emergency department with intense epigastric pain, nausea and vomiting.
Endoscopy was performed and erosive bulbitis was diagnosed. She was prescribed a proton pump inhibitor and discharged the next day. We report you this case to inform you that cade oil
ingestion can lead to digestive system complications such as gastritis and mucosal erosion and may necessitate prompt intervention with endoscopic procedures.
KEywORDS: Cade oil, Juniper tar, Erosive bulbitis, Endoscopy, Mucosal erosion
SS-012 Toksikoloji
The Effects of Synthetic Cannabinoids on Alveolar-Arterial Oxygen Gradient
Egemen Küçük1, Hikmet Çoban2
1Department of Emergency Medicine, Sakarya University Training and Research Hospital, Sakarya Turkey
2Department of Chest Disease, Sakarya University Training and Research Hospital, Sakarya Turkey
AIM: Synthetic cannabinoids are chemicals that produce several marijuana-like effects in humans. Aim of this study is to investigate the effects of syn¬thetic cannabinoids on to alveolar-
arterial oxygen gradient.
MATERIAL-METhOD: A total of 112 patients, who admitted directly to emergency clinic with synthetic cannabinoid usage, were determined between February 2014 and August 2014. Blood
gases of 41 patients were determined as arterial blood gases on room air, and included in to study. Patients were evaluated according to age, sex, decade, partial pressure of arterial oxygen,
partial pressure of arterial carbon dioxide, pH, bicarbonate, metabolic status, age consistent expected alveolar-arterial oxygen gradient and calculated alveo¬lar-arterial oxygen gradient.
RESuLTS: Synthetic cannabinoid using was higher in males, mean age of patients was 23.32±6.14 years. Number of patients in the third decade were significantly higher than the other
decades. The calculated alveolar-arterial oxygen gradient (26.02 ± 11.07) value of patients was signifi¬cantly higher than age consistent expected alveolar-arterial oxygen gradient (8.45 ±
1.74) value (p = 0.02). Respiratory acidosis, was significantly higher than the other types of the metabolic disorders. The best cutoff point for calculated alveolar-arterial oxygen gradient was
12.70, with sensitivity of 90% and specifity of 85%. Area under curve was 0.70 for calculated alveolar-arterial oxygen gradient.
DISCuSSION: The value of alveolar-arterial oxygen gradient has been increased due to synthetic cannabinoid usage. This can be used as a supportive param¬eter in the diagnosis of synthetic
cannabinoid usage.
KEywORDS: Synthetic Cannabinoids; Blood Gases; Diagnose
SS-013 Toksikoloji
A new threat in the emergency department: Synthetic Cannabinoids (Bonzai, jameika)
Egemen Küçük1, Irfan Küçük2, Yasemin Yıldız, Kirazaldı3
1Department of Emergency Medicine, Sakarya University Training and Research Hospital, Sakarya Turkey
2Department of Gastroenterology, Diyarbakir Military Hospital, Diyarbakir Turkey
3Department of Emergency Medicine, Sakarya Universty, Sakarya Turkey
OBjECTIvES: The aim of this study is to examine the epidemiological characteristics of patients who admitted directly to our emergency department with the use of synthetic cannabinoids
known as Bonzai or Jameika.
MATERİAL AN METhODS: Patients who presented to the emergency department with the using of synthetic cannabinoids known as Jameika, Bonzai were determined from judicial records of
hospital police between date of 01.02.2014 - 31.07.2014. Patients were evaluated according to age, sex, presenting complaint, the date of application and treatment process in the emergency
department.
RESuLTS: A total of 112 patients were admitted to our emergency department between the specified dates, 111 patients were male and only 1 patient was female. Mean age of patients was
23.32 ± 6.14 (15 - 48). Sixty four per cent of patients were located between age of 18-24. There were 60 patients in the third decade of life, 35 patients in the second decade, 15 patients
in the fourth decade and 2 patients in the fifth decade of life. A total of 83 patients were admitted directly to emergency clinic in the last two months. Cardiac side effects (%33.03) such as
tightness in the chest, shortness of breath and palpitation were found significantly higher. Sixty-one patients were evaluated in the emergency department and discharged from hospital.
