Benan Bayrakci | Hacettepe University (original) (raw)
Papers by Benan Bayrakci
Indian Journal of Critical Care Medicine, 2017
Successful utilization of extracorporeal membrane oxygenation (ECMO) in children was defined as e... more Successful utilization of extracorporeal membrane oxygenation (ECMO) in children was defined as early as the 1970s. [1,2] Beginning of continuous renal replacement therapies (CRRTs) also dates back to 1970s, and expectations from the therapy as well as the technique has evolved since then. [3,4] In our day, continuous venovenous hemofiltration or hemodiafiltration is used frequently in Pediatric Intensive Care Units (PICUs) for renal replacement therapy, but experience of CRRT application on ECMO circuit is still limited. Acute kidney injury is frequently observed in ECMO patients. The hypoxic insult and systemic inflammatory response associated with the ECMO process or the underlying condition are the two important factors causing acute kidney injury. Reduced perfusion of the kidneys before ECMO, reperfusion injury after ECMO, and disrupted hormonal mechanisms are predisposing factors. [5] Acute kidney injury and requirement of renal replacement are associated with increased mortality in these patients. [6] Even when the kidneys are minimally injured and functioning as in a normal child, the massive fluid overload at the beginning of ECMO process cannot be easily overcome solely by the kidneys. It is well described that fluid overload affects survival in critically ill children and CRRT enhances fluid management in ECMO patients. [7,8] Slow but continuous nature of the renal replacement is superior to intermittent hemodialysis in this hemodynamically unstable patient group. [9] Background and Aims: Continuous venovenous hemofiltration or hemodiafiltration is used frequently in pediatric patients, but experience of continuous renal replacement therapy (CRRT) application on extracorporeal membrane oxygenation (ECMO) circuit is still limited. Among several methods used for applying CRRT on ECMO patients, we aim to share our experience on inclusion of a CRRT device in the ECMO circuit which we believe is easier and safer to apply. Materials and Methods: The data were collected on demographics, outcomes, and details of the treatment of ECMO patients who had CRRT. During the study period of 3 years, venous cannula of ECMO circuit before pump was used for CRRT access for both the filter inlet and outlet of CRRT machine to minimize the thromboembolic complications. The common indication for CRRT was fluid overload. Results: CRRT was used in 3.68% of a total number of patients admitted and 43% of patients on ECMO. The patients have undergone renal replacement therapy for periods of time ranging between 24 h and 25 days (260 h mean). The survival rate of this group of patients with multiorgan failure was 33%. Renal recovery occurred in all of the survivors. Complications such as electrolyte imbalance, hypothermia, and bradykinin syndrome were easily managed. Conclusions: Adding a CRRT device on ECMO circuit is a safe and effective technique. The major advantages of this technique are easy to access, applying CRRT without extra anticoagulation process, preventing potential hemodynamic disturbances, and increased clearance of solutes and fluid overload using larger hemofilter.
Journal of Pediatric Intensive Care
This document was downloaded for personal use only. Unauthorized distribution is strictly prohibi... more This document was downloaded for personal use only. Unauthorized distribution is strictly prohibited.
Journal of Artificial Organs, 2007
Although extracorporeal membrane oxygenation (ECMO) is known to improve survival in neonates with... more Although extracorporeal membrane oxygenation (ECMO) is known to improve survival in neonates with respiratory failure, there has been a signifi cant decrease in the use of ECMO in recent years. Alternative modalities such as high-frequency oscillatory ventilation (HFOV), inhaled nitric oxide (iNO), and surfactant therapy are associated with this decline. The criteria for the initiation of ECMO, developed about 20 years ago, are likely no longer relevant. We examined the predictive signifi cance of the oxygenation index (OI) as a patient entry criterion for ECMO use. We sought a critical OI level predicting death or chronic lung disease (CLD) with and without ECMO use. We also examined whether patients with certain OIs are more likely to have worse outcomes. One hundred and seventy-four term-newborn admissions between 1995 and 2000 requiring mechanical ventilation were enrolled in the study. Receiver operating curve analysis was performed to fi nd a cutoff value of OI for ECMO initiation. Mortality rates and CLD probability were compared to the worst OIs. Our 6-year ECMO administration experience showed that an OI of 33.2 is a suitable cutoff value for ECMO initiation with high sensitivity and specifi city as a predictive criterion. The critical OI value associated with the CLD risk when ECMO is not used is in the 40s. OI is a good predictor of CLD; the probability of CLD increases with higher OIs. Our data support the trend toward the use of new interventions over ECMO, especially for patients with OI scores of less than 33.2. Only when the probability of ventilator-associated lung injury becomes signifi cant is it better to consider ECMO than conventional modalities.
