Ticagrelor is one of the new generation antiplatelet agents, which acts by reversibly binding to P2Y12 platelet receptors. Literature-related data on overdose intake of ticagrelor is quite limited. Here, we report a 23-year old male patient, who presented to our emergency clinic (ER) with the complaint of suicidal intake of 15 tablets of 90 mg ticagrelor (Brilinta® 90 mg tablet, Astra Zeneca Pharmaceuticals, Istanbul). Ticagrelor is one of the new generation antiplatelet agents that is currently being used in the treatment of acute coronary syndrome in our country. The overdose use of the drug for suicidal purpose or accidentally, is a relatively new issue for ER physicians. According to our knowledge, suicidal ticagrelor overdose intake is a case that has not been reported in the literature previously. In this article, we shared the asymptomatic process of a case with 1350 mg ticagrelor toxicity. With the increased use and prevalence of the drug in our country, we think that the ER physicians may encounter ticagrelor poisoning at higher rates. Therefore, in ticagrelor poisoning, ER physicians need to be aware and familiar with the drug.

Extracorporeal treatments (ECT) include a heterogeneous group of methods for the removal of endogenous or exogenous toxins from the body and/or for the temporary replacement of one of the vital organs.ECT methods may play a key role in preventing mortality and morbidity in appropriate intoxication cases that do not respond to conventional treatments. In general, toxins with low molecular weight, low endogenous clearance, low volume of distribution and low protein binding are suitable for removal by ECT methods. Currently, the most common ECT methods are intermittent hemodialysis, intermittent hemofiltration/hemodiafiltration, continuous renal replacement therapy, hemoperfusion, therapeutic plasma exchange, exchange transfusion, albumin dialysis and extracorporeal membrane oxygenation.ECT methods are invasive procedures that bring some risks of complications. Therefore, in all toxin exposures that may benefit from ECT, the application decision should be made by evaluating the benefit and risk ratio on a case-by-case basis. In determining the most appropriate ECT method for the patient, both the characteristics of the toxin exposed and also the medical history and clinical status of the patient should be taken into consideration.In the near future, presenting a wide range of data about ECT applications beyond the case presentations to the literature will help to determine the optimal use strategies of these methods.

Objective: We aimed to compare patients presenting with digoxin intoxication clinic with serum digoxin levels with demographic data. Materials and Methods: This is a retrospective study. Patients admitted to the emergency room with suspected digoxin intoxication included into the study. Patients with missed data, and patients younger than 18 years were excluded. Statistical analysis was performed using the SPSS v25 (SPSS Inc, Chicago, IL) program package. Results: A total of 118 patients were investigated in our retrospective study. Among these, 38 (%32,2) were men and 80 were female (%67,8). Patients with a digoxin level above 2 were evaluated for intoxication. Digoxin intoxication was detected in 31 patients (26.3%). Of 31 patients with digoxin intoxication, 19 (61.2%) were hospitalized. Patients who had digoxin intoxication admission complaints were fatigue in 6 patients (19,35%), nausea in 4 patients (12,9%), bradycardia in 4 patients (12,9%), and general condition disorder in 4 patients (12,9%). Conclusion: Blood level in digoxin intoxication may not always be decisive. After a detailed anamnesis, physical examination, ECG findings should be followed, routine electrolyte and other blood tests should be examined and cardiology should be consulted.

Serotonin syndrome is a life-threatening, undesirable drug reaction. It is a combination of symptoms caused by over activation at central and peripheral serotonin receptors secondary to high serotonin levels. Olanzapine, a second generation antipsychotic agent, is an antagonist of serotonin receptor. Despite the effect of serotonin antagonism, it is reported that olanzapine may paradoxically trigger serotonin syndrome. In this case report, we present a patient with SS due to chronic olanzapine use accompanied by bullous drug reaction.

Objective: We aimed to evaluate the demographical and clinical variations and treatment and complications of the patients admitted to emergency department with mushroom intoxication. Materials and Methods: This is a retrospective study. Patients admitted to the emergency room with symptoms after eating mushrooms, included into the study. Patients with missed data, and patients younger than 18 years were excluded. Statistical analysis was performed using the Statistical Package for the Social Sciences version 16.0. Results: 114 patients were included in the study. %58.8 of the cases are female and %41.2 of the cases are male. It was found out that the patients in the 65 of the cases (%57) had applied to the hospital during the autumn months. 38 patients refused treatment. Hemodialysis was performed in 28 (36.8%) of 76 patients who accepted treatment. Only one patient (0.9%) died during hospitalization. Conclusion: Mushroom poisoning is an important health problem in our country. Informing the public is essential in preventing poisoning.

