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Bu yazıda eczacı tarafından yanlış hazırlanmış ilaç alımı sonrası, sodyum nitrit ve potasyum nitrite bağlı ciddi bir methemoglobinemi olgusu sunulmaktadır. İlk fizik muayenesinde hasta taşikardik ve takipneikdi. Hastanın siyanozu ve gri - mavi bir deri rengi vardı. Bilinen bir kardiyak hastalığı olmamasına rağmen, %100 oksijen ile satürasyonu %85 idi. Geldiğinde siyanoz, bilinç değişikliği, konvülziyonu ve hipotansiyonu olan hasta entübe edildi. Alınan venöz kan gazında methemoglobinemi (%86,2) ve metabolik asidoz saptandı. Hastaya metilen mavisi 2 mg/kg intravenöz ve 500 mg intravenöz askorbik asit uygulandı. Takibinde methemoglobin seviyesi 12 saat içinde tedrici olarak geriledi ve klinik düzelme görüldü. Methemoglobinemi, ciddi bulgulara ve ölüme neden olabilecek bir durumdur. Klinik bulgular septik şok ile karışabilmektedir. Acil hekimleri oksijene yanıt vermeyen siyanoz durumlarında methemoglobinemi olabileceğini mutlaka düşünmelidir. We present here, a child with an extremely high methemoglobin level caused by inadvertently prepared sodium nitrite and potassium nitrite by a pharmacist. On physical examination, he had tachycardia and tachypnea. He had cyanosis, and mottled and blue-gray skin color. Oxygen saturation was 85% on room air. He was intubated due to seizure and arterial hypotension. Although he had no history of cyanotic heart disease, cyanosis was resistant to 100% oxygen therapy. Venous blood gas sampling revealed metabolic acidosis and methemoglobinemia (86.2%). Methylene blue dye at a dose of 2mg/kg and ascorbic acid at a dose of 500 mg were administered intravenously and the clinical improvement was observed in 12 hours. Methemoglobinemia can cause severe systemic findings and death. The clinical findings can mimic septic shock. Emergency physicians should have awareness of methemoglobinemia in patients with cyanosis unresponsive to oxygen therapy.

Objective: Near infrared spectroscopy (NIRS) is a new technology for monitoring of cardiopulmonary resuscitation (CPR). The useof NIRS has advantages to monitoring cerebral oxygenation in the cardiac arrest patients. In this prospective study, the efficacy of theNIRS device on the determination of ROSC or futility of CPR was investigated in pediatric out-of-hospital cardiac arrest patients inthe emergency department.Methods: All the out-of-hospital cardiac arrest patients who admitted to our pediatric emergency department were included in thisprospective study. All patients were monitored via NIRS besides standard monitoring during CPR. Cardiopulmonary resuscitationwas performed accordingly Pediatric Advanced Life Support 2010 guideline.Results: 10 patients were included to this study. The median (IQR) age of patients was 40.0 (14.0-88.2) months. Three (30%) of 10patients had been achieved sustained ROSC. Abruptly increments in cerebral regional oxygen saturation (CrSO2) were observed inall these three patients. Minimum values of the CrSO2 were significantly higher and the percentages of the median times under the30% of CrSO2 were significantly lower in the ROSC group (p=0.02, p=0.02).Conclusions: Our study indicated that low CrSO2 value can be a predictive factor for futility of CPR. Additionally, abruptly incrementof CrSO2 during CPR can be an indicator for ROSC but on-going high level of CrSO2 values should be maintain for sustained ROSC.

