Causes of rhabdomyolysis in acute poisonings

Snežana Janković; Jasmina Jović Stošić; Slavica Vučinić; Nataša Perković Vukčević; Gordana Vuković Ercegović

doi:10.2298/3126

Snežana Janković Institute for Scientific Information, Military Medical Academy, Belgrade, Serbia
Jasmina Jović Stošić Clinic for Emergency and Clinical Toxicology, Military Medical Academy, Belgrade, Serbia Faculty of Medicine of the Military Medical Academy, University of Defanse, Belgrade, Serbia
Slavica Vučinić Clinic for Emergency and Clinical Toxicology, Military Medical Academy, Belgrade, Serbia; Faculty of Medicine of the Military Medical Academy, University of Defanse, Belgrade, Serbia
Nataša Perković Vukčević Clinic for Emergency and Clinical Toxicology, Military Medical Academy, Belgrade, Serbia
Gordana Vuković Ercegović Clinic for Emergency and Clinical Toxicology, Military Medical Academy, Belgrade, Serbia

DOI: https://doi.org/10.2298/3126

Ključne reči: rhabdomyolysis||, ||rabdomioliza, poisoning||, ||trovanje, creatine kinase||, ||kreatin kinaza, diagnosis||, ||dijagnoza, pharmaceutical preparations||, ||lekovi, opiate alkaloids||, ||narkotici, pesticides||, ||pesticidi, coma||, ||koma,

Sažetak

Uvod/Cilj. Rabdomioliza (RM) predstavlja potencijalno letalan sindrom, o čijoj učestalosti i karakteristikama u akutnim trovanjima nema mnogo podataka. Cilj rada bio je da se odrede uzročnici i težina RM u ovim stanjima. Metode. Retrospektivno su analizirane istorije bolesti 656 bolnički lečenih bolesnika zbog akutnog trovanja različitim agensima tokom jedne godine. Izdvojeni su bolesnici sa RM, a kriterijum je bio da su imali aktivnost kreatin kinaze (CK) u serumu višu od 250 U/L. Težina RM procenjivana je na osnovu skale težine trovanja (PSS). Bolesnici su bili podeljeni u tri grupe: prvu grupu sa blagom RM (CK od 250 do 1 500 U/L), drugu grupu sa srednje teškom RM (CK od 1 500 do 10 000 U/L) i treću grupu sa teškom RM (CK viša od 10 000 U/L). Rezultati. RM je nađena kod 125 (19%) bolesnika sa akutnim trovanjima, pri čemu je uglavnom bila blaga (61%) ili umerena (36%), a samo kod 3% bolesnika teška. Učestalost pojave RM bila je najveća kod akutnih trovanja opijatima (41%), pesticidima (38%), neurolepticima (26%), antikonvulzivima (26%), etil alkoholom (20%) i gasovima (19%). Psihotropni lekovi bili su najzastupljeniji uzročnici trovanja, a samim tim i RM. Smrtni ishod je zabeležen kod 25,6% bolesnika sa RM, pri čemu je letalitet iznosio 19,73% u trovanjima sa blagom RM, 31,11% sa srednje teškom i 75% u trovanjima sa teškom RM. Zaključak. Sindrom RM pojavljuje se relativno često u akutnim trovanjima. Za ishod trovanja od presudnog značaja je toksični agens, ali teška RM i njene komplikacije mogu značajno da utiču na tok i prognozu trovanja. Rutinska analiza CK, kao relevantnog pokazatelja RM kod akutnih trovanja, može ukazati na razvoj ovog sindroma i doprineti pravovremenom preduzimanju terapijskih mera za sprečavanje nastanka akutne bubrežne insuficijencije kao najčešće posledice ekstenzivne RM.

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Uzročnici rabdomiolize u akutnim trovanjima

Sažetak

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