Havale ve sarada basit laboratuar incelemelerinin yeri
The role of routine laboratory investigation in children with seizure and epilepsy
Yazar: HASİBE UYĞUN KÜÇÜKAPAN
Danışman: PROF. DR. HALÛK YAVUZ
Selçuk Üniversitesi / Meram Tıp Fakültesi / Çocuk Sağlığı ve Hastalıkları Ana Bilim Dalı
Derece: Tıpta Uzmanlık, 2011
Konu: Çocuk Sağlığı ve Hastalıkları = Child Health and Diseases
Dizin: Ateş = Fever ; Epilepsi = Epilepsy ; Laboratuvarlar = Laboratories ; Nöbetler = Seizures ; Nöbetler-febril = Seizures-febrile ; Testler = Tests ; Çocuk hastalıkları = Child diseases ; Çocuklar = Children

Özet:
Amaç: Bu çalışmanın amacı, havaleyle başvuran çocuklarda tanı ve tedavide laboratuar incelemelerinin yerini değerlendirmektir.Olgular ve yöntem: 01.01.2000-31.12.2010 tarihleri arasında Selçuk Üniversitesi Meram Tıp Fakültesi Çocuk Nöroloji Polikliniği'ne havale sebebiyle başvuran 1586 hastanın dosyası geriye dönük olarak incelendi. Yeni doğanlar çalışmaya dâhil edilmedi. Hastalar hikâye ve laboratuar bulgularına göre gruplandırıldı. Özellikle havaleye yol açabilecek kan şekeri ve elektrolit anormallikleri araştırıldı.Bulgular: Çalışmamızda hastaların 893'ü (%56,3) erkek, 693'ü (%43,7) kız idi. Erkek / kız: 1,28 idi. Hastaların yaş ortalaması 65±52,68 ay idi (en küçük 1, en büyük 214 ay). Ortanca değeri 50 ay idi. Hastaların 388'i (%24,5) ateşli havale, 237'si (%15) ilk ateşsiz havale, 961'i (%60,5) ise sara idi. 1040 hastadan (% 65,6) EEG istenmiş olup bunların %44,1'inde anormal bulgu izlenmiştir. 592 hastadan (%37,3) BMR istenmiş olup bunların %26,3'ünde anormal bulgu izlenmiştir. 250 hastadan (%15,8) BBT istenmiş olup bunların 36,8'inde anormal bulgu izlenmiştir. 525 hastadan (% 33,1) 1 kez, 70 hastadan (% 4,4) birden fazla olmak üzere toplamda 595 hastadan (%37,5) tetkik istenmiştir. Toplam 6000 tetkik istenmiş olup bunların %26,3'ü hastane referans değerlerine göre anormal tespit edildi. Ancak klinik olarak anlamlı ve havale tetikleyici olarak düşünülen anormallik sadece 16 hastada (tetkik istenenlerin %2,3'ünde, bütün tetkiklerin %0,2'sinde) (8 hipoglisemi, 3 hiponatremi, 3 hipokalsemi, 2 hipomagnezemi) tespit edildi. Kan şekeri bakılan 417 hastanın 8'inde havale yapacak seviyede kan şekeri düşüklüğü tespit edildi. Bunların 3 tanesi ilk ateşsiz havale, 5 tanesi sara hastası idi. Bunlarında ikisinde uzamış havale birinde adrenal yetmezlik mevcuttu. Kalsiyum bakılan 443 hastanın 31'inde kalsiyum düşük bulundu ancak bunların 3 tanesinde havale yapabilecek seviyedeydi. Bu hastaların hepsi sara grubunda yer alırken birinde Di George Sendromu mevcuttu. Na bakılan 432 hastanın 68'inde hiponatremi vardı bunların ancak 3 tanesinde (ikisi sara, biri ilk ateşsiz havale grubunda) havale yapabilecek seviyedeydi. Bunların ikisinde sepsis vardı. Mg bakılan 236 hastanın 17'sinde hipomagnezemi mevcuttu ancak bunların 2 tanesi (biri ilk ateşsiz diğeri sara grubunda) havale yapacak düzeydeydi. Ateşli havale grubunda havale yapabilecek kan şekeri ve elektrolit anormalliğine rastlanmadı.Sonuç: Havaleyle başvuran hastalarda rutin olarak laboratuar incelenmesi istenmemelidir, klinik olarak gerekliyse istenmelidir. Bu takdirde maliyet biraz azaltılabilir.Anahtar kelimeler: havale, çocuk, laboratuar testleri

Abstract:
Objective: The aim of this study was to evaluate the role of laboratory tests in diagnosis and treatment of children with seizures.Cases and Methods: We have retrospectively examined the files of 1586 patient with seizures who applied to the pediatric neurology department of Selçuk University Meram medical school between 01.01.2000-31.12.2010. The newborns were excluded. Diagnosis and the subgroups were identified depending on the history and the laboratory findings. We specifically determined whether abnormal serum chemistries were a seizure trigger factor.Results: In our study 893 (%56,3) patients were male and 693 (%43,7) patients were female, male/ female: 1,28/1. Mean age was 65±52,68 (range between 1 and 214 months). Median age was 50 months. 388 (%24,5) patients were diagnosed as febrile seizure, 237 (%15) were diagnosed as afebrile seizure, 961 (%560,5) patients were diagnosed as epilepsy. EEG was performed in 1040 (% 65,6) patients and abnormal electroencephalography findings were detected in %44,1 of these patients. BMR was performed in 592 (%37,3) patients and abnormal BMR findings were detected in %26,3 of these patients. BBT was performed in 250 (%15,8) patients and abnormal BBT findings were detected in % 36,8 of these patients. Laboratory tests were performed in 525 (% 33,1) patients for once and were performed in 70 (% 4,4) for twice, so that laboratory test were performed in 595 (%37,5) patients. The total number of tests were 6000 and % 26,3 of these were abnormal according to hospital reference values but clinical significant laboratory abnormalities such as a seizure trigger were determined in only sixteen (%2,3) patients (8 cases with hypoglycemia, 3 cases with hypocalcemia, 3 cases with hyponatremia and 2 cases with hypomagnesimia). Blood sugar was performed in 417 patients but hypoglycemia as a seizure trigger was detected in only 8 patients. 3 of them were diagnosed as afebrile seizure and 5 of them were diagnosed as epilepsy, 2 of them were diagnosed as status epilepticus and a patient had adrenal insufficiency. Serum calcium was performed in 443 patients, and hypocalcemia was detected in 31 patients but it was as a seizure trigger in only 3 patients. All of them were diagnosed as epilepsy and one of them was also diagnosed as Di George Syndrome. Serum sodium was performed in 432 patients and hiponatremia was detected in 68 patients but it was as a seizure trigger in only 3 patients (2 of them diagnosed as epilepsy, one of them diagnosed as afebrile seziure). 2 of them had sepsis. Serum magnesium was performed in 236 patients and hypomagnesimia was detected in 17 patients but it was as a seizure trigger in only 2 patients ( one of them diagnosed as epilepsy and the other one diagnosed as afebrile seizure. Blood sugar and electrolytes abnormalities weren?t detected in any patient with febrile seziure.Conclusion: The laboratory tests shouldn?t be performed routinely, it should be performed if clinically indicated. So that it leads to decrease cost.Keywords: Seizures; child; laboratory tests?