Sıvı yönetimi ve optimizasyonu, anesteziyoloji ve yoğun bakımda sık karşılaşılan günlük sorunlar- dandır. İdeal hemodinamik yönetim dokulara oksijen sunumunu arttırmakta, postoperatif sonuç- ları iyileştirmekte ve cerrahi maliyeti düşürmektedir. Sıvı tedavisinin istenmeyen etkilerinin erken öngörülmesi ve takibinde damar dışı akciğer sıvısı (EVLW) ölçümü giderek kabul gören bir yöntem haline gelmiştir. Akut dolaşım yetmezliği tedavisinde temel amaç doku perfüzyonunu ve oksjeni- zasyonunu iyileştirirken sıvı yüklenmesinden kaçınmaktır. EVLW, akciğerlerde pulmoner damarlar dışında bulunan interstisyel, intrasellüler, alveoler ve lenfatik sıvıyı kapsar ve sağlıklı kişilerde normal değerleri 3-7 ml kg-1’dir. Bu konudaki çalışmalar, cut-off değeri olarak 10 ml kg-1 üzerinde- ki değerlerin pulmoner ödeme işaret ettiğini göstermiştir. EVLW ölçümünde altın standart gravi- metrik yöntem olmakla birlikte, post-mortem yapılabilmesi nedeniyle günümüzde akciğer ultra- sonografisi ve transpulmoner termodilüsyon teknikleri daha yaygın kullanılmaktadır. Gelecekte özellikle ALI/ARDS hastalarının hemodinamik yönetiminde EVLW ölçümünün önemli bir yer tut- ması beklenmektedir ve bu alanda yapılacak çalışmaların EVLW bazlı sıvı tedavisine odaklanması yararlı olacaktır.

Fluid management and optimization is one of the most frequently observed problems in anesthe- siology and critical care. An ideal hemodynamic management increases oxygen supply to tissues, improves postoperative outcomes and decreases surgical costs. Extravascular lung water (EVLW) measurement has gained widespread acceptance in the early prediction and management of adverse effects caused by fluid treatment. The fundamental aim of acute circulatory failure treat- ment is to improve tissue perfusion and oxygenation while avoiding fluid overload. EVLW consists of extravascular interstitial, intracellular, alveolar and lymphatic fluid in the lungs and its normal values are 3-7 ml kg-1. Studies have reported that values above 10 ml kg-1 as a cut-off value points to pulmonary edema. Although the gold standard in EVLW measurement is the gravimetric method, lung ultrasound and transpulmonary thermodilution is more widely utilized since gravi- metric measurement can only be performed post-mortem. EVLW measurement is expected to gain importance in the hemodynamic measurement of ALI/ARDS patients and future studies will benefit from focusing on EVLW based fluid therapy

Mushroom poisoning is a frequently encountered health problem around the globe. Depending on its type and toxin, it results in a wide spectrum of issues that range from asymptomatic findings to fatal organ failure. Since the toxin of the mushroom leading to poisoning is often unidentified, syndromic classification may benefit clinical management according to the findings of target organ system toxicity. A 64-year-old female patient with comorbidities such as diabetes mellitus, coronary artery disease, hypertension and hyperlipidemia was admitted to the intensive care unit. Approximately four hours after consuming wild mushrooms the patient’s diarrhea, muscle cramps, cold sweating, blurry vision, coughing and shortness of breath complaints have been begun. Her respiratory system examination revealed tachypnea, generalized bilateral rhonchus, bronchorrhea and wheezing. Patient was normotensive and had bradycardia (heart rate 35 beats/minute). She had anxiety and the Glasgow Coma score was 15. Her pupillary bilateral isochoric, miotic and light reflexes were diminished. In her arterial blood gas pH level 7.26, partial carbon dioxide pressure: 34 mmHg, potassium: 5.3 mmol/L, sodium: 130 mmol/L, lactate: 5.3 mmol/L, bicarbonate: 16 mEq/L and base excess: -10,3 mmol/L was found. Target organ system toxicity findings and timing of occurrence indicated early-onset cholinergic syndrome. Treatments that consisted of intravenous atropine, fluid, electrolytes and sodium bicarbonate alleviated the toxicity in a short period of time. Late mycologic examination results that followed the treatment revealed that the patient was poisoned by Inocybe lacera, a mushroom type that contains muscarine. With this case presentation, we summarized the syndromic classification that we use in the clinical management in the light of current information in the literature.