OLGU SUNUMLARI
İlaç İntoksikasyonu ve Hemodiyaliz Sonrası Gelişen Kompartman Sendromuna Bağlı Bilateral Üst Ekstremite Periferik Sinir Hasarı
Bilateral Upper Extremity Peripheral Nerve Injury Due to Compartment Syndrome After Drug Intoxication and Hemodialysis
Received Date : 20 Mar 0020
Accepted Date : 21 Aug 2020
Available Online : 18 Jan 2021
Orhan GÜVENERa, Nurgül ARINCI İNCELb, Pınar Müge SARIKAYAa
aClinic of Physical Medicine and Rehabilitation, Mersin City Training and Research Hospital, Mersin, TURKEY
bDepartment of Physical Medicine and Rehabilitation, Mersin University Faculty of Medicine, Mersin, TURKEY
Doi: 10.31609/jpmrs.2020-74611 - Makale Dili: EN
J PMR Sci. 2021;24(1):66-70
ÖZET
Akut kompartman sendromu (AKS), artmış interstisyel
basınç nedeniyle lokal dolaşımı bozan ağrılı bir patolojidir. AKS’ye;
kırıklar, kanama riskini artıran tüm patolojiler, girişimsel işlemlerden
sonra meydana gelebilen arteriyel yaralanmalar, rabdomiyoliz, koma
ve iyatrojenik nedenler sebep olabilir. Bu yazımızda, 21 yaşında genç
bir kadının intihar amaçlı ilaç alımı sonrası gelişen bilateral periferik üst
ekstremite sinir hasarı olgusunu sunuyoruz. Hastamızda ilaç alımı sonrası
rabdomiyoliz, akut böbrek yetersizliği ve hemolitik anemi tabloları
ortaya çıktı. Hastanede yatışı sürecinde, kompartman sendromu gelişti.
Hasta, fizik tedavi ve rehabilitasyon programına alındı. Tedavi sürecinin
ilk dönemlerinde, hastanın sol üst ekstremitesinde, kompleks bölgesel
ağrı sendromu tanısı kondu. Dokuz aylık bir tedavi süreci sonunda
hastanın sağ eli neredeyse tamamen fonksiyoneldi, ancak sol eldeki
sertlik ve atrofi devam etmekteydi.
Anahtar Kelimeler: Kompleks bölgesel ağrı sendromu; kompartman sendromu; periferik sinir hasarı; ilaç intoksikasyonu
ABSTRACT
Acute compartment syndrome (ACS) is a painful condition disrupting
local circulation due to increased interstitial pressure. Although
the most common cause is fractures, vascular injuries without
fractures, arterial injuries after interventional procedures, rhabdomyolysis,
drunkenness, and coma may also result in ACS. Here we report
a case of 21 year-old young woman with bilateral peripheral upper extremity
dysfunction after suicidal drug intoxication. She suffered from
acute renal failure, rhabdomyolysis and hemolytic anemia. During hospitalisation
and dialysis, compartment syndrome and peripheral nerve
injury showed up too. After recovering from the life threatening complications,
the patient continued her treatment with the physical therapy
and rehabilitation program for upper extremity peripheral nerve
problems. Unfortunately during this phase she was complicated with
complex regional pain syndrome. After a 9 month period of medical
and physical therapy, she has a nearly fully functioning right hand but
stiffness and atrophy of the left hand still causes disability.
Keywords: Complex regional pain syndrome; compartment syndrome; peripheral nerve injury; drug intoxication
REFERENCES
- Via AG, Oliva F, Spoliti M, Maffulli N. Acute compartment syndrome. Muscles Ligaments Tendons J. 2015;5(1):18-22.[PubMed] [PMC]
- Patel YA, Marzella N. Dietary supplement-drug interaction-induced serotonin syndrome progressing to acute compartment syndrome. Am J Case Rep. 2017;18:926-30.[Crossref] [PubMed] [PMC]
- Zhang YW, Ju C, Ke XL, Xiao X, Xiao Y, Chen X, et al. Ipsilateral radial nerve, median nerve, and ulnar nerve injury caused by crush syndrome due to alcohol intoxication: a case report. Medicine (Baltimore). 2019;98(38):e17227.[Crossref] [PubMed] [PMC]
- Mehnert MJ, Hsu V, Young G. Complex regional pain syndrome: ıntroduction, history, and physical examination. In: Freedman M, Gehret J, Young G, Kamen L, eds. Challenging Neuropathic Pain Syndromes: Evaluation and Evidence-Based Treatment. 1st ed. St. Louis, Missouri: Elsevier; 2018. p.31-6.[Crossref]
- Goirigolzarri-Artaza J, Casado-Álvarez R, Benítez-Peyrat J, León-Aliz E, Goicolea J, García-Touchard A. Acute compartment syndrome of the hand after transradial catheterization. Rev Esp Cardiol (Engl Ed). 2017;70(8):672-3.[Crossref] [PubMed]
- Toraman A, Çetintepe L, Aydoğdu İ, Erdem N, Tutcu Şahin S, Güvence N, et al. [Rabdomiyolize bağlı akut böbrek yetmezliği ve otoimmun hemolitik anemi birlikteliği]. CBU-SBED. 2016;3(2):175-7.[Link]
- Galea M, Jelacin N, Bramham K, White I. Severe lactic acidosis and rhabdomyolysis following metformin and ramipril overdose. Br J Anaesth. 2007;98(2):213-5.[Crossref] [PubMed]
- Packer CD, Hornick TR, Augustine SA. Fatal hemolytic anemia associated with metformin: a case report. J Med Case Rep. 2008;2:300.[Crossref] [PubMed] [PMC]
- Rathnapala A, Matthias T, Jayasinghe S. Severe lactic acidosis and acute renal failure following ingestion of metformin and kerosene oil: a case report. J Med Case Rep. 2012;6:18.[Crossref] [PubMed] [PMC]