MANTAR ZEHİRLENMESİ: TEK MERKEZDEN 10 YILLIK PEDİATRİK ACİL BAŞVURULARININ GERİYE DÖNÜK DEĞERLENDİRİLMESİ
Öz
AMAÇ: Bu çalışma mantar tüketimi ile ilgili çocuk acil başvurularının klinik özellikleri ve sonlanımlarını değerlendirerek merkezimize ait tabloyu resmetmek, hasta yönetimi ve eğitim planlamasına yol gösterici veri üretmek amacıyla gerçekleştirildi.
GEREÇ VE YÖNTEM: Geriye dönük 10 yıllık sürede mantar zehirlenmesi tanısı ile acil servise başvurmuş 18 yaş altı hastaların dosyaları incelendi ve oluşturulan bir form üzerinden hastaların demografik ve klinik özellikleri kaydedilerek değerlendirildi.
BULGULAR: Değerlendirilen süre kapsamında çocuk acil servise başvurmuş toplam 689.000 hastadan 65 çocuk (%0,009) mantar zehirlenmesi tanısı almıştı. Mantar yedikten sonra semptomların başlama süresi ortalama 5,2±10,3 saatti ve hastaların %71’inde semptomlar ilk 6 saat içinde başlamıştı. Büyük çoğunluğunda gastrointestinal yakınmalar ön planda olup, kusma (%78) en sık görülen semptomdu. Hastaların tamamı hastaneye yatırıldı. Hastanede izlem süresi ortalama 3±1,5 gündü. Hasta yaşının küçük olması, başvuru fizik muayenesinde patolojik bulgu saptanması ve spesifik hepatoprotektif ve antidot tedavileri verilmiş olması hastanede yatış süresinin daha uzun olması ile ilişkili bulundu(p<0.05). Hastaların yaklaşık 1/3’ü çocuk yoğun bakım koşullarında izlenmiş olup, kaybedilen hasta olmadı. Ancak semptomları geç başlayan ve tıbbi yardıma geç başvuran sadece bir çocukta (%2) ilerleyici geri dönüşsüz karaciğer yetmezliği nedeniyle organ nakil merkezine sevk gerekti.
SONUÇ: Çocuklarda mantar zehirlenmeleri çoğunlukla gastrointestinal sistem belirtilerinin ön planda olduğu iyi bir klinik seyir gösterse de özellikle semptomları geç başlayan ve tıbbi yardıma geç başvuran hastalarda karaciğer yetmezliği ile sonuçlanabilecek ağır klinik tablo açısından dikkatli yaklaşım gereklidir.
Anahtar Kelimeler
Kaynakça
- 1. Wennig R, Eyer F, Schaper A, Zilker T, Andresen-Streichert H. Mushroom Poisoning. Dtsch Arztebl Int. 2020;16;117(42):701-8.
- 2. Gurbuz S, Oguzturk H, Turgut K, et al. Mushrooms: the velvety poison. Acta Medica Mediterranea. 2015;31:947
- 3. Brandenburg WE, Ward KJ. Mushroom poisoning epidemiology in the United States. Mycologia. 2018;110(4):637-41.
- 4. Alagözlü H, Sezer H, Candan F, et al. A survey of patients with acute poisoning in the Sivas region, Turkey, between 1994 and 1998. Turkish Journal of Medical Sciences. 2002;32(1), 39-42.
- 5. Eren SH, Demirel Y, Ugurlu S, et al. Mushroom poisoning: retrospective analysis of 294 cases. Clinics. 2010;65(5):491–6.
- 6. Schmutz M, Carron PN, Yersin B, Trueb L. Mushroom poisoning: a retrospective study concerning 11-years of admissions in a Swiss Emergency Department. Intern Emerg Med. 2018;13(1):59-67.
- 7. Ecevit Ç, Hızarcıoğlu M, Akgün Gerçek P, ve ark. Acil servise başvuran mantar zehirlenmelerinin retrospektif olarak incelenmesi. ADÜ Tıp Fakültesi Der. 2004;5(3):11-4.
- 8. Hızel S, Mısırlıoğlu ED, Özdoğan S, ark. Mantar zehirlenmesi olan çocuk olguların değerlendirilmesi. TSK Koruyucu Hekimlik Bülteni. 2007;6(5): 341-4.
- 9. Erguven M, Yilmaz O, Deveci M, et al. Mushroom poisoning. Indian J Pediatr. 2007;74(9):847-52.
- 10. Unluoglu I, Alper Cevik A, Bor O, et al. Mushroom poisonings in children in Central Anatolia. Vet Hum Toxicol. 2004;46(3):134-7.
- 11. Lapinski TW, Prokopowicz D. Epidemiological factors of mushroom poisoning in the north-east of Poland. Przegl Epidemiol. 1998;4:463-7.
