AI Summary & Key Takeaways
AI InsightSupportive treatment still maintains its importance in VPA intoxication and intensive care follow-up and treatment was necessary for two patients in our study and L carnitine was started for patients with suitable indications and preserves its importance in treatment.
📌 3 Key Takeaways
Abstract
Objective: Our aim was to determine prognostic factors effecting clinical course of the patients referring to the Child Emergency Service in our hospital with valproic acid (VPA) poisoning. Methods: Patients who had VPA poisoning diagnoses between 2010 and 2016 in our Child Emergency Service were retrospectively examined. Demographical characteristics, clinical findings, laboratory results, treatment methods and effective factors for prognosis were evaluated for the patients. Results: The study were included 114 patients whose avarage age is 9.91±4.69 years Sixty-six of the patients were female and forty-eight were male. The most common reason for inclusion has been overdosing (100 patients, 87.72%). Fourteen patients (12.28%) had pure VPA poisoning. VPA serum level median value was 141.80 µ/mL (min-max; 102.20 - 640.38 µ/mL). Central nervous system depression was the most common clinical finding (six patients, 5.2%). Thrombocytopenia hyperammoniemia in eighteen patients (15.8%). Average follow-up duration for the patients was 16.14 hours. L-carnitine treatment was applied for six patients (5.3%). Conclusions: In long-term VPA usage, the importance of thrombocytopenia and ammonia level should not be forgotten during prognosis. Supportive treatment still maintains its importance in VPA intoxication and intensive care follow-up and treatment was necessary for two patients in our study and L carnitine was started for patients with suitable indications and preserves its importance in treatment.
Özet
Amaç: Çocuk Acil Servisimize valproik asit(VPA) zehirlenmesi başvuran hastaların klinik seyrini etkileyen prognostik faktörlerin belirlenmesi amaçlanmıştır. Yöntem: Çocuk Acil Servisimize 2010-2016 yılları arasında VPA zehirlenme tanısı alan hastalar geriye dönük incelendi. Hastaların, demografik özellikleri, klinik bulguları, laboratuar sonuçları, tedavi yöntemleri ve prognozda etkili faktörler değerlendirildi. Bulgular: Çalışmaya 114 hasta dahil edildi. Hastaların yaş ortalaması 9,91±4,69 yıl idi. Hastaların 66'sı kız ve 48'i erkekti. Alım nedenleri arasında en sık neden doz aşımı (100 hasta, %87,72) idi. 14 hasta (%12,28) ise suisidal saf VPA zehirlenmesi idi. VPA serum düzeyi ortanca değeri 141,80 µ/mL (min-max; 102,20 - 640,38 µ/mL) idi. En sık klinik bulgu (6 hasta, %5,2) santral sinir sistemi depresyonu mevcuttu. On altı hastada (%14,0) trombostopeni ve 18 hastada (%15,8) hiperamonyemi tespit edildi. Hastaların ortalama takip süresi 16,14 saat idi. Altı hastaya (% 5,3) L-karnitin tedavisi uygulandı. Sonuç: Uzun dönem VPA kullanımında trombositopeni ve amonyak seviyesininde prognozdaki yeri unutulmamalıdır. VPA intoksikasyonunda destekleyici tedavi halen önemini korumakta olup çalışmamızda 2 hastamızda yoğun bakım takip ve tedavisi gerekmiş olup, L carnitin uygun endikasyonlu hastalara başlandı ve tedavide yerini korumaktadır.