Objectives: To investigate the predictive value of magnesium, neutrophil/lymphocyte ratios (NLR) in determining the severity of morbidity and mortality in patients with organophosphate poisoning (OP) admitted to the emergency department. Materials ad Methods: This study was conducted retrospectively by scanning the medical recordings of patients aged over 18 years who were admitted to our emergency department with OP between 2010 and 2015. The demographic characteristics, medical history, laboratory findings, and Glasgow Coma Scale (GCS) scores of the patients were recorded. Results: The data of 153 patients, 91 males and 62 females, were evaluated. There was no significant correlation between the changes in magnesium, hemoglobin, hematocrit, leukocytosis, platelets, potassium, calcium, glucose, alanine aminotransferase (ALT), troponin, and mortality in patients with OP (p>0.05). There was a significant relationship between the increase in lactate dehydrogenase (LDH) (p=0.004), low lymphocyte count (p=0.003), decreased cholinesterase (p=0.001), higher (NLR) (p=0.002), GCS (p<0.001), mechanical ventilator (MV) requirement (p<0.001), age (P=0.009), vasopressor treatment (p<0.001), and mortality. Conclusion: No significant relationship determined between magnesium levels and prognosis. Low lymphocyte count, decreased cholinesterase, increased LDH and NLR in patients with OP were significantly correlated with mortality. Increased NLR ratio, one of the parameters in routine hemograms, may give information to physicians about the long-term follow-up of such patients with OP.

Metoclopramid is the dopamine receptor antagonist. It has been used widely as antiemetic agent. This drug enters the blood-brain barrier and causes extrapyramidal symptoms such as Parkinsonism, malign neuroleptic syndrome, akathisia, tardive dyskinesia and acute dystonic reaction. Our case is a 17-year-old female, who took 3x10 mg metoclopramid for the purpose of treatment for three days and applied to our emergency service with the involuntary spasm in the neck and both arms.

Introduction and Objectives: Parasuicide is an important health problem which frequently occupies our emergency services and shows the possibility of future suicides. The investigation of the epidemiological and clinical features of parasuicidal patients in our region will guide us in approaching these patients. Method: Adult parasuicidal patients who were admitted to our emergency department in 45 months were examined according to their gender, the way they came from the inside/outside of Erzurum province, the suicide form, the application season and complaints for the patients who were intoxicated with medication. In the groups, the parameters which were found to be significant with x2, t test or Mann Whitney U test were examined by multivariate analysis. Results: A total of 533 patients, 66.8 percent of whom were females, were more likely to have suicide attempts in married women and single men. Antidepressant intoxication is higher in females, while salicylate and alcohol intake is higher in males. Aggressive suicides are more common in males and non-aggressive suicides are more common in females. Patients referred from outside the province of Erzurum are usually patients with organophosphate poisoning and loss of consciousness. Suicidal attempt is most commonly seen in the spring. While the rate of attempted suicide was higher in spring with antidepressant drug; In the summer, the rate of attempting suicide by taking organophosphate is high. Conclusion: There are significant differences in the parasuicidal patients admitted to our emergency department according to the grouping mentioned in the methods. These data will provide guidance for treatment planning and follow-up in ED.

Objective: This report describes the epidemiology and analyses the clinic status, treatment, morbidity of carbonmonoxide intoxication cases in a university hospital. Furthermore, the results of blood tests of cases mentioned in this study were evaluated in detail. Materials and Methods: In this retrospective study, patients diagnosed with toxic effects of carbonmonoxide were evaluated between years 2014-2018. The data extracted from the patients’ files included seasonal variation, age, gender, underlying comorbidities, smoking and alcohol abuse history, vital parameters, clinical manifestations and source of poisoning, laboratory and imaging records, treatment and outcome. Results: A total of 653 patients were included in the study. Admissions during the winter was found to be higher that other seasons with a significant difference (p < 0.001). The most frequent symptoms were headache (%62.3), nausea (%42.3), sudden loss of consciousness (%15.9) and dizziness (%12.1). Lactate levels were positively correlated with carboxyhemoglobin values (r= 0.257, p < 0.001) and troponin I levels (r=0.267, p<0.001). A blood lactate concentration >2 mmol/L was associated with %40 sensitivity and %75 specificity for predicting hyperbaric oxygen therapy requirement. Hyperbaric oxygen therapy group had a longer hospitalization period, which was statistically significant (mean difference -0.98; 95% CI = -1.38, -0.57) (p <0.001). Conclusion: Emergency medicine clinics are fighting almost alone in carbonmonoxide poisoning cases. Now it is required to develop new perspectives in these cases. Lactate can be used safely in the management of patients as an option.

