Bonzai zehirlenmesinde ağir klinik tablo: Dirençli metabolik asidoz ve çoklu organ yetmezliği

Abstract

Consumption of synthetic cannaninoid receptor (SCR) antagonists has increased rapidly since 2004. Wide range of symptoms occur at intoxications and usually regress within 24 hours. Twenty-seven year old male missing for two days was found unconscious. pH, PCO2, PO2, NaHCO3 and glucose were 6.86, 10 mmHg, 125 mmHg, 7 mml L-1 31 mg dL'were measured respectievly in ABG analysis CK was 1682 U L-1, hepatic and renal function tests were abnormal. Blood toxicology tests were negative. Patient was intubated and refered to ICU with bonzai intoxicaion diagnosis. As asidosis can't be recovered by NaHCO3 infusion, CVVHDF was started. Nevertheless asidosis continued for two days. At day 5, CK and AST leves reached 12310 and 1453 U L-1 respectively. RFT started to normalize. The patient was conscious and extubated. All findings returned to normal and he was refered to ward. SCR show action via CB1 and CB2 receptors. As each SC has different binding affinity to receptors, clinic presentation differs from patient to patient. In the labaratory tests hypokalemia, asidosis, hyperglycemia, CK increases are seen frequently. Severe hypoglycemia of our patient might be related to prolonged starvation. CVVHDF was performed due to refractor metabolic asidosis. Although CVVHD is not in routine theraphy of bonzai intoxication, acute renal failure due to acute tubuler necrosis was reported. Prolonged unconsciousness of the patients with no additional substance intake history might be due to multi organ failure. In conclusion, bonzai intoxication may result in very different clinical presentations. At unconscious cases with MOF, CVVHDF performed with supportive therapy can be life-saving.