Organik Fosfor Zehirlenmelerinde Tanı ve Tedavide Güncel Yaklaşımlar

Year 2015, Volume: 1 Issue: 2, 126 - 138, 15.08.2015

Öznur Uludağ

Abstract

Tarımda üretimi arttırmak için; zararlı organizmaları kontrol altına almak ve zararlarını azaltmak amacıyla organik fosfor bileşikleri sık kullanılmaktadır. Bu bileşikler oldukça toksik olup maruziyetinde mortalitesi çok yüksektir. Aynı zamanda kitle imha aracı
olarak kimyasal silah yapımında da kullanılmaktadır. Özellikle ekonomisi tarıma dayalı toplumlarda kaza veya intihar amaçlı girişimlerde sık rastlanan önemli ve önlenebilir
zehirlenme nedenlerinden birisidir. Bu makalede yoğun bakım tedavisi gerektiren
zehirlenmeler içerisinde ön sıralarda bulunan organik fosfor bileşiklerinin genel özellikleri,
toksik etkileri, zehirlenmelerinde tanı ve tedavide dikkat edilmesi gereken hususlar, günceltedavi yaklaşımları ile ortaya konulmaya çalışılmıştır.

Keywords

Pestisit, insektisit, organik fosfor, zehirlenme, yoğun bakım

References

• Özkaya G, Çeliker A, Koçer-Giray B.İnsektisit zehirlenmeleri ve Türkiye’deki durumun değerlendirilmesi