Most of the patients who need inpatient treatment, were admitted to intensive care units. Fifty-two patients were consulted in the emergency department, most of them were obtained from
internal medicine and anesthesia clinics.
CONCLuSION: Synthetic cannabinoid intoxication is especially seen in male young adults, and has been increasing in recent months. Cardiac side effects are more common. Knowledge level
of physicians’ should be increased with trainings about this subject and For a more comprehensive epidemiological data, multicenter studies should be carried out.
KEywORDS: Synthetic cannabinoids, young age, intoxication
SS-014 Toksikoloji
Lipid Emulsion Treatment Decreased high Levels of Phenytoin in Rats
Afşin Emre Kayıpmaz1, Cemil Kavalcı1, Nilüfer Bayraktar2, Didem Bacanlı3, Tolga Reşat Aydos4, Tufan Akın Giray1, Ümmü Gülsüm Kocalar1, Sibel Benli1
1Emergency Department, Baskent University Faculty of Medicine, Ankara, Turkey
2Department of Biochemistry, Baskent University Faculty of Medicine, Ankara, Turkey
3Experimental Animals Breeding and Research Center, Baskent University, Ankara, Turkey
4Department of Medical Pharmacology, Baskent University Faculty of Medicine, Ankara, Turkey
INTRODuCTION-AIMS: Phenytoin is a widely used, lipofilic anti-epileptic agent. Because of its narrow therapeutic index, toxicity is not a rare entity. Central nervous system signs, encep-
halopathy and death may occur according to the exposed dose. Although treatment modalities like active charcoal, charcoal hemoperfusion and molecular adsorbent recirculation system
was tried in phenytoin toxicity, today there is no specific antidote for phenytoin. Therefore, we need a low-cost supportive therapy agent which can easily apply in the emergency conditions.
We suggest lipid emulsion treatment as an easy applicable and low-cost add-on treatment for phenytoin toxicity since phenytoin is a lipofilic drug. The aim of our study is to construct a
phenytoin toxicity model in experimental animals and observe the efficacy of lipid emulsion treatment.
METhODS: We randomly divided 28 rats into 4 groups with an equal number of rats in each group: Group 1: Control Group (received no treatment), Group 2: Phenytoin Group (received
75 mg/kg phenytoin intraperitoneally), Group 3: Lipid Emulsion Group (received 4 ml/kg 20% lipid emulsion intravenously), Group 4: Phenytoin + Lipid Emulsion Group (received 75 mg/kg
phenytoin intraperitoneally and 4 ml/kg 20% lipid emulsion intravenously). We performed blood draws twice in each group: Group 2 and 4 for measuring phenytoin, albumin, ALT and AST
levels; Group 1 and 3 for measuring ALT and AST levels.
RESuLTS: Lipid emulsion decreased statistically significantly the phenytoin level of treatment group (Group 4) in comparison with the control group (Group 2) (respectively p=0.023 and p=0.017).
7
SÖZLÜ BİLDİRİLER
CONCLuSİON: We demonstrated the efficacy of lipid emulsion treatment in reducing serum phenytoin levels in our animal model. Our findings show, lipid emulsion treatment, which has a
safe adverse effect profile, is a promising method for cases with phenytoin intoxication.
KEywORDS: Lipid emulsion treatment, phenytoin toxicity, rat
SS-015 Toksikoloji
Sudden Sensorineural hearing Loss After heroin Intake
Binnur Eşfer, Selim İnan, Murat Ongar, Nihat Özüpek, Vicdan Koçak Metin, Burak Demirci, İrfan Kala, Muhammed Evvah Karakılıç
Ankara Numune Training and Research Hospital,Emergency Medicine,Ankara,Turkey
INTRODuCTION: There are lots of complications of heroin overdose include slow and difficult breathing, dry mouth, extremely small pupils, pinpoint pupils, tongue discoloration, low blood
pressure, weak pulse, bluish-colored nails and lips, constipation spasms of the stomach and intestinal tract,coma, delirium, disorientation,drowsiness, muscle spasticity, temporary limb
paralysis, transverse myelitis, seizures and stroke. Hearing loss is exremely rare complications of heroin and there are only a few cases of heroin overdose associated hearing loss reported
in the literature.We will present a case with opioid-induced sudden sensorineural hearing loss.