Noninvasive Ventilation in High-Risk Infections and Mass Casualty Events, 2013
The Indian Journal of Pediatrics, 2008
Objective. The objective of this study was to determine whether there there are any associations ... more Objective. The objective of this study was to determine whether there there are any associations between time of admission and mortality rates in the pediatric intensive care unit.
TURKISH JOURNAL OF MEDICAL SCIENCES, 2014
To collect data from throughout Turkey in order to facilitate the organization of pediatric inten... more To collect data from throughout Turkey in order to facilitate the organization of pediatric intensive care units (PICUs), and to develop short-term immediate action plans and draft long-term strategic plans. A total of 35 specialists including 17 pediatric critical care (PCC) specialists, 9 PCC fellows in training, and 9 pediatricians working in PICUs evaluated PICUs and their infrastructures, mortality rates, appropriateness of indications for PICU admissions, PICU bed numbers, and utilization of those PICU beds. PICU bed numbers, PCC specialist numbers, and PICU nurse numbers are insufficient in Turkey. The high percentage of inappropriate and inefficient use of current PICU beds is also another problem. In the light of this report, it is obvious that pediatric intensive care services are successful and efficient only in the presence of PCC specialists in PICUs. Studies for improving the infrastructure of PICUs and the training of PCC specialists and other health personnel should be started immediately.
The Turkish journal of pediatrics
Immunoglobulin replacement therapy is the essential treatment of B-cell deficiencies. Because of ... more Immunoglobulin replacement therapy is the essential treatment of B-cell deficiencies. Because of the high expense of therapy, optimal dose, infusion intervals and serum IgG levels should be well defined. Data of 19 X-linked agammaglobulinemia (XLA), 7 hyper-IgM syndrome (HIM) and 20 common variable immunodeficiency (CVID) patients were analyzed. Infection frequencies and hospitalization requirements were correlated with the immunoglobulin doses used and serum IgG levels achieved. The characteristics before diagnosis and after treatment were compared among the XLA, HIM and CVID groups. By using a median dose of 370 mg/kg/month immunoglobulin, which maintained serum IgG levels at a median concentration of 440 mg/dl, the annual incidence of infections dropped from 12.4 to 3.2 and annual hospitalization requirements decreased from 1.6 to 0.16 per patient. Serum IgG levels of 300-500 mg/dl were found to be satisfactory, except in the CVID group. Increasing the level over 500 mg/dl neither prevented pneumonia further nor decreased the need for hospitalization. Monthly replacement was found to be adequate, except for XLA patients. Serum IgG levels between 300-500 mg/dl are sufficient for effective treatment of hypogammaglobulinemias. These concentrations can be maintained with 300-400 mg/kg/month doses. Higher doses and IgG levels are not needed.
Therapeutic Apheresis and Dialysis, 2007
Severe amitriptyline toxicity may cause coma, hypotension, convulsions, supraventricular and vent... more Severe amitriptyline toxicity may cause coma, hypotension, convulsions, supraventricular and ventricular arrhythmias, metabolic/respiratory acidosis and cardiac arrest. Management with gastric lavage, activated charcoal, alkalinization with sodium bicarbonate and supportive care with mechanical ventilation, antiarrhythmics and anticonvulsants if required, is the common approach. Herein, we report successful treatment of severe amitriptyline poisoning in three cases by plasma exchange in addition to the above supportive measures. Plasma exchange may have a beneficial role in lethal doses of amitriptyline ingestion because of the high plasma protein binding property of amitriptyline.