- 12. Shannon MW, Borron SW, Burns MJ, et al. Haddad and Winchester's Clinical Management of Poisoning and Drug Overdose (Fourth Edition), Elsevier-Saunders, Philedelphia. 2007;454-71.
- 13. Schenk-Jaeger KM, Rauber-Lüthy C, Bodmer M, et al. Mushroom poisoning: a study on circumstances of exposure and patterns of toxicity. Eur J Intern Med. 2012;23(4):e85-91.
- 14. Yardan T, Eden AO, Baydın A, Arslan B, Vural K. Mantar Zehirlenmeleri. O.M.Ü. Tıp Dergisi. 2008;25(2):75–83.
- 15. Shaw KN, Bachur RG (ed). Plants/Mushrooms. In: Fleisher &Ludwig's Textbook of pediatric emergency Medicine 7. Edition. 2016:1098-99.
- 16. Aggarval P,Wali J. Environmental toxins: Mushrooms. In: Diagnosis & management of common poisonings. Oxford University Press. 1997:384-8.
- 17. Pajoumand A, Shadnia S, Efricheh H, et al. A retrospective study of mushroom poisoning in Iran. Hum Exp Toxicol. 2005;24(12):609-13.
- 18. Chew KS, Mohidin MA, Ahmad MZ, Kamauzaman THNT, Mohamad N. Early onset muscarinic manifestations after wild mushroom ingestion. Int J Emerg Med. 2008;1:205–8.
- 19. Ye Y, Liu Z. Management of Amanita phalloides poisoning: A literature review and updateJ Crit Care. 2018;46:17-22.
- 20. Giannini L, Vannacci A, Missanelli A, et al. Amatoxin poisoning: a 15-year retrospective analysis and follow-up evaluation of 105 patients. Clin Toxicol (Phila). 2007;45(5):539-42.
- 21. Enjalbert F, Rapior S, Nouguier-Soulé J, et al. Treatment of amatoxin poisoning: 20-year retrospective analysis. J Toxicol Clin Toxicol. 2002;40(6):715-57.
- 22. Yang CF, Sheng CQ, Ao Y, et al. Timing of liver transplantation for pediatric acute liver failure due to mushroom poisoning: a case report and literature review. BMC Pediatr. 2020 ;23;20(1):351.
- 23. Beuhler MC, Graeme KA (Edited by). "Overview of mushroom poisoning." Critical Care Toxicology: Diagnosis and Management of the Critically Poisoned Patient; Brent J, Eds. 2016:2103-2128.
MUSHROOM POISONING: RETROSPECTIVE EVALUATION OF 10 YEARS PEDIATRIC EMERGENCY ADMISSIONS FROM ONE CENTER
Öz
OBJECTIVE: This study was conducted to draw a picture of our center by evaluating the clinical features and outcomes of pediatric emergency practices related to mushroom consumption, and to produce data that will guide patient management and education planning.
MATERIAL AND METHODS: The files of patients below 18 years of age who applied to the emergency department with the diagnosis of mushroom poisoning in a 10-year period retrospectively were examined and the demographic and clinical characteristics of the patients were recorded a form and evaluated.
RESULTS: Within the evaluated period, 65 children (0.009%) were diagnosed with mushroom poisoning out of a total of 689.000 patients who applied to the pediatric emergency department. The mean time to onset of symptoms after eating mushrooms was 5.2±10.3 hours, and symptoms started within the first 6 hours in 71% of the patients. Gastrointestinal complaints were predominant in the vast majority, and vomiting (78%) was the most common symptom. All of the patients were hospitalized. The mean follow-up period in the hospital was 3±1.5 days. The younger age of the patient, the detection of pathological findings in the physical examination at admission, and the administration of specific hepatoprotective and antidote treatments were associated with a longer hospital stay (p<0.05). Approximately 1/3 of the patients were followed under pediatric intensive care conditions, and no patient died. However, only one child (2%) whose symptoms started late and who applied to medical help late required referral to an organ transplant center because of progressive irreversible liver failure.
CONCLUSIONS: Although mushroom poisoning in children mostly shows a good clinical course with gastrointestinal system symptoms, a careful approach is required in terms of severe clinical picture that may result in liver failure, especially in patients with late onset and late presentation.
Anahtar Kelimeler
Kaynakça
- 1. Wennig R, Eyer F, Schaper A, Zilker T, Andresen-Streichert H. Mushroom Poisoning. Dtsch Arztebl Int. 2020;16;117(42):701-8.
- 2. Gurbuz S, Oguzturk H, Turgut K, et al. Mushrooms: the velvety poison. Acta Medica Mediterranea. 2015;31:947
- 3. Brandenburg WE, Ward KJ. Mushroom poisoning epidemiology in the United States. Mycologia. 2018;110(4):637-41.