CASE: 30-year-old male patient was found unresponsive by his family after heroin use and brought to the emergency room by 122. Heroin was found at his bedside by his family. On ad-
mission, he was unresponsive and he had pinpoint pupils, was hypotensive. There were no significant pathological finding to explain the state of consciousness in cranial CT, diffusion MR
and laboratory tests. He was monitorized and taken to observation room.Treatment was started with intravenous fluids and naloxone. Patient who regains consciousness transferred to the
intensive care unit(ICU). After 48 hour observation in ICU his mental status improved but he complained of new onset bilateral hearing loss. Otorhinolaryngology concultation was request.
Audiometry was performed and it showed severe bilateral sensorineural hearing loss. Ear and control kranial MRI was performed and showed no other abnormalities. We thought sudden
sensorineural hearing loss related with opioid.In control examinations and control audiometries, patients failed to recover from opioid induced sensorineural hearing loss.
CONCLuSION: There are a few case about hearing loss after intravenous heroin intake. The underlying pathology is not completely understood. Overstimulation of the kappa receptors and
decreased afferent activity in the cochlea could be a possible explanation for the hearing loss.In conclusion high doses of heroin intake will lead to sudden sensorineural hearing loss.We
should keep in mind that rare condition.
KEywORDS: Heroin Overdose, Opioid Intake,Sensorineural Hearing Loss,
SS-016 Toksikoloji
A Case Report: unintentional human Exposure to Tilmicosin
Abdussamed Vural, Mehmet Yılmaz, Bahadır Karaca, Fatih Tutucu, İsmail Altıntop, Mükerrem Altuntaş, Hüseyin Çebiçci
Department of Emergency Medicine, Training and Research Hospital,Kayseri,Turkey
INTRODuCTION: Tilmicosin phosphate (MICOTIL 300, 300 mg/mL) is a semisynthetic antibiotic of the macrolide group that is used in veterinary medicine for the treatment of bovine res-
piratory disease and ovine respiratory diseases especially associated with Mannheimia (Pasteurella) haemolytica and multocida (1–3). We want to present a case of a serious needle stick
injury in a cattle feedlot worker who was unintentionally exposed to tilmicosin which has a serious cardiac toxicity.
CASE: A 25-year-old man with no prior history of heart disease developed mild chest pain and palpitation 5 hours after unintentional injection of a 5 cc syringe filled with Micotil 300 (tilmico-
sin phosphate,300 mg/mL). The worker accidentally injected the dose 1500 mg into his elbow of the right arm as the animal moved to avoid administration of the medication. Approximately
2 hours after the accidental injection, the worker developed mild chest pain and severe palpitation and was transported to the our emergency service. His vital signs upon arrival in the emer-
gency department were as follows: blood pressure 120/80mmHg, pulse 115 bpm, respiratory rate 22 bpm. An injection site was visible on his right elbow. Electrocardiogram (ECG) showed
several abnormalities, including an incomplete right bundle branch block and sinus tachycardia. There were no previous ECGs available for comparison. The patient’s cardiac monitoring was
performed in the emergency service. There was no acidosis and no increased anion gap and also the other laboratory tests including the level of troponin I as well were normal. but the patient
was transferred to the intensive care unit because of its potentially life threatening effect (cardiac toxicity) on human being. No cardiac arrhythmias and chest pain were noted at follow-up
in hospitilazition period. At follow-up, the post-hospitalization electrocardiogram showed normal sinus rhythm. An incomplete right bundle branch block and tachycardia had resolved. No
further cardiac evaluation was performed and the patient was discharged home on day 2 of hospital admission.