Therapeutic Apheresis and Dialysis, 2010
A high proportion of the patients with Salmonella enterica serotype Typhi infection develop sever... more A high proportion of the patients with Salmonella enterica serotype Typhi infection develop severe sepsis. The mortality rate is high despite aggressive antimicrobial therapy in these patients. The case of a 10-year-old boy who developed thrombocytopenia-associated multiple organ failure (TAMOF) secondary to S. typhi infection is reported. The patient did not respond to antimicrobial treatment, including ciprofloxacin, in addition to conven-tional supportive measures, so plasma exchange was performed. The thrombocytopenia and organ failure had resolved after 3 days of plasma exchange therapy. Plasma exchange is suggested to be a life-saving intervention in a child with TAMOF secondary to S. typhi infection.
A VDSL receiver front-end with a programmable gain low noise amplifier is presented. The amplifie... more A VDSL receiver front-end with a programmable gain low noise amplifier is presented. The amplifier consumes only 35mW from a 3.3V supply in a 0.35µm BiCMOS technology and is suitable for DMT-based VDSL systems with bandwidths up to 12MHz. The linearity is expressed in Missing Band Depth (MBD) for a worst case bandplan. The LNA uses an inverting architecture and has a constant input impedance. A technique was used to suppress the distortion caused by the switches in the signal path. The area is only 0.2mm2.
European Journal of Emergency Medicine, 2010
Carbon monoxide (CO)-induced cardiotoxicity has been investigated infrequently in children and re... more Carbon monoxide (CO)-induced cardiotoxicity has been investigated infrequently in children and reports of its cardiovascular effects are limited to isolated case reports. Our aims were to describe acute cardiac effects and associated factors with myocardial injury in children with CO poisoning. We reviewed the medical records of children below 17 years of age who were diagnosed with CO poisoning at pediatric emergency department between July 2004 and June 2007. Patients who had carboxyhemoglobin level at least 10% were included. Myocardial injury was defined as elevated cardiac biomarkers (creatine kinase-MB or troponin-t). Carboxyhemoglobin level, electrocardiogram (ECG) findings, cardiac biomarkers, and echocardiograph results were recorded for each patient. Cardiac biomarkers were drawn in 107 patients, of which 16 patients (15%) had cardiac biomarkers confirmed diagnosis of myocardial injury. Sinus tachycardia was present in 32% of patients on baseline ECG. None of the patients had ischemic changes on ECG. Echocardiograph was performed in 27 patients (25% of patients with biomarkers drawn), of which nine patients had low ejection fraction and abnormal left ventricular function. Determinators of myocardial injury included a Glasgow Coma Scale (GCS) score <or=14 and hypotension (for GCS score <or=14 and hypotension, relative risk: 90 and 95% confidence interval: 9.9-813. Myocardial injury may exist in children with CO poisoning without abnormal ECG findings. GCS score <or=14 and hypotension were associate factors with myocardial injury.
Clinical Drug Investigation, 2007
20 tablets of digoxin each containing 0.25mg (total dose ingested equivalent to 0.1 mg/kg), 32 ta... more 20 tablets of digoxin each containing 0.25mg (total dose ingested equivalent to 0.1 mg/kg), 32 tablets of warfarin each containing 5mg (equivalent to 3.2 mg/kg), and approximately 15 tablets of propafenone each containing 300mg (equivalent to 90 mg/kg). The patient developed hypotension and sinus bradycardia necessitating external cardiac pacing 17 hours after drug ingestion. In addition to gastric lavage, activated charcoal, blood alkalinisation, administration of vitamin K and temporary cardiac pacing, the authors performed plasma exchange for drug removal and administered rifampicin in order to increase the metabolism of digoxin, propafenone and warfarin. The patient was discharged without any sequelae. Plasma exchange may be lifesaving in drug ingestions where there is a low volume of distribution and high plasma protein binding. Rifampicin, an inducer of cytochrome p450, may be used in intoxications for elimination of drugs with inactive metabolites.