Phosphine gas is a gas that is frequently used as rodenticide and insecticide due to its high diffusion capacity and the absence of residues in agricultural products. Since this gas is highly toxic, it is found in our country as aluminum phosphite tablets impregnated with clay, these tablets emit phosphine gas when they meet with the moisture in the air or gastric hydrochloric acid. Mortality rates in aluminum phosphite intoxications are 40-80% depending on the exposure dose. There is no control mechanism in the supply of aluminum phosphide tablets which are so dangerous and no information is given about the serious conditions that may occur during the use of these tablets. A 2 month old baby, whose family practiced drying pepper-eggplant, was reported to have been exposed to phosphine gas by inhalation, admitted to hospital with vomiting and cyanosis and lost his life within 24 hours. We present our case, who lost his life due to erroneous usage of aluminum phosphite, with additional emphasis on early diagnosis, treatment and gathering sample for toxicologic analysis, with corresponding forensic and medical documents

Introduction: Throughout the history of humanity, suicides in all societies are not only a matter of concern to the psychiatrists, but also have economic, cultural and social aspects. The World Health Organization divides the suicides into completed suicides and suicide attempts and determines that the completed suicides result in deaths. Suicide attempts are all non-lethal voluntary attempts to destroy, harm, and poison oneself. Method: Our study was done retrospectively in the emergency department of Faculty Hospital at Atatürk University. The files of the intoxication patients who applied to our hospital between 01.01.2010 and 31.12.2011 were examined. The patients who applied to our hospital after taking pills for suicidal reasons were included in the study. In addition to demographic data such as age, gender, marital status, these patients were classified according to the drugs they took like psychiatric drugs (antidepressant, anxiolytic) and analgesic (paracetamol, NSAID) and antibiotic drugs. Psychiatric diagnose, Glasgow coma score, blood pH at the time of presentation, glucose and hospitalization time(less than 1 day, more than 1 day) were registered. Results: From the file scan, the data of a sum of 234 patients was reached. 69.7% (n = 163) of the patients were female. The mean age of the patients was 24.64 (± 9.463). According to marital status, 75 (32.1%) of the patients were married, 150 (64.1%) were single, 5 were widow (2.1%) and 4 (n = 1.7) patients were engaged. According to the drugs they used for suicide, there were 72 (30.8%) patients who used psychiatric drugs and 83 (35.5) patients who used analgesics and antibiotics. The number of patients that were hospitalized above 24 hours was 38 (16.2%). In the statistical analysis, there was no significant difference between GCS, pH and Glucose values of the patients who committed suicide with Psychiatric and Antibiotic-Analgesic drugs (p> 0.05). Similarly, there was also no significant difference between hospitalization times (p> 0.05). Discussion: As a result of our study, it was found that the patients that committed and attempted suicide were under 30 years old and mostly women. Considering the drugs used for suicidal purposes, no difference could be detected between the use of analgesic-antibiotics and psychiatric medication on blood parameters and GCS.

A 35-year-old female patient was admitted to our hospital with organ failure due to excessive consumption of wild mushrooms. She had a medical history of previous tuberculosis and, in accordance with it, a destructed lung. Hepatorenal syndrome and encephalopathy clinics were established. The patient’s clinical findings related to fungal intoxication declined with penicillin G and supportive fluid electrolyte treatment, however, the patient died from ARDS due to her destructed lung. Fungal intoxication may be asymptomatic throughout the incubation period. Health care professionals should consider that fungal intoxication may also occur in patients admitted with asymptomatic symptoms due to seasonal conditions and nutritional habits.

