Öz
Giriş:
Akut parasetamol zehirlenmesi (APİ) ile başvuran çocuklarda aldığı bildirilen parasetamol dozu (BPD) ile kan parasetamol düzeyini karşılaştırmak ve sevk edilen hastalarda N-asetilsistein (NAC) uygulama endikasyonlarını araştırmaktır.
Yöntemler:
Çalışmamız üçüncü basamak bir hastanenin çocuk acil servisinde (AS) Haziran 2015-Haziran 2019 tarihleri arasında APİ olan çocuklarda geriye dönük olarak yapılmıştır. Demografik özellikler, zehirlenmelerin nedenleri, BPD (mg/kg) ve kan parasetamol düzeyleri (8-4-12-16. ve/veya 24. saatte) değerlendirildi. Antidot ve AS'ye sevk endikasyonu için BPD >150 mg/kg olarak kabul edildi.
Bulgular:
Toplamda 117 akut APİ olgusu incelendi. Hastaların yaş ortalaması 8,97 (±6,0) yıl ve %68,3’ü kızdı. Ortanca BPD dozu 2725 mg (ortalama 138±51,9 mg/kg) idi. Ergenlerde BPD miktarlara daha küçük çocuklara göre anlamlı derecede daha yüksekti (p<0.001). Hastaların %88,9’una 4. saat KPD görülürken; 8., 12., 16. ve 24. saatte sırasıyla hastaların %11,1, %9,4, %3,5 ve %3,5’inde KPD bakılmıştı. Sevk edilenlerin sadece 34/66’sında BPD >150 mg/kg olmasına rağmen, ilk merkezdeki hekimler aktif kömür (%90,9), gastrik yıkama işlemi (%68) ve damar içi NAC (%48) uygulama eğilimindeydiler. Hekimlerin üçüncü basamağa sevk etmeden önce BPD >150 mg/kg olması durumunda NAC kullandığı görüldü (p=0,001).
Sonuç:
NAC endikasyonunu belirlemek için BPD kullanılmamalıdır. Antidot kullanımı, kan parasetamol düzeyi bakılamayan merkezlerde veya ilk 8 saat içinde üst merkeze sevk edilemeyecek hastalarda kullanılmalıdır.
Anahtar Kelimeler: Parasetamol, zehirlenme, N-asetilsistein, asetaminofen, çocuklar
Kaynakça
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