Turkiye Klinikleri Journal of Medical Sciences

.: ORIGINAL RESEARCH
Detection of Rhabdomyolysis in Patients Admitted to Emergency Department due to Drug Overdose as a Suicide Attempt: A Propective Original Clinical Study
İntihar Amaçlı İlaç Alımı Nedeni ile Acil Servise Başvuran Hastalarda Rabdomiyolizin Araştırılması: Prospektif Orijinal Klinik Çalışma
Hilal HOCAGİLa, Filiz İZCİb, Abdullah Cüneyt HOCAGİLa, Mehmet TATLIc, Semih SÖZENd, Tuğba AKKAYA HOCAGİLe
aDepartment of Emergency Medicine, Bülent Ecevit University Faculty of Medicine, Zonguldak, TURKEY
bDepartment of Psychiatry, İstanbul Bilim University Faculty of Medicine, İstanbul, TURKEY
cEmergency Medicine Clinic, Kayseri Training and Research Hospital, Kayseri, TURKEY
dEmergency Medicine Clinic, Kartal Yavuz Selim State Hospital, İstanbul, TURKEY
eDepartment of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, USA
Turkiye Klinikleri J Med Sci. 2019;39(3):237-44
doi: 10.5336/medsci.2018-64073
Article Language: EN
Full Text
ABSTRACT
 Objective: Drug-induced rhabdomyolysis is the most common cause of disorders leading to acquired muscular inflammation. The aim of this study is to investigate rhabdomyolysis frequency in patients admitted to the emergency room (ER) due to one or different types of multiple drug ingestion with suicidal intentions. Material and Methods: This prospective clinical study was performed between June 2013 and November 2013 in Dr. Lütfi Kırdar Kartal Training and Research Hospital's ER, which had a daily admittance average of 800-1000 patients. The study included 103 patients. Creatinephosphokinase in the blood and myoglobin in the urine examined at the 3rd, 6th, 12th and 24th hours of admission to the ER. Results: Of the patients, 77 (74.8%) were female and 26 (25.2%) were male. Mean age was 28.8±9.5 years. Male subjects ingested a greater variety and a greater number of drugs than female subjects (p<0.05). Creatine phosphokinase level was found to be higher in the patients who took a higher number of drugs. Creatine phosphokinase was higher than 171 (U/L) in 15 patients (14.6%). Myoglobinuria was detected in 7.8% of all patients. No rhabdomyolysis was observed in patients who were admitted to the hospital within the first 3 hours of ingestion. The most commonly used agent for suicide attempt was non-steroidal antiinflammatory drugs (NSAIDs) (36.9%), paracetamol (31.1%) and antidepressants (30.1%). Conclusion: It was found that patients with delayed admission to the ER had a higher incidence of rhabdomyolysis. Antidepressants were the third leading agents used for suicidal intentions following NSAIDs and paracetamol.

Keywords: Rhabdomyolysis; suicide attempt
ÖZET
 Amaç: İlaçların tetiklediği rabdomiyoliz kazanılmış kas inflamasyonu nedenlerinden en sık olanıdır. Bu çalışmanın amacı öz kıyım amaçlı bir veya farklı türde çok miktarda ilaç alımı nedeni ile acil servise kabul edilen hastalarda rabdomiyoliz sıklığını araştırmaktır. Gereç ve Yöntemler: Bu prospektif klinik çalışma günlük ortalama 800-1000 hastanın başvurduğu Dr. Lütfi Kırdar Kartal Eğitim ve Araştırma Hastanesi Acil servisinde 2013 yılı Haziran ve Kasım ayları arasında yapıldı. Çalışmaya 103 hasta dahil edildi. Hastaların acil servise kabulünden sonra 3'üncü, 6'ıncı, 12'inci ve 24'üncü saatlerde kan kreatin fosfokinaz ve idrarda miyoglobin değerlerine bakıldı. Bulgular: Hastaların 77'si (%74,8) kadın ve 26'sı (%25,2) erkekti. Yaş ortalamaları 28,8±9,5 yıldı. Erkek hastalar kadın hastalardan daha fazla miktarda ve çeşitte ilaç almışlardı (p<0,05). Yüksek sayıda ilaç alan hastalarda kreatin fosfokinaz seviyesi yüksek bulundu. Kreatin fosfokinaz 15 hastada (%14,6) 171(U/L) den daha yüksekti. Miyoglobinüri hastaların %7.8'inde tespit edildi. İlaç alımının ilk üç saati içinde acil servise başvuran hastaların hiçbirinde rabdomiyoliz görülmedi. Öz kıyım amaçlı en sık kullanılan ajanlar non-steroid antiinflamatuar ilaçlar (NSAİİ) (%36,9), parasetamol (%31,1) ve antidepresanlardı (%30,1). Sonuç: Gecikmeli olarak acil servise getirilen hastalarda rabdomiyoliz insidansının daha yüksek olduğu tespit edildi. Öz kıyım amaçlı olarak NSAİİ ve parasetamolü takiben antidepresanlar üçüncü sıklıkta kullanılan ilaçlardı.

Anahtar Kelimeler: Rabdomiyoliz; intihar girişimi
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