Turkiye Klinikleri Journal of Pediatrics

.: ORIGINAL RESEARCH
What About Cardiotoxicity? An Evaluation of Cardiac Markers in Children with Suicidal Attempt by Drug Overdose
Peki ya Kardiyotoksisite? Aşırı Doz İlaç Alımı ile İntihar Girişiminde Bulunan Çocuklarda, Kardiyak Belirteçlerin Değerlendirilmesi
Şeyma KAYALIa, Nuran BELDERb
aHealth Sciences University Keçiören Training and Research Hospital, Department of Pediatric Cardiology, Ankara, TURKEY
bHealth Sciences University Keçiören Training and Research Hospital, Department of Pediatrics, Ankara, TURKEY
Turkiye Klinikleri J Pediatr. 2020;29(1):8-13
doi: 10.5336/pediatr.2019-71601
Article Language: EN
Full Text
ABSTRACT
 Objective: Overdose drug intake is a common method of suicide attempt among children and adolescents which can cause cardiac complications. However, the current body of knowledge about cardiotoxicity largely consists of limited adult studies and case reports. We investigated the prevalence of cardiac involvement through cardiac biomarkers and electrocardiographic findings of suicidal attempt at pediatric age. Material and Methods: A retrospective review of 158 suicide attempts by drug overdose under age of 18 who were admitted to pediatric emergency department was made. Demographic features, applied medical procedures, patients' routine laboratory findings, electrocardiographic findings and serum levels of high sensitive troponin I, CK-MB and myoblobin were rewieved. Results: Of these 158 cases, 82.3% (130) were girls and the average age was 15.5±1.4 (7-17) years. Seventy nine cases (50%) were multidrug intake. The mean duration of admission to the emergency room was 3.9 hours after drug intake. None of the cases had obvious electrocardiographic changes in terms of myocardial injury. However, mild QRS widening and QT prolongation were detected in three patients. Elevated myoglobin level was detected in 36 cases whereas two cases had elevated CK-MB levels. Increased level of high sensitive troponin I level was in only one case who took overdose asetil salisylic acide and mianserine. Conclusion: Cardiac complications may occur in suicidal attempt by drug overdose in children. High clinical suspicion with evaluation through electrocardiography and cardiac biomarkers is needed to detect this vital condition.

Keywords: Cardiotoxicity; drug overdose; pediatric age; suicide
ÖZET
 Amaç: Aşırı dozda ilaç alımı, çocuk ve ergenlerde kardiyak komplikasyonlara neden olabilen yaygın bir intihar girişimi yöntemidir. Bununla birlikte, kardiyotoksisite hakkında mevcut bilgi birikimi büyük ölçüde sınırlı yetişkin çalışmaları ve vaka raporlarından oluşmaktadır. Bu çalışmada , intihar girişimi bulunan çocuklarda kardiyak etkilenimi, kardiyak biyobelirteçler ve elektrokardiyografik bulgular ile değerlendirdik. Gereç ve Yöntemler: Çocuk acil servisine intihar amaçlı aşırı dozda ilaç alımı ile başvuran 18 yaş altı 158 hasta retrospektif olarak gözden geçirildi. Demografik özellikler, uygulanan tıbbi prosedürler, hastaların rutin laboratuvar bulguları, elektrokardiyografik bulguları ve yüksek duyarlı troponin I, CK-MB ve miyoblobin düzeyleri değerlendirildi. Bulgular: Çalışmaya dahil olan 158 vakanın 130'u (%82,3) kız, yaş ortalaması 15,5±1,4 (7-17) yıl idi. Yetmiş dokuz olgu (%50) çoklu ilaç alımı ile başvurdu. Acil servise ortalama başvuru süresi ilaç alımından itibaren 3,9 saat idi. Hiçbir olguda miyokard hasarı açısından belirgin elektrokardiyografik değişiklikler saptanmadı. Ancak, üç hastada QRS mesafesinde hafif genişleme ve QT uzaması tespit edildi. Otuz altı olguda yüksek miyoglobin düzeyi, iki olguda yüksek CK-MB düzeyi bulundu. Artmış yüksek duyarlı troponin I seviyesi, sadece aşırı dozda asetil salisilik asit ve mianserin alan bir vakada saptandı. Sonuç: Çocuklarda intihar amaçlı aşırı dozda ilaç alımı ile kardiyak komplikasyonlar ortaya çıkabilir. Bu hayati durumu tespit etmek için yüksek klinik şüphe ile birlikte, elektrokardiyografik değerlendirme ve kardiyak biyobelirteçlerin ölçümü gereklidir.

Anahtar Kelimeler: Kardiyotoksisite; aşırı doz ilaç alımı; çocukluk çağı; intihar
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