CONCLuSİON: This case provides evidence that unintentional injection of tilmicosin can cause cardiac symptoms and also may lead to myocardial injury (1) so the patients were monitored
for cardiac complications. Tilmicosin should be administered by properly trained personnel to reduce the risk of accidental self-injection.
KEywORDS: Human Exposure,Tilmicosin, Unintentional
SS-017 Toksikoloji
Evaluation of drug overdose patients admitted to the emergency department of Bolu in the province
Bülent Yılmaz1, Arif Duran2, Mansur Kürşad Erkuran2, Güray Can1, Tarık Ocak3
1AİBÜ İzzet Baysal Training and Research Hospital Gastroenterology Training Clinic Bolu
2AİBÜ İzzet Baysal Training and Research Hospital Emergency Medical Training Clinic, Bolu
3İstanbul Kanuni Sultan Süleyman Training and Research Hospital Emergency Medical Training Clinic, İstanbul
OBjECTIvE: Drug overdose is one of the leading causes of death following traffi c accidents, especially in the young. The aim of retrospective study was to analyze the rate characteristics
the frequency of drug overdose, sociodemographic features and the etiologic features in our city (Bolu province, Turkey).
MATERIALS-METhODS: In the study, subjects who applied to Bolu Izzet Baysal AİBÜ Training and Research Hospital the emergency department due to drug overdose between 01th January
2007 and 31th December 2014 were analysed retrospectively. Data on sociodemographic features, methods used for drug overdose attempts and reasons were obtained by reviewing the
medical fi les of the cases.
RESuLTS: Of 703491 patients who applied to the emergency department, 3729 (0.53%) were found from the records to apply with drug overdose. 2313 (62%) (22,98±13,75 year) of the
subjects were females and 1416(38%)(23,52±17,08 year) were males. Drug overdoses were found to increase in the 15-50 age group (72,2%). The most commonly preferred agents were
antiinflammatory drugs 54% (n=2177). The nonsteroidal anti-inflammatory drug intake was compared with other medicines overbought statistically significant (p> 0.05). The most com-
monly patients admitted to evening hour period(16-24 hour period;49,7%), month of may (10,4 %), seasons of spring(29,3%) and year of 2014 (14,3%).
CONCLuSION: In our study, drug overdose attempts were found to be a social problemfor our region and it was more common in the productive population between the ages of 15-50 years
and in females. The most commonly preferred agents were antiinflammatory drugs non-steroidal antiinflammatory drugs.
KEywORDS: Drug overdose, emergency medicine, seasons
8
ORAL PRESENTATIONS
SS-018 Toksikoloji
Case Report: Cardiac Arrest as a result of Cardiac and Renal Toxicity due to Mycetism
Yahya Kemal Günaydın, Can Gökay Yıldız, Kemal Biçer, Nazire Belgin Akıllı, Ramazan Köylü, Lütfullah Altıntepe, Başar Cander
Konya Education and Research Hospital, Department of Emergency Medicine, Konya, Turkey
INTRODuCTION: Mycetism is an important health problem which is seen very common in our country. Eating mushrooms gathered unconsciously may cause a process from simple gast-
rointestinal complaints to severe hepatic failure and death. However, cardiac and renal toxicity and death due to this are reported rarely.
CASE: A 30 year old male patients referred our emergency department due to the complaint of nausea and vomiting on the next day after eating the mushrooms that he gathered. Patient’s
overall status was well; he was conscious and his vital signs were stable. Physical examination was normal. In blood analysis, creatinine level was detected slightly higher by 1.68 mg/dl. Liver
function test values were normal. The patient was admitted to emergency toxicology unit for follow-up. Nausea and vomiting continued, therefore, antiemetic and proton pump inhibitor were
administrator. Furthermore, penicillin G and n-acetyl cystein treatment was started. Since creatinine increased 2.7 mg/dl in the second day, after consultation with nephrology and carbon
hemoperfusion was performed. Creatinine and troponine values were detected as 4.27 mg/dl and 7.15 ng/ml, respectively in the third day, therefore, cardiology consultation was ordered.