British Journal of Clinical Pharmacology, 2009
Pseudoephedrine (PE) is a sympathomimetic amine commonly used for the treatment of nasal congesti... more Pseudoephedrine (PE) is a sympathomimetic amine commonly used for the treatment of nasal congestion in children.This substance is generally considered quite safe, but overdosage might result in severe adverse effects such as hyperirritability, psychosis, ataxia and even stroke .
Journal of Critical Care, 2015
To investigate admission prevalence of intraabdominal hypertension (IAH) and to determine clinica... more To investigate admission prevalence of intraabdominal hypertension (IAH) and to determine clinical and laboratory characteristics on admission day associated with IAH in critically ill pediatric patients. One hundred thirty newly admitted critically ill pediatric patients were included. Intra-abdominal pressure (IAP) was measured 4 times (every 6 hours) with the bladder pressure method. Data included the demographics, diagnostic category, pediatric logistic organ dysfunction score and pediatric risk of mortality score II, clinical concomitant factors, and conditions potentially associated with increased intra-abdominal pressure. Seventy patients (56.1%) had a normal IAP (≤10 mmHg, mean IAP [mmHg] 7.18 ± 1.85), while 60 patients (43.9%) had IAP >10 mmHg (mean IAP [mmHg] 15.46 ± 5.21). Hypothermia frequency, lactate levels, number of patients with oligo-anuria, and mechanical ventilation requirement were higher among patients with IAH compared to patients without IAH (both, P< .05). Hypothermia (OR, 3.899; 95% CI, 1.305-11.655; P< .03) and lactate levels (OR, 1.283 for each mmol/L increase; 95% CI, 1.138-1.447; P< .001) were only significantly associated with IAH. Intra-abdominal hypertension seems to affect nearly half of newly admitted critically ill pediatric patients. Lactate level and the presence of hypothermia seem to be the independent predictors of the presence of IAH.
Indian Journal of Critical Care Medicine, 2017
Successful utilization of extracorporeal membrane oxygenation (ECMO) in children was defined as e... more Successful utilization of extracorporeal membrane oxygenation (ECMO) in children was defined as early as the 1970s. [1,2] Beginning of continuous renal replacement therapies (CRRTs) also dates back to 1970s, and expectations from the therapy as well as the technique has evolved since then. [3,4] In our day, continuous venovenous hemofiltration or hemodiafiltration is used frequently in Pediatric Intensive Care Units (PICUs) for renal replacement therapy, but experience of CRRT application on ECMO circuit is still limited. Acute kidney injury is frequently observed in ECMO patients. The hypoxic insult and systemic inflammatory response associated with the ECMO process or the underlying condition are the two important factors causing acute kidney injury. Reduced perfusion of the kidneys before ECMO, reperfusion injury after ECMO, and disrupted hormonal mechanisms are predisposing factors. [5] Acute kidney injury and requirement of renal replacement are associated with increased mortality in these patients. [6] Even when the kidneys are minimally injured and functioning as in a normal child, the massive fluid overload at the beginning of ECMO process cannot be easily overcome solely by the kidneys. It is well described that fluid overload affects survival in critically ill children and CRRT enhances fluid management in ECMO patients. [7,8] Slow but continuous nature of the renal replacement is superior to intermittent hemodialysis in this hemodynamically unstable patient group. [9] Background and Aims: Continuous venovenous hemofiltration or hemodiafiltration is used frequently in pediatric patients, but experience of continuous renal replacement therapy (CRRT) application on extracorporeal membrane oxygenation (ECMO) circuit is still limited. Among several methods used for applying CRRT on ECMO patients, we aim to share our experience on inclusion of a CRRT device in the ECMO circuit which we believe is easier and safer to apply. Materials and Methods: The data were collected on demographics, outcomes, and details of the treatment of ECMO patients who had CRRT. During the study period of 3 years, venous cannula of ECMO circuit before pump was used for CRRT access for both the filter inlet and outlet of CRRT machine to minimize the thromboembolic complications. The common indication for CRRT was fluid overload. Results: CRRT was used in 3.68% of a total number of patients admitted and 43% of patients on ECMO. The patients have undergone renal replacement therapy for periods of time ranging between 24 h and 25 days (260 h mean). The survival rate of this group of patients with multiorgan failure was 33%. Renal recovery occurred in all of the survivors. Complications such as electrolyte imbalance, hypothermia, and bradykinin syndrome were easily managed. Conclusions: Adding a CRRT device on ECMO circuit is a safe and effective technique. The major advantages of this technique are easy to access, applying CRRT without extra anticoagulation process, preventing potential hemodynamic disturbances, and increased clearance of solutes and fluid overload using larger hemofilter.