Amaç: Zehirlenmeler çocuk yaş grubunda sık görülen, hızlı tanı ve tedavi gerektiren, önlenebilir çevresel acillerdendir. Bu çalışmada zehirlenme nedeniyle başvuran hastaların epidemiyolojik ve klinik özellikleri incelenmiştir.Yöntemler: Haziran 2010-Ocak 2015 yılları arasında çocuk acil servisine zehirlenme nedeniyle başvuran hastaların hastane kayıtları geriye dönük olarak değerlendirilmiştir.Bulgular: Çalışmaya alınan 997 zehirlenme olgusunun, %55’inin kız olduğu görülmüştür. Hastaların ortanca yaşının 43 ay [çeyrekler arası aralık: 24-166], %58,1’inin 5 yaş altında, %30,7’sinin 12 yaş üstünde olduğu bulunmuştur. Zehirlenmelerin, beş yaş altında çoğunlukla erkeklerde (%57,5) ve tamamının kaza sonucu, 12 yaş üstünde ise kızlarda (%81) ve özkıyım amaçlı (%76,1) olduğu saptanmıştır. Olguların %84,7’si tek etkenle, %15,3’ü ise birden fazla etkenle zehirlenmiştir. En sık ilaçlarla (%56,7), ikinci sırada ise kostik/korozif maddelerle (%27,8) olan zehirlenmeler saptanmıştır. İlaçlar ile olan zehirlenmelerin en sık analjezikler (%26,9) ve santral sinir sistemi ilaçları (%24) ile olduğu görülmüştür. Hastaların %71,3’ünün asemptomatik olduğu, semptomatik hastalarda ise en sık gastrointestinal sistem bulguları olduğu bulunmuştur. İlaçlarla zehirlenen olguların %21’ine mide lavajı; %28’ine aktif kömür uygulanmış, %2’sine antidot tedavisi verilmiştir. Hastaların %92’si çocuk acil servisinden taburcu edilirken, 14 olgu (%1,4) yoğun bakımda tedavi edilmiştir. Beş yıl süresince zehirlenmeye bağlı mortalite gözlenmemiştir.Sonuç: Zehirlenmeler çocuk yaş grubunda morbiditenin önemli ve önlenebilir bir nedenidir. Beş yaş altı grupta kaza sonucu, adölesan yaş grubunda özkıyım amaçlı zehirlenmelerin sık olduğu, ilaçlar ve kostik/korozif maddelerle olan zehirlenmelerin en önemli neden olduğu bulunmuştur. Yaş gruplarına göre bu epidemiyolojik ve klinik özelliklerin bilinmesi, nedene yönelik hızlı tanı ve tedavi yapılmasını sağlayacak; gerekli önlemler alınarak zehirlenmelerin azaltılmasına katkı sağlayacaktır. Introduction: Poisonings are common and preventable environmental emergencies requirin rapid diagnosis and treatment in the pediatric age group. The epidemiological and clinical characteristics of poisoning patients were investigated in this study.Methods: Hospital records of patients admitted to the pediatric emergency department due to poisoning between June 2010 and January 2015 were evaluated retrospectively.Results: Fifty-five percent of 997 poisoning cases were girls. The median age of the patients was 43 months [Interquartile range: 24-166], 58.1% of patients were under age five and 30.7% were older than 12 years of age. Poisoning under age of 5 was observed predominantly in males as a result of an accident (57.5%) and in above 12 years of age in girls (81%) and due to suicidal purposes (76.1%). In 84.7% of cases, single-drug poisoning was detected. The most common toxicity agents were drugs and caustic/corrosive substances (56.7% and 27.8%, respectively). Analgesics (26.9%) and central nervous system drugs (24%) were the most commonly used drugs. 71.3% of patients were asymptomatic and gastrointestinal findings were found to be the most common symptom in symptomatic patients. Gastric lavage, activated charcoal and antidote treatment were performed in 21%, 28% vad 2% of cases of drug-related poisonings, respectively. 92% of patients were discharged from the emergency department, while 14 patients (1.4%) were treated in the intensive care unit. Mortality due to poisoning was not observed during the five years.Conclusion: Poisoning is an important and preventable cause of morbidity in the pediatric age group. Accidental poisoning is frequently observed in children younger than five years of age while suicidal poisoning is common in adolescence. Drugs and caustic/corrosive substances were found to be the most important cause of poisoning. Recognition of these epidemiologic and clinical features according to age groups will contribute to rapid diagnosis and treatment as well as reduction in incidence of poisoning by taking the necessary precautions.