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    Comparison of Intravenous Lipid Emulsion, Bicarbonate, and Glucagon Treatments in a Rabbit Model of Clomipramine Toxicity
    (Mre Press, 2020) Kara, Hasan; Bayir, Aysegul; Ak, Ahmet; Unlu, Ali; Kayis, Seyit Ali
    Background: This experimental study aimed to evaluate intravenous lipid emulsion, sodium bicarbonate, and glucagon as treatment options for the cardiotoxicity associated with clomipramine, a tricyclic antidepressant, and the antidotal effects of these drugs. Methods: In this experimental study, female and male New Zealand rabbits were divided into a sham group, a sodium bicarbonate treatment group, an intravenous lipid emulsion treatment group, and a glucagon treatment group. After the administration of a single dose of oral clomipramine (70 mg/kg), through an orogastric tube, vital parameters such as mean arterial pressure and oxygen saturation were measured, using a bedside monitor. Intoxication was established after the mean arterial pressure decreased to 40%-45%, within approximately 30-45 minutes. Treatments were administered after intoxication was established. Results: Although the mean arterial pressure values significantly changed over time in the sham and glucagon treatment groups, no significant changes were observed in the intravenous lipid emulsion and sodium bicarbonate treatment groups. Significant differences were observed among the values at 0 min compared with 30, 60, and 120 min in both the sham and the glucagon treatment groups. The clomipramine level changed significantly in all groups. Conclusion: Tricyclic antidepressant poisoning remains a difficult therapeutic challenge. Glucagon, a lipophilic drug, appears to be a promising candidate for the treatment of clomipramine-induced cardiotoxicity and should be considered early for the treatment of severe tricyclic antidepressant overdose.
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    Red cell distribution width and neurological scoring systems in acute stroke patients
    (Dove Medical Press Ltd, 2015) Kara, Hasan; Degirmenci, Selim; Bayir, Aysegul; Ak, Ahmet; Akinci, Murat; Dogru, Ali; Akyurek, Fikret
    Objectives: The purpose of the present study was to evaluate the association between the red blood cell distribution width (RDW) and the Glasgow Coma Scale (GCS), Canadian Neurological Scale (CNS), and National Institutes of Health Stroke Scale (NIHSS) scores in patients who had acute ischemic stroke. Methods: This prospective observational cohort study included 88 patients who have had acute ischemic stroke and a control group of 40 patients who were evaluated in the Emergency Department for disorders other than acute ischemic stroke. All subjects had RDW determined, and stroke patients had scoring with the GCS, CNS, and NIHSS scores. The GCS, CNS, and NIHSS scores of the patients were rated as mild, moderate, or severe and compared with RDW. Results: Stroke patients had significantly higher median RDW than control subjects. The median RDW values were significantly elevated in patients who had more severe rather than milder strokes rated with all three scoring systems (GCS, CNS, and NIHSS). The median RDW values were significantly elevated for patients who had moderate rather than mild strokes rated by GCS and CNS and for patients who had severe rather than mild strokes rated by NIHSS. The area under the receiver operating characteristic curve was 0.760 (95% confidence interval, 0.676-0.844). Separation of stroke patients and control groups was optimal with RDW 14% (sensitivity, 71.6%; specificity, 67.5%; accuracy, 70.3%). Conclusion: In stroke patients who have symptoms <24 hours, the RDW may be useful in predicting the severity and functional outcomes of the stroke.