Journal of Pediatric Intensive Care
This document was downloaded for personal use only. Unauthorized distribution is strictly prohibi... more This document was downloaded for personal use only. Unauthorized distribution is strictly prohibited.
Journal of Artificial Organs, 2007
Although extracorporeal membrane oxygenation (ECMO) is known to improve survival in neonates with... more Although extracorporeal membrane oxygenation (ECMO) is known to improve survival in neonates with respiratory failure, there has been a signifi cant decrease in the use of ECMO in recent years. Alternative modalities such as high-frequency oscillatory ventilation (HFOV), inhaled nitric oxide (iNO), and surfactant therapy are associated with this decline. The criteria for the initiation of ECMO, developed about 20 years ago, are likely no longer relevant. We examined the predictive signifi cance of the oxygenation index (OI) as a patient entry criterion for ECMO use. We sought a critical OI level predicting death or chronic lung disease (CLD) with and without ECMO use. We also examined whether patients with certain OIs are more likely to have worse outcomes. One hundred and seventy-four term-newborn admissions between 1995 and 2000 requiring mechanical ventilation were enrolled in the study. Receiver operating curve analysis was performed to fi nd a cutoff value of OI for ECMO initiation. Mortality rates and CLD probability were compared to the worst OIs. Our 6-year ECMO administration experience showed that an OI of 33.2 is a suitable cutoff value for ECMO initiation with high sensitivity and specifi city as a predictive criterion. The critical OI value associated with the CLD risk when ECMO is not used is in the 40s. OI is a good predictor of CLD; the probability of CLD increases with higher OIs. Our data support the trend toward the use of new interventions over ECMO, especially for patients with OI scores of less than 33.2. Only when the probability of ventilator-associated lung injury becomes signifi cant is it better to consider ECMO than conventional modalities.
Noninvasive Ventilation in High-Risk Infections and Mass Casualty Events, 2013
The Indian Journal of Pediatrics, 2008
Objective. The objective of this study was to determine whether there there are any associations ... more Objective. The objective of this study was to determine whether there there are any associations between time of admission and mortality rates in the pediatric intensive care unit.
TURKISH JOURNAL OF MEDICAL SCIENCES, 2014
To collect data from throughout Turkey in order to facilitate the organization of pediatric inten... more To collect data from throughout Turkey in order to facilitate the organization of pediatric intensive care units (PICUs), and to develop short-term immediate action plans and draft long-term strategic plans. A total of 35 specialists including 17 pediatric critical care (PCC) specialists, 9 PCC fellows in training, and 9 pediatricians working in PICUs evaluated PICUs and their infrastructures, mortality rates, appropriateness of indications for PICU admissions, PICU bed numbers, and utilization of those PICU beds. PICU bed numbers, PCC specialist numbers, and PICU nurse numbers are insufficient in Turkey. The high percentage of inappropriate and inefficient use of current PICU beds is also another problem. In the light of this report, it is obvious that pediatric intensive care services are successful and efficient only in the presence of PCC specialists in PICUs. Studies for improving the infrastructure of PICUs and the training of PCC specialists and other health personnel should be started immediately.