- 4. Alagözlü H, Sezer H, Candan F, et al. A survey of patients with acute poisoning in the Sivas region, Turkey, between 1994 and 1998. Turkish Journal of Medical Sciences. 2002;32(1), 39-42.
- 5. Eren SH, Demirel Y, Ugurlu S, et al. Mushroom poisoning: retrospective analysis of 294 cases. Clinics. 2010;65(5):491–6.
- 6. Schmutz M, Carron PN, Yersin B, Trueb L. Mushroom poisoning: a retrospective study concerning 11-years of admissions in a Swiss Emergency Department. Intern Emerg Med. 2018;13(1):59-67.
- 7. Ecevit Ç, Hızarcıoğlu M, Akgün Gerçek P, ve ark. Acil servise başvuran mantar zehirlenmelerinin retrospektif olarak incelenmesi. ADÜ Tıp Fakültesi Der. 2004;5(3):11-4.
- 8. Hızel S, Mısırlıoğlu ED, Özdoğan S, ark. Mantar zehirlenmesi olan çocuk olguların değerlendirilmesi. TSK Koruyucu Hekimlik Bülteni. 2007;6(5): 341-4.
- 9. Erguven M, Yilmaz O, Deveci M, et al. Mushroom poisoning. Indian J Pediatr. 2007;74(9):847-52.
- 10. Unluoglu I, Alper Cevik A, Bor O, et al. Mushroom poisonings in children in Central Anatolia. Vet Hum Toxicol. 2004;46(3):134-7.
- 11. Lapinski TW, Prokopowicz D. Epidemiological factors of mushroom poisoning in the north-east of Poland. Przegl Epidemiol. 1998;4:463-7.
- 12. Shannon MW, Borron SW, Burns MJ, et al. Haddad and Winchester's Clinical Management of Poisoning and Drug Overdose (Fourth Edition), Elsevier-Saunders, Philedelphia. 2007;454-71.
- 13. Schenk-Jaeger KM, Rauber-Lüthy C, Bodmer M, et al. Mushroom poisoning: a study on circumstances of exposure and patterns of toxicity. Eur J Intern Med. 2012;23(4):e85-91.
- 14. Yardan T, Eden AO, Baydın A, Arslan B, Vural K. Mantar Zehirlenmeleri. O.M.Ü. Tıp Dergisi. 2008;25(2):75–83.
- 15. Shaw KN, Bachur RG (ed). Plants/Mushrooms. In: Fleisher &Ludwig's Textbook of pediatric emergency Medicine 7. Edition. 2016:1098-99.
- 16. Aggarval P,Wali J. Environmental toxins: Mushrooms. In: Diagnosis & management of common poisonings. Oxford University Press. 1997:384-8.
- 17. Pajoumand A, Shadnia S, Efricheh H, et al. A retrospective study of mushroom poisoning in Iran. Hum Exp Toxicol. 2005;24(12):609-13.
- 18. Chew KS, Mohidin MA, Ahmad MZ, Kamauzaman THNT, Mohamad N. Early onset muscarinic manifestations after wild mushroom ingestion. Int J Emerg Med. 2008;1:205–8.
- 19. Ye Y, Liu Z. Management of Amanita phalloides poisoning: A literature review and updateJ Crit Care. 2018;46:17-22.
- 20. Giannini L, Vannacci A, Missanelli A, et al. Amatoxin poisoning: a 15-year retrospective analysis and follow-up evaluation of 105 patients. Clin Toxicol (Phila). 2007;45(5):539-42.
- 21. Enjalbert F, Rapior S, Nouguier-Soulé J, et al. Treatment of amatoxin poisoning: 20-year retrospective analysis. J Toxicol Clin Toxicol. 2002;40(6):715-57.
- 22. Yang CF, Sheng CQ, Ao Y, et al. Timing of liver transplantation for pediatric acute liver failure due to mushroom poisoning: a case report and literature review. BMC Pediatr. 2020 ;23;20(1):351.
- 23. Beuhler MC, Graeme KA (Edited by). "Overview of mushroom poisoning." Critical Care Toxicology: Diagnosis and Management of the Critically Poisoned Patient; Brent J, Eds. 2016:2103-2128.
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Konular | Klinik Tıp Bilimleri |
| Bölüm | Makaleler-Araştırma Yazıları |
| Yazarlar | |
| Yayımlanma Tarihi | 5 Nisan 2023 |
| Kabul Tarihi | 6 Temmuz 2022 |
| Yayımlandığı Sayı | Yıl 2023 Cilt: 24 Sayı: 2 |
Kaynak Göster