Furthermore, carbon hemoperfusion and plasmapheresis were performed. ECG and cardiac enzyme monitoring were suggested by cardiology department. ECHO performed was normal.
Creatinine and troponine values continued to increase (troponine:23.3 ng/ml; creatinine: 5.7 mg/dl) whereas Liver Function tests and ECG were normal in days 4 and 5. Patient had palpitation
and dyspnea in the morning in day 6. He had ventricular tachycardia (VT). Cardioversion was applied and amiodorone was added into the treatment. Cardiology and nephrology consultations
were repeated. VT and dyspnea continued. Upon increase of hypoxy, sedation was started; the patient was intubated and connected to mechanic ventilator. The patient was taken intohemo-
perfusion again. Patient’s blood pressure decreased during hemoperfusion; noradrenalin and dopamine were infused. Amiodorone and sedative agents were discontinued because of hypo-
tension. The patient was reassessed with ECHO by cardiology department. Ejection fraction by 30% and left ventricle failure were detected. Intraaortic balloon pump application was decided;
however, VT appeared again. Cardioversion and amiodorone was performed; VF (ventricular fibrillation) and then asystole developed. Resuscitation was unresponent and the patient died.
CONCLuSION: Hepatic failure does not develop after mycetism only. Cardiac and renal toxicity which may appear rarely may progress mortally. Therefore, this should not be ignored during
follow-up of these patients.
KEywORDS: Mycetism, Cardiac Arrest, Renal Toxicity
SS-019 Toksikoloji
Intravenous Lipid Therapy in Calcium Channel Blocker and Beta Blocker Poisoning: 4 Case Report
Yahya Kemal Günaydın, Ozan Özelbaykal, Nurser Muraçar, Nazire Belgin Akıllı, Ramazan Köylü, Başar Cander
Konya Education and Research Hospital, Department of Emergency Medicine, Konya, Turkey
İNTRODuCTİON: In recent studies, intravenous (IV) lipid emulsion therapy is recommended to be given during resuscitation, especially in lipophilic antiarrhythmics and local anesthetics
toxicity.
CASE 1: 22 year old woman presented to our emergency department, in 2 hours after ingesting 15 tablets, 10 mg bisoprolol for attempt of suicide. Patient’s GCS was 3/15, arterial tension
(TA) was 60/40 mmHg, pulse was 40/min. Endotracheal intubation was performed. IV noradrenaline, dopamine infusion and glucagon treatment was started. 4 hours after admission she
was still unconscious, hypotensive and bradycardic. IV lipid, 1.5 ml/kg bolus followed by 0.25 ml/kg/min 1 hour infusion, was given. On second day, patient’s vital signs and consciousness
were improved.
CASE 2: 21 year old man presented to our emergency department, in 2 hours after ingesting 20 tablets, 50mg metoprolol for attempt of suicide. Patient was confused and his GCS was 13/15.
Patient’s TA was 80/40 mmHg pulse was 55/min. IV noradrenaline, dopamine infusion and glucagon treatment was started. 4 hours after admission patient’s consciousness was normal but
he was still hypotensive and bradycardic. IV lipid,1.5 ml/kg bolus followed by 0.25 ml/kg/min 1 hour infusion, was given. On second day his vitals were stabilised.
CASE 3: 18 year old woman presented to our emergency department, in 1 hour after ingesting 40 tablets, 10 mg amlodipine for attempt of suicide. Patient’s vitals were; TA:60/40 mmHg
pulse:40/min and respiratory rate:30/min. IV noradrenaline, dopamine infusion and glucagon treatment was started.4 hours after admission patient was still hypotensive and bradycardic.
Upon this, IV lipid, 1.5 ml/kg bolus followed by 0.25 ml/kg/min 1 hour infusion, was given. On second day her TA and pulse improved.