The Turkish journal of pediatrics
Immunoglobulin replacement therapy is the essential treatment of B-cell deficiencies. Because of ... more Immunoglobulin replacement therapy is the essential treatment of B-cell deficiencies. Because of the high expense of therapy, optimal dose, infusion intervals and serum IgG levels should be well defined. Data of 19 X-linked agammaglobulinemia (XLA), 7 hyper-IgM syndrome (HIM) and 20 common variable immunodeficiency (CVID) patients were analyzed. Infection frequencies and hospitalization requirements were correlated with the immunoglobulin doses used and serum IgG levels achieved. The characteristics before diagnosis and after treatment were compared among the XLA, HIM and CVID groups. By using a median dose of 370 mg/kg/month immunoglobulin, which maintained serum IgG levels at a median concentration of 440 mg/dl, the annual incidence of infections dropped from 12.4 to 3.2 and annual hospitalization requirements decreased from 1.6 to 0.16 per patient. Serum IgG levels of 300-500 mg/dl were found to be satisfactory, except in the CVID group. Increasing the level over 500 mg/dl neither prevented pneumonia further nor decreased the need for hospitalization. Monthly replacement was found to be adequate, except for XLA patients. Serum IgG levels between 300-500 mg/dl are sufficient for effective treatment of hypogammaglobulinemias. These concentrations can be maintained with 300-400 mg/kg/month doses. Higher doses and IgG levels are not needed.
Therapeutic Apheresis and Dialysis, 2007
Severe amitriptyline toxicity may cause coma, hypotension, convulsions, supraventricular and vent... more Severe amitriptyline toxicity may cause coma, hypotension, convulsions, supraventricular and ventricular arrhythmias, metabolic/respiratory acidosis and cardiac arrest. Management with gastric lavage, activated charcoal, alkalinization with sodium bicarbonate and supportive care with mechanical ventilation, antiarrhythmics and anticonvulsants if required, is the common approach. Herein, we report successful treatment of severe amitriptyline poisoning in three cases by plasma exchange in addition to the above supportive measures. Plasma exchange may have a beneficial role in lethal doses of amitriptyline ingestion because of the high plasma protein binding property of amitriptyline.
Therapeutic Apheresis and Dialysis, 2010
A high proportion of the patients with Salmonella enterica serotype Typhi infection develop sever... more A high proportion of the patients with Salmonella enterica serotype Typhi infection develop severe sepsis. The mortality rate is high despite aggressive antimicrobial therapy in these patients. The case of a 10-year-old boy who developed thrombocytopenia-associated multiple organ failure (TAMOF) secondary to S. typhi infection is reported. The patient did not respond to antimicrobial treatment, including ciprofloxacin, in addition to conven-tional supportive measures, so plasma exchange was performed. The thrombocytopenia and organ failure had resolved after 3 days of plasma exchange therapy. Plasma exchange is suggested to be a life-saving intervention in a child with TAMOF secondary to S. typhi infection.
A VDSL receiver front-end with a programmable gain low noise amplifier is presented. The amplifie... more A VDSL receiver front-end with a programmable gain low noise amplifier is presented. The amplifier consumes only 35mW from a 3.3V supply in a 0.35µm BiCMOS technology and is suitable for DMT-based VDSL systems with bandwidths up to 12MHz. The linearity is expressed in Missing Band Depth (MBD) for a worst case bandplan. The LNA uses an inverting architecture and has a constant input impedance. A technique was used to suppress the distortion caused by the switches in the signal path. The area is only 0.2mm2.
