Primena jednoprotočne albuminske dijalize u akutnoj fazi amanitinskog sindroma uzrokovanog trovanjem pečurkama

  • Dragana Jovanović Military Medical Academy, Clinic for Anesthesiology and Intensive Therapy, Belgrade, Serbia
  • Dejan Pilčević Military Medical Academy, Clinic for Nephrology, Belgrade, Serbia; University of Defence, Faculty of Medicine of the Military Medical Academy, Belgrade, Serbia
  • Jelena Isailović Military Medical Academy, Clinic for Anesthesiology and Intensive Therapy, Belgrade, Serbia
  • Nataša Perković Vukčević Military Medical Academy, Clinic for Emergency and Clinical Toxicology, Belgrade, Serbia; †University of Defence, Faculty of Medicine of the Military Medical Academy, Belgrade, Serbia
  • Rade Vuković Military Medical Academy, Clinic for Anesthesiology and Intensive Therapy, Belgrade, Serbia
DOI: https://doi.org/10.2298/VSP241210060J
Ključne reči: amanitin;, dijaliza;, hepatička encefalopatija;, jetra, insuficijencija;, trovanje pečurkama

Sažetak


Uvod. Učestalost trovanja pečurkama je u porastu kako u svetu tako i u našoj zemlji. Najotrovnija vrsta pečuraka na našim prostorima je Zelena pupavka (Amanita phalloides), koja prouzrokuje amanitinski sindrom kod otrovanih pacijenata i smatra se odgovornom za većinu smrtnih slučajeva kod pacijenata otrovanih pečurkama. Jetra je jedan od primarnih ciljnih organa toksičnog delovanja amatoksina. Klinički simptomi i znaci trovanja amatoksinom se različito manifestuju, od jednostavnih gastrointestinalnih poremećaja do smrtnog ishoda. Trenutno ne postoje literaturna saznanja o postojanju specifičnog antidota koji bi trebalo da se primenjuje u akutnoj fazi amanitinskog sindroma. Osnovu terapije čine simptomatska i suportivna terapija. Albuminska dijaliza je ekstrakorporalni, nebiološki mehanizam potpore funkcije jetre koji se koristi kod insuficijencije jetre različitih etiologija. Prikaz bolesnika. Inicijalni tretman pacijenta lečenog pod kliničkom slikom alimentarne intoksikacije pečurkama i amanitinskog sindroma uključio je simptomatsku i suportivnu terapiju. Zbog povišenih vrednosti enzima jetre, kao i amonijaka i prisutne oligurije, multidisciplinarnom analizom donesena je odluka da se u lečenju ovog pacijenta primeni jednoprotočna albuminska dijaliza (JPAD) kao terapijska mera potpore funkcijama jetre i bubrega. Posle prolaznog poboljšanja, u nastavku lečenja, dolazi do pogoršanja opšteg stanja. To se manifestovalo pogoršanjem stanja svesti i, posledično, respiratorne funkcije. Dalje lečenje uključivalo je mehaničku ventilaciju i ponovljene JPAD procedure. Ovo je na kraju dovelo do pozitivnih ishoda, uključujući poboljšanje svesti, bolju respiratornu funkciju i normalizaciju laboratorijskih pokazatelja funkcija jetre i bubrega. Zaključak. S obzirom da je funkcija jetre kompromitovana u amanitinskom sindromu, JPAD predstavlja dobar izbor u lečenju pacijenata sa teškom kliničkom slikom trovanja pečurkama. Prikazani pacijent je prvi pacijent otrovan pečurkama sa ovim stepenom težine kliničke slike, lečen u našoj ustanovi, kod koga nije zabeležen smrtni ishod. Na osnovu daljih ispitivanja i analiza i većeg kliničkog iskustva koje će se steći daljom upotrebom JPAD-a, potrebno je napraviti jasan protokol za upotrebu ove metode u toku lečenja pacijenata otrovanih pečurkama.

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Objavljeno
2025/09/26
Broj časopisa
Vol. 82 Br. 09 (2025): Vojnosanitetski pregled
Rubrika
Prikaz bolesnika