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Puzzelen met pubers

  • casuïstische mededelingen
  • Published:
Tijdschrift voor Kindergeneeskunde

Samenvatting

Auto-intoxicaties komen frequent voor bij pubers, maar de aard van de intoxicatie kan onduidelijk zijn. Patiënte 1 presenteerde zich comateus en met andere neurologische symptomen ten gevolge van een Fero-Gradumet® auto-intoxicatie. IJzer is toxisch voor de gastro-intestinale mucosa, veroorzaakt capillaire lek en leidt tot systemische toxiciteit wanneer het in de organen wordt opgenomen. Patiënte 2 presenteerde zich met een coma, convulsies, bradycardie en hypoxie. De ingestie van nagellakremoverpads was hiervoor verantwoordelijk, doordat het bestanddeel gammabutyrolacton (GBL) wordt omgezet naar gammahydroxybutyraat (GHB). Bij elke patiënt in een kritische toestand is waarborging van de ademweg, ademhaling en circulatie (de A, B en C) het belangrijkst. Met de beschrijving van deze twee patiënten tonen we dat het lastig kan zijn om te achterhalen wat de aard van een intoxicatie is.

Summary

Auto-intoxications in adolescents are common, but the type of intoxication is not always obvious at presentation. Patient 1 was admitted with a coma and other signs of neurological dysfunction. This presentation was due to an auto-intoxication with Fero-Gradumet® . Iron has a toxic effect on the gastrointestinal mucosa, causes capillary leak by damage of the endothelial layer and leads to systemic toxicity when iron is distributed into the organs. Patient 2 was admitted with a coma, bradycardia, low oxygen saturation and seizures. These symptoms were caused by an auto-intoxication with nail polish remover pads. These pads contain gammabutyrolactone, a precursor of gammahydroxybutyrate (GHB). Ingestion of these pads can cause the same symptoms as a GHB intoxication. In every critically ill patient, stabilisation of airway, breathing and circulation (A, B and C) is the most important. These two cases show that the cause of the symptoms can be due to unusual auto-intoxications.

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Authors and Affiliations

  1. arts-assistent kindergeneeskunde, thans Mâima Medisch Centrum, Veldhoven, The Netherlands

    E. Simonse

  2. arts-assistent kindergeneeskunde, thans Erasmus MC-Sophia, Rotterdam, The Netherlands

    S.W.K de Kort

  3. www.bsl.nl

    C.G.H. Valk-Swinkels, N.E. van ’t Veer &  E.J.M Veldkamp

  4. kinderarts-neonatoloog, Amphia Ziekenhuis, Breda, The Netherlands

    R.H.T van Beek

Authors
  1. E. Simonse
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  2. S.W.K de Kort
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  3. C.G.H. Valk-Swinkels
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  4. N.E. van ’t Veer
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  5. E.J.M Veldkamp
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  6. R.H.T van Beek
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Additional information

ziekenhuisapotheker in opleiding, ziekenhuisapotheker, kinderarts

Correspondentieadres: drs. E. Simonse, Máxima Medisch Centrum, Veldhoven

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Simonse, E., de Kort, S., Valk-Swinkels, C. et al. Puzzelen met pubers. TIJDSCHR. KINDERGENEESKUNDE 80, 99–101 (2012). https://doi.org/10.1007/s12456-012-0027-1

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  • DOI: https://doi.org/10.1007/s12456-012-0027-1

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