Teofilin zehirlenmesinde hemoperfüzyon: olgu sunumu
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Date
2014-01-23
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Uludağ Üniversitesi
Abstract
Teofilin bronkospastik hastalıkların tedavisinde kullanılan bir metilksantin derivesidir. Terapötik aralığı çok dar olup kan teofilin düzeyi 15 μg/mL’nin üzerinde olduğunda zehirlenme için risk oluşturmaktadır. Ciddi teofilin zehirlenmeleri fatal sonuçlanabileceği için yoğun bakımda tedavi edilmelidir. Bu olgularda mide yıkama, nazogastrik sonda aracılığı ile aktif karbon ve semptomatik tedavi uygulanır. Bu tedavilere cevap alınamayan durumlarda ekstrakorporeal bir yöntem uygulanabilmektedir. Yüksek doz teofilin alımı sonrası, klasik tedavi yöntemlerine yanıt alınamayan ve etkin hemoperfüzyon uygulanan iki olguyu sunduk. Birinci olguda tedaviye dirençli bulantı, kusma ve tremor mevcuttu. İkinci olguda ise tonik klonik nöbet, hipotansiyon, atriyal fibrilasyon ve kardiyak arrest gelişti. Kardiyopulmoner resüsitasyona yanıt alındı. Her iki olgu hemoperfüzyon uygulanmasını takiben başarıyla yoğun bakımdan taburcu edildi. Sonuç olarak; destekleyici klasik tedavi yöntemleriyle iyileşme sağlanamayan teofilin zehirlenmelerinde aktif karbon filtreli hemoperfüzyon, serum teofilin düzeyinin düşürülmesinde etkin bir yöntem olarak düşünülmelidir
Theophylline is a methylxanthine derivative which is used in the treatment of bronchospastic pulmonary diseases. The therapeutic range of theophylline is very narrow. It carries a risk for intoxication when the blood level is over 15μg/mL. Serious theophylline poisoning should be treated in intensive care conditions as it may cause fatal consequences. In these cases, gastric lavage, active charcoal administration through a nasogastric tube and symptomatic treatments can be applied. If these treatments are unsuccessful, extracorporeal methods like hemodialysis or charcoal hemoperfusion can be applied. We present two cases which were unresponsive to method of classic treatment and treated with hemoperfusion after theophylline intoxication. The first case presented with nausea, vomiting, and tremor refractory to treatment. The second case experienced extensive episodes of hypotension, atrial fibrillation, tonic clonic seizures and finally cardio pulmonary arrest. Cardiopulmonary ressuciation was successful. Both cases were successfully discharged from the intensive care unit after hemoperfusion therapy. In conclusion, hemoperfusion with active charcoal filters is a successful method for reducing serum theophylline concentration in patients unresponsive to classic supportive treatment.
Theophylline is a methylxanthine derivative which is used in the treatment of bronchospastic pulmonary diseases. The therapeutic range of theophylline is very narrow. It carries a risk for intoxication when the blood level is over 15μg/mL. Serious theophylline poisoning should be treated in intensive care conditions as it may cause fatal consequences. In these cases, gastric lavage, active charcoal administration through a nasogastric tube and symptomatic treatments can be applied. If these treatments are unsuccessful, extracorporeal methods like hemodialysis or charcoal hemoperfusion can be applied. We present two cases which were unresponsive to method of classic treatment and treated with hemoperfusion after theophylline intoxication. The first case presented with nausea, vomiting, and tremor refractory to treatment. The second case experienced extensive episodes of hypotension, atrial fibrillation, tonic clonic seizures and finally cardio pulmonary arrest. Cardiopulmonary ressuciation was successful. Both cases were successfully discharged from the intensive care unit after hemoperfusion therapy. In conclusion, hemoperfusion with active charcoal filters is a successful method for reducing serum theophylline concentration in patients unresponsive to classic supportive treatment.
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Keywords
Hemoperfüzyon, Hemoperfusion, Teofilin, Zehirlenme, Intoxication, Theophylline
Citation
Çalışkan, G. vd. (2014). "Teofilin zehirlenmesinde hemoperfüzyon: olgu sunumu" Uludağ Üniversitesi Tıp Fakültesi Dergisi, 40(2),89-93.