European Journal of Emergency Medicine, 2010
Carbon monoxide (CO)-induced cardiotoxicity has been investigated infrequently in children and re... more Carbon monoxide (CO)-induced cardiotoxicity has been investigated infrequently in children and reports of its cardiovascular effects are limited to isolated case reports. Our aims were to describe acute cardiac effects and associated factors with myocardial injury in children with CO poisoning. We reviewed the medical records of children below 17 years of age who were diagnosed with CO poisoning at pediatric emergency department between July 2004 and June 2007. Patients who had carboxyhemoglobin level at least 10% were included. Myocardial injury was defined as elevated cardiac biomarkers (creatine kinase-MB or troponin-t). Carboxyhemoglobin level, electrocardiogram (ECG) findings, cardiac biomarkers, and echocardiograph results were recorded for each patient. Cardiac biomarkers were drawn in 107 patients, of which 16 patients (15%) had cardiac biomarkers confirmed diagnosis of myocardial injury. Sinus tachycardia was present in 32% of patients on baseline ECG. None of the patients had ischemic changes on ECG. Echocardiograph was performed in 27 patients (25% of patients with biomarkers drawn), of which nine patients had low ejection fraction and abnormal left ventricular function. Determinators of myocardial injury included a Glasgow Coma Scale (GCS) score <or=14 and hypotension (for GCS score <or=14 and hypotension, relative risk: 90 and 95% confidence interval: 9.9-813. Myocardial injury may exist in children with CO poisoning without abnormal ECG findings. GCS score <or=14 and hypotension were associate factors with myocardial injury.
Clinical Drug Investigation, 2007
20 tablets of digoxin each containing 0.25mg (total dose ingested equivalent to 0.1 mg/kg), 32 ta... more 20 tablets of digoxin each containing 0.25mg (total dose ingested equivalent to 0.1 mg/kg), 32 tablets of warfarin each containing 5mg (equivalent to 3.2 mg/kg), and approximately 15 tablets of propafenone each containing 300mg (equivalent to 90 mg/kg). The patient developed hypotension and sinus bradycardia necessitating external cardiac pacing 17 hours after drug ingestion. In addition to gastric lavage, activated charcoal, blood alkalinisation, administration of vitamin K and temporary cardiac pacing, the authors performed plasma exchange for drug removal and administered rifampicin in order to increase the metabolism of digoxin, propafenone and warfarin. The patient was discharged without any sequelae. Plasma exchange may be lifesaving in drug ingestions where there is a low volume of distribution and high plasma protein binding. Rifampicin, an inducer of cytochrome p450, may be used in intoxications for elimination of drugs with inactive metabolites.
British Journal of Clinical Pharmacology, 2009
Pseudoephedrine (PE) is a sympathomimetic amine commonly used for the treatment of nasal congesti... more Pseudoephedrine (PE) is a sympathomimetic amine commonly used for the treatment of nasal congestion in children.This substance is generally considered quite safe, but overdosage might result in severe adverse effects such as hyperirritability, psychosis, ataxia and even stroke .
Journal of Critical Care, 2015
To investigate admission prevalence of intraabdominal hypertension (IAH) and to determine clinica... more To investigate admission prevalence of intraabdominal hypertension (IAH) and to determine clinical and laboratory characteristics on admission day associated with IAH in critically ill pediatric patients. One hundred thirty newly admitted critically ill pediatric patients were included. Intra-abdominal pressure (IAP) was measured 4 times (every 6 hours) with the bladder pressure method. Data included the demographics, diagnostic category, pediatric logistic organ dysfunction score and pediatric risk of mortality score II, clinical concomitant factors, and conditions potentially associated with increased intra-abdominal pressure. Seventy patients (56.1%) had a normal IAP (≤10 mmHg, mean IAP [mmHg] 7.18 ± 1.85), while 60 patients (43.9%) had IAP >10 mmHg (mean IAP [mmHg] 15.46 ± 5.21). Hypothermia frequency, lactate levels, number of patients with oligo-anuria, and mechanical ventilation requirement were higher among patients with IAH compared to patients without IAH (both, P< .05). Hypothermia (OR, 3.899; 95% CI, 1.305-11.655; P< .03) and lactate levels (OR, 1.283 for each mmol/L increase; 95% CI, 1.138-1.447; P< .001) were only significantly associated with IAH. Intra-abdominal hypertension seems to affect nearly half of newly admitted critically ill pediatric patients. Lactate level and the presence of hypothermia seem to be the independent predictors of the presence of IAH.