CASE 4: 76 year old woman presented to our emergency department, in 6 hours after ingesting 28 tablets, 5 mg amlodipine for attempt of suicide. Patient was confused. Patient’s vitals were;
TA:70/40 mmHg pulse:40/min. IV noradrenaline, dopamine infusion and glucagon treatment was started. TA levels of patient got worse and became unconscious. Upon this, endotracheal
intubation and mechanical ventilation was performed. IV lipid, 1.5 ml/kg bolus followed by 0.25 ml/kg/min 1 hour infusion, was given. İnfusion repeated 2 times. In 4 hours patient had cardiac
arrest. Patient did not respond to resuscitation and died.
CONCLuSION: Intravenous lipid emulsion therapy can be effective in the treatment of lipophilic anti-arrhythmic drug poisoning. But greater number of clinical studies are necessary to
determine the precise indications.
KEywORDS: IV lipid, CCB, BB, Poisoning.
SS-020 Toksikoloji
The role of oxidative stress in α-amanitin induced hepatotoxicity in an experimental mouse model
Zerrin Defne Dundar1, Mehmet Ergin1, Ibrahim Kilinc2, Tamer Colak1, Pembe Oltulu3, Basar Cander1
1Emergency Medicine Department, Necmettin Erbakan University Meram Faculty of Medicine, Konya, Turkey
2Biochemistry Department, Necmettin Erbakan University Meram Faculty of Medicine, Konya, Turkey
3Medical Pathology Department, Necmettin Erbakan University Meram Faculty of Medicine, Konya, Turkey
OBjECTIvE: To evaluate trends in oxidative stress markers, SOD, CAT, GPx, MDA, TOS, and TAS, in a mouse α-amanitin poisoning model with three different toxin levels.
METhODS: The mice were randomly divided into four groups: Group 1 (control group), Group 2 (low dose poisoning group; 0.2 mg/kg α-amanitin), Group 3 (moderate dose poisoning
group; 0.6 mg/kg α-amanitin), and Group 4 (high dose poisoning group; 1.0 mg/kg α-amanitin). At hour 0, the their calculated dose of α-amanitin was injected to the mice in poisoning
groups intraperitoneally. At hour 48, all mice were sacrificed and their livers were collected for biochemical and histopathological evaluation.
RESuLTS: Median liver tissue SOD activity in moderate and high dose groups was significantly higher than the median SOD activity in control (for both, p = 0.001). Median liver tissue CAT
activity in Group 2 was significantly higher than the median CAT activity in Group 1 (p = 0.001). Median liver tissue CAT activity in Groups 3 and 4 was significantly lower than the median
CAT activity in Group 1 (for both, p = 0.001). Median liver tissue GPx activity in Groups 2, 3, and 4 was significantly higher than the median GPx activity in Group 1 (for Group 2, p = 0.006;
for Group 3 and 4, p = 0.001). The median liver tissue MDA levels of Groups 3 and 4 were significantly higher than the median MDA level of Group 1 (for Group 3, p = 0.015; for Group 4,
p = 0.003). There was a significant positive correlation between liver CAT activity and liver TAS level, and a significant negative correlation between liver CAT activity and liver TOS level (r =
0.935 and r = −0.789 respectively; for both, p<0.001).
CONCLuSIONS: Our findings support a significant role for increased oxidative stress in α-amanitin induced hepatotoxicity. In particular, identifying the pathophysiological mechanism
responsible for the direct relationship between CAT, α-amanitin, and TAS levels may be very helpful for further treatment investigations.