Amaç: Bu çalismada, acil klinigine parasetamol intoksikasyonu nedeniyle basvuran hastalarin; demografik, klinik degiskenleri, tedavileri ve komplikasyonlarini degerlendirmeyi amaçladik. Materyal ve Metot: Bu çalisma retrospektif bir çalismadir. Keçiören Saglik Arastirma ve Uygulama Merkezi Hastanesi acil kliniginde parasetamol intoksikasyonu tanisi alan hastalar çalismaya dahil edildi. Verileri eksik olanlar, gebeler, parasetamol disi ilaçlarla zehirlenen hastalar çalisma disi birakildi. Verilerin analizi SPSS 16 programinda yapildi. p<0.05 istatistiksel olarak anlamli kabul edildi. Bulgular: Çalismaya 55 hasta dahil edildi. Hastalarin yas ortalamasi 34±12 yil olup, %63,6’si kadindi. Hastalarin aldiklari parasetamol miktari 11.02±4.04 gr ve dördüncü saat parasetamol düzeyleri 28.8 µg/dl (IQR 25-75: 12.5-41.7) olarak bulundu. Hastalarin aldiklari parasetamol miktari ile kan parasetamol düzeyi arasinda istatistiksel anlamli zayif düzeyde korelasyon saptandi (r=0,475 ve p=0,04). Hastalarin takip süresince bakilan karaciger fonksiyon testlerinde artis saptandi ve bu fark istatistiksel olarak anlamliydi (p<0.05). Sonuç: Çalisma bulgularimiza göre hastalarimiz yaridan fazlasi toksik doz parasetamol almis olmasina ragmen büyük bir kisminda zehirlenme siddetinin hafif oldugu görülmüstür. Parasetamol zehirlenmelerinde hastalarin karaciger fonksiyon testlerinde baslangiç degerlerine göre artis olabilmektedir.

Objective: To investigate the demographic data of patients who applied to our clinic with suicide attempt between the years 2014 and 2016. Materials and Methods: The patients with suicidal attempt were analyzed retrospectively. The demographic characteristics of the patients such as gender, age, marital status, residence address and the way of suicide attempt, occupations, educational status and treatment modalities in emergency department were examined and discussed. Results: A total of 79 patients were included in the study. The mean age of the study group was 25.2 years and the standard deviation was 9.2. Fourty two of the patients (53.2%) used more than one type of drugs and 37 patients (46.8%) used single drug. At the emergency medicine follow up, 81% (n: 64) of the patients were applied gastric lavage as well as active charcoal and IV drip, while gastric lavage and active charcoal was applied to 3.8% (n: 3), only gastric lavage was applied to 2.5% (n: 2) and only active charcoal was applied to 2.5% (n: 2). Patients with IV drip and active charcoal combined were 5.1% (n: 4) and also only IV drip was applied to 5.1% (n: 4). Conclusion: It is clear that the first attempts are very important in psychological and physiological aspects. Although there is not enough study, these units in which emergency interventions are carried out are units that may have serious effects on survival rates.

Carbon monoxide (CO) poisoning is the most common cause of mortality due to inhalation toxicity. CO can affect multiple systems in the body and manifest a wide range of symptoms; thus, the diagnosis of CO poisoning can easily be overlooked. In reality, the cases of CO poisoning is much higher than reported, which makes it crucial to take first-step protective measures. The most sensitive tissues to CO poisoning are vital organs (brain, heart) with a high oxygen demand. Neuropsychiatric syndrome which may develop in the chronic period (three to 240 days) should also be considered. If diagnosed, the treatment of CO poisoning should be symptomatic and aimed at removing carboxyhemoglobin (COHb) from the blood, coupled with provision of effective basic life and advanced cardiac life support. The best way to remove COHb is to deliver 100% oxygen. Hyperbaric oxygen (HBO) therapy reduces COHb much faster; therefore, patients with the indications of HBO therapy should be started on this treatment without delay