Objective: The effects of changes in moon phases on human psychology and behavior have been extensively studied. In our study, we aimed to compare the effect of the five different phases of the moon on the frequency of patients suicidal admissions to the hospital. Materials and Methods: Patients who presented to emergency department between January 2018 and December 2018 due to attempts of suicide were inclueded. Patients data were analyzed in relation to the new moon, full moon, last quarter moon, first quarter moon and lunar eclipses in the moon calendar. Moon cycles were taken from the moon calendar and the dates when the moon was visible and the exact date of the cycle have been evaluated. Results: 419 patients included in this study, 280 were female and 139 were male. Suicide attempts is most commonly seen in the 18-49 age range, and it is found that the frequency of suicide due to secondary gain is high in female gender. The most frequent suicide attempts have been found to be the in the new moon, lunar eclipse, last quarter moon, first quarter moon and the full moon, respectively (Pearson chi2(5) = 59.2428 Pr = 0.000). When we analyzed the same data with Cramér’s V test, we got the result of 0.2751, which confirms our hypothesis that the frequency of suicides increased with the advances of lunar cycles. Conclusion: It was found that during specific phases of the moon the rate of suicide attempts the present to the emergency department had been increased.

Objectives: The aim of this study was to determine whether there was a significant relationship between carboxyhemoglobin levels and plasma lactate levels at the time of admission in patients who had been admitted to the emergency department due to carbon monoxide intoxication. Materials ad Methods: In this retrospective-cross-sectional study, patients diagnosed with toxic effects of carbon monoxide were evaluated among the patients admitted to the emergency department between 01.01.2013-01.01.2017. Blood gas data obtained from the peripheral artery in the first 30 minutes of patients’ admission to the emergency department were examined. Patients were classified as Group 1 (10% -20%) and Group 2 (20% and above) according to their carboxyhemoglobin levels. Results: A total of 404 patients were included in the study. The mean carboxyhemoglobin level was 21.2 ± 8% for all cases and 14.6 ± 3% for Group 1 and 27.8 ± 6% for Group 2. The difference between the two groups was statistically significant (mean difference 13.2; 95% CI = 12,198-14,157) (p <0.001). The number of patients with lactate levels above normal in Group 2 was higher than Group 1 (p <0.001). There was a significant difference in lactate levels between two exposure groups (p <0.001). At the same time, when all parameters were evaluated, there was a correlation between carboxyhemoglobin levels and lactate levels (r = 0,601, p <0,001). In the ROC analysis to determine the value of lactate levels in the diagnosis of severe exposure (Group 2), AUC was calculated as 0,791 (95% confidence interval, 0.748-0.835; p <0.001; Figure 1). The positive predictive value for lactate level 3 mmol/L was 88% and the negative predictive value was 63% and this level could be used as cut-off value. Conclusion: In the evaluation of cases of carbon monoxide poisoning, the question of whether plasma lactate level can be used as a marker is still being discussed. Based on the significant results that we found in our study, plasma lactate levels ,which is correlated with carboxyhemoglobin levels, may be helpful in the classification and evaluation of patients with carbon monoxide intoxication.

Fluorouracil (5-FU) is the most common chemotherapeutic agent suggested for colorectal cancers. Cardiogenic side effects such as coroner artery vasospasm, ventricular dysrhythmia, and cardiac ischemia are also rarely stated. 48-year-old male patient applied to the emergency service with conditions of chest pain, nausea and vomiting. ECG was performed and found to be normal sinus rhythm. In the control ECG of the patient, there were ST elevations in inferior and anterior derivations. The control troponin value for the patient was found to be 0,073 µg/L (normal range 0,010-0.023 µg/L). When the patient expressed that his chest pain aggravated even more as he was being prepared for coroner angiography, control ECG was reperformed and seen that lateral derivations were added to ST elevations in inferior and anterior derivations. The patient, who has started to chemotherapy two days ago and still receives 5-FU infusion, is thought to have myocardial infarction with ST elevation based on the cardiotoxic impact of 5-FU, and he was taken to coroner angiography. His CAG is reported as LAD: Plaque CX: Plaque RCA: 40% lesion observed at CB alignment. 5-FU is a partner medical agent used to treat head and neck, gastrointestinal system, bladder, and chest malignancies. Despite cardiac toxicity being a rare and serious complication, the life-threatening toxicity is observed in 0,5% of the patients. In the previous reports, it is underlined that the only mechanism contributing to STEMI development after 5-FU infusion is vasospasm. In our case, the patient came to us with myocardial infarction with ST elevation resulting from the emergence of chest pain after the use of 5-FU. Patients should be closely followed when receiving 5-FU treatment. Due to the cardiac side effects that may seriously show a fatal course, patients should be examined in detail before the treatment.