KEywORDS: amanitin, oxidative stress, mushroom poisoning, biomarker, mouse
9
SÖZLÜ BİLDİRİLER
SS-021 Toksikoloji
Examination using lc-ms/ms determination of grayanotoxin levels in blood and urine and in honey consumed by patients presenting to the emergency depart-
ment with mad honey intoxication and of relations with clinical data: a preliminary study
Ali Aygün1, Abdülkadir Gündüz1, Süleyman Türedi1, Süha Türkmen1, Yunus Karaca1, Ahmet Faik Ayaz2, Su Youn Ahn3, Suncheun Kim3
1Karadeniz Technical University, Faculty of Medicine, Department of Emergency Medicine, Trabzon, Turkey
2Karadeniz Technical University, Faculty of Science, Department of Biology, Trabzon, Turkey
3Daejeon Institute, National Forensic Service, Daejeon, Republic of Korea
INTRODuCTION: ‘Mad honey’ results from grayanotoxin (GTX) in flowers of plants of the genus Rhododendron L. (Ericaceae) being mixed in with honey by bees. There are no studies
showing either toxin levels in honey or the levels of this toxin in people intoxicated by this natural product. Holstege et al. later developed a rapid high-performance liquid chromatography–
tandem mass spectrometry (LC-MS/MS) method permitting quantitative determination of GTX I, II and III in biological samples including rumen contents, feces and urine.
The purpose of this study was to investigate grayanotoxin levels in blood and urine and in honey consumed by patients with mad honey intoxication and to determine whether or not there
is an association with clinical status.
MATERİALS-METhODS: Four cases presenting to the Karadeniz Technical University Medical Faculty Emergency Medicine Clinic and diagnosed with mad honey intoxication were included
in the study. Mad honey, blood and urine samples were obtained from patients intoxicated with GTXs.
Patients’ blood and urine specimens were centrifuged at 12,000 rpm at 5°C. After centrifugation, the supernatants were collected and lyophilized at -50°C overnight, and the dry materials
were stored at -80 °C for further analysis. The samples were transfered to South Korea and they were analyzed in National Forensic Services, South Korea.
Throughout the analysis, optimized validated HPLC and LC-MS/MS working conditions were selected based on a recent publication published elsewhere Cho et al.
RESuLTS: All patients presented with dizziness and nausea, and hypotension and bradycardia were present in all subjects. The highest blood GTX I and GTX III levels were determined in
Case 1. Patients’ mean blood GTX I level was 30.62 ng/mL mean GTX III 4.917 ng/mL. Mean urine GTX I was 0.447 mcg/mL and mean GTX III level 1.998 mcg/mL. Mean GTX I level in honey
consumed was 4.683mcg/g and mean GTX III level 8.423 mcg/g. Patients’ mean blood pressure was 77.5 / 47.5 mmHg and mean heart rate 38 beats/min.
CONCLuSİON: This is a preliminary study, and the first to show grayanotoxin levels in specimens from human body fluids. Overall, a simple and reliable sample pretreatment procedure and
a validated LC-MS/MS method for determination and quantification were successfully performed on the honey and blood and urine samples from human body.
KEywORDS: Mad Honey, Grayanotoxins(GTXs), Rhododendron, Human Whole Blood, Urine, LC-MS/MS
SS-022 Toksikoloji
Multi-drug screen urine test in emergency department
Zerrin Defne Dundar1, Mehmet Akif Onal2, Alpay Tuncar1, Mehmet Ergin1, Basar Cander1
1Emergency Medicine Department, Necmettin Erbakan University Meram Faculty of Medicine, Konya, Turkey
2Emergency Department, Konya Training and Research Hospital, Konya, Turkey
OBjECTIvE: We aimed to evaluate the results of multi-drug screen urine tests performed in our emergency department within a period of 2 years.
METhODS: In this retrospective study, the following data were recorded from medical files of patients admitted to emergency department and evaluated by multi-drug screen urine test
between January 2013 and December 2014: Age, gender, comorbidity, medications, history of suicide attempt/substance abuse, result of multi-drug urine analysis, length of stay in hospital,
and outcomes.
RESuLTS: A total of 199 patients were included in the final analysis. 69 (34.6%) of them were female and 130 (65.4%) were male. The mean age of the patients was 31.7±13.8 years. 53
(26.6%) of patients had at least one comorbidities. In 84 (42.2%) of patients, there was drug intake history with suicidal purpose. In 53 (26.6) of patients, there was a history of alcohol and
substance abuse. When we analyzed the multi-drug screen urine test results, the most frequent detected substance was opioid derivatives in 30 (15.1%) patients. In frequency order, APAP
(n=23, 11.6%), TCA (n=20, 10.1%), BZO (n=19, 9.5%), THC (n=11, 5.5%), and mAMP (n=11, 5.5%) were detected in urine test. Multi-drug test showed that there were more than two drugs
in 22 (11.1%) patients. The test was negative in 97 (48.7%) patients. Opiate and methamphetamine were detected oftenest concomitantly in the patients using cannabinoid and derivatives.
