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    Comparison of Effects of Separate and Combined Sugammadex and Lipid Emulsion Administration on Hemodynamic Parameters and Survival in a Rat Model of Verapamil Toxicity
    (INT SCIENTIFIC LITERATURE, INC, 2016) Tulgar, Serkan; Kose, Halil Cihan; Piroglu, Isilay Demir; Karakilic, Evvah; Ates, Nagihan Gozde; Demir, Ahmet; Gergerli, Ruken; Guven, Selin; Piroglu, Mustafa Devrim
    Background: Toxicity of calcium channel blockers leads to high patient mortality and there is no effective antidote. The benefit of using 20% lipid emulsion and sugammadex has been reported. The present study measured the effect of sugammadex and 20% lipid emulsion on hemodynamics and survival in a rat model of verapamil toxicity. Material/Methods: In this single-blinded randomized control study, rats were separated into 4 groups of 7 rats each: Sugammadex (S), Sugammadex plus 20% lipid emulsion (SL), 20% lipid emulsion (L), and control (C). Heart rates and mean arterial pressures were monitored and noted each minute until death. Results: Average time to death was 21.0 +/- 9.57 minutes for group C, 35.57 +/- 10.61 minutes for group S, 37.14 +/- 16.6 minutes for group L and 49.86 +/- 27.56 minutes for group SL. Time to death was significantly longer in other groups than in the control group (p<0.05). Conclusions: Verapamil overdose is has a comparatively high mortality rate and there is no effective antidote. Treatment generally involves gastric decontamination and symptomatic treatment to counteract the drug's negative effects. In animal studies sugammadex and lipid emulsion had a positive effect on survival in patients with calcium channel blocker toxicity. Sugammadex and intralipid increased survival in a rat model of verapamil toxicity. The combination of both drugs may decrease cardiotoxicity. Sugammadex alone or combined with 20% lipid emulsion reduce the need for inotropic agents. The mechanism requires clarification with larger studies.
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    The impact of intravenous lipid emulsion on lipophilicity in poisoned patients: A systematic review.
    (ALLIED ACAD, 2017) Karakilic, Evvah; Kaya, Elif; Erdem, Ahmet; Arslan, Engin Deniz; Durdu, Tamer; Tulgar, Serkan; Iscanli, Dogan
    Objective: Although the action mechanism of intravenous lipid emulsion has not been fully elucidated yet, its use in liposoluble drugs intoxications. In this study, we examined the lipophilic features of causative agents and the success of the treatment ILE therapy in intoxication cases. Methods: We reviewed 765 cases published in PubMed between 1966 and June, 2015. After applying exclusion criteria, totally 141 cases ingested single substance and received ILE therapy with 20% ILE solution were included in present study. Amount of lipid solutions given and the results were recorded. Success rate was statistically assessed according to log p values of the substances taken and the amount of lipid emulsion used. Results: 141 patients were involved in this study; log p values were calculated for all drugs regardless of the success of ILE therapy. ILE therapy under the amount of 100 ml failed to achieve successful outcome. ALOGPS and ChemAxon log P values were higher in cases, which received ILE therapy <= 500 ml and showed successful results. It was found that log p value had no contribution to the treatment success in the group received ILE therapy>500 ml. Conclusions: It was found that ILE therapy<500 ml was successful in drugs with higher lipophilicity while success rate was higher in ILE therapy>500 ml and that liposolubility had no significant contribution to treatment success.
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    MODIFIED KDIGO FOR PREDICTING MORTALITY IN ICU PATIENTS RECEIVING CONTINUOUS RENAL REPLACEMENT THERAPY FOR ACUTE RENAL FAILURE: KDIGO-URINARY OUTPUT VS. KDIGO-SERUM CREATININE LEVEL
    (CARBONE EDITORE, 2016) Tulgar, Serkan; Cakiroglu, Basri; Cevik, Banu Eler; Karakilic, Evvah; Ates, Nagihan Gozde; Gergerli, Ruken; Ozdemir, Erman
    Introduction: Acute Renal Injury (ARI) is a constant problem for patients in intensive care and Continuous Renal Replacement Therapy (CRRT) is an ever-more important part of acute renal injury (ARI) treatment. Various criteria have been used for the diagnosis and classification of acute renal failure, including RIFLE (Risk-Injury-Failure-Loss-End stage), AKIN (Acute Kidney Injury Network) and most recently KDIGO (Kidney Disease: Improving Global Outcomes). Many studies have only evaluated urinary output or serum creatinine when categorizing ARI. Our aim was to determine the predictors of mortality in intensive care patients treated with CRRT and to compare mortality with ARI level as determined by KDIGO-Serum Creatinine (KDIGO-SCr) and KDIGO-urinary output (KDIGO-UO) Materials and methods: This retrospective study was performed on intensive care patients receiving CRRT at our institute between January 2010-December 2011. Patient files were reviewed and demographic data, hospitalization time, laboratory findings, CRRT commencement and ARI levels were noted. Results: Seventy patients were included in the study. Mortality was found to be associated with patients' age, Glascow Coma Scale (GCS) score, Acute Physiology and Chronic Health Evaluation (APACHE) II score and adjusted predicted death rate. (p<0,01). Receiver Operating Curve (ROC) area under the curve was statistically significant for determination of mortality using KDIGO-SCR (p<0.01) although the same was not true for KDIGO-UO (p>0.05). Conclusions: We believe that RIFLE, AKIN, KDIGO criteria are each good predictors of mortality. In the case of KDIGO criteria, based solely on serum creatinine or urinary output, KDIGO-SCr was found to be a better predictor of mortality when compared to KDIGO-UO.