Most frequent drugs were tricyclic antidepressants 13.5% (n=27) and paracetamol 11.5% (n=23) additively in the patients those had substance abuse. The mean length of stay in hospital was
2.37±1.50 days and the mean length of stay in intensive care unit was 2.03±1.34 days. 159 (80.3%) patients were discharged from hospital and 20 (10.1%) patients were admitted to ward.
CONCLuSION: The history of using multi-drug, suicidal attempt and substance abuse should be questioned carefully in the patients admitted to the emergency with different complaints.
Importance of multi-drug screen urine analysis in the emergency department will be understood for patient management by considering this case group can apply to the hospital with
different clinical profiles.
KEywORDS: toxicology, urine, multi-drug, screening
SS-023 Toksikoloji
Severe Poisoning by Deadly Nightshade (Atropa Belladonna)
Hilmi Akdağ1, Metin Özdemir2, Emine Merve Akdağ3, Mehmet Nihat Özüpek2, İrfan Kala2
1Department of Anesthesiology and Reanimation,Yıldırım Beyazıt University, Ankara, Turkey
2Department of Emergency Medicine, Ankara Numune Research and Training Hospital, Ankara, Turkey
3Department of Psychiatry, Ankara Numune Research and Training Hospital, Ankara, Turkey
Atropa Belladona is a plant classified in the solanaceae family and its roots, leaves and fruits contain the belladonna alkaloids: atropine, hyocyamine, and scopolamine responsible for the
anticholinergic toxicity of the plant. It has thick oval dark green foliage with black cherry-like berries making it look identical to blueberries and attractive to eat. This also happens to be a
common reason for intoxication after ingestion of these berries in adults and children’s. Atropa belladonna alkaloids cause delirium, hallucination, tachycardia, mydriasis, dry mouth, flushed
skin, blurred vision, urinary retention, and anhidrosis.
In our case, 25 year old male patient was admitted a local hospital in rural area with complaints of blurred vision and urinary retention. After first assessment the patient had been sent to
our hospital for unknown toxidrome. In admission the patient was agitated and disorientated and seemed to be grasping at imaginary objects. His vital signs included blood pressure 125/65
mmHg, pulse rate:130 temprature:37,8. His pupils were dilated.ECG: sinus tachycardia. He had no history of psychiatric illness, suicide attempt or drug abuse. We tried to get detailed history
from his family as he might have been intoxicated, then his father told us that they had gone picnic in the morning and while they had been walking in the forest, he had eaten some fruits
like blueberry. 3 hours after ingestion his complaints began with blurred vision. They showed us some of these fruits which he had taken with. Clinical findings and the appearance of the
fruit consistent with anticholinergic poisoning with Atropa Belladona. Gastric lavage and active charcoal was not implemented because of aspiration risk due to his delusion. The patient was
monitorized and we administered 2 mg midozolam three times for sedation. The external cooling was given for temperature control. Due to the apparent acute anticholinergic crisis with
altered mental status, 0.5 mg of physostigmine was administered with slow intravenous push. This dose was repeated four times over 60 minutes. 10 minutes after the fourth dose, the
patient demonstrated a deceleration in heart rate, to 95 beats/min, with marked improvement in mental status. The patient was transferred to the intensive care unit with stable vital signs.
Intoxication with Atropa Belladona is a severe condition with variable presentation. It’s should be considered in the presence of anti-cholinergic toxidrome. The treatment is essentially
symptomatic. If sedation is considered then benzodiazepine therapy is appropriate. Physostigmine can be used in severe intoxication.
KEywORDS: atropa belladonna, anticholinergic intoxication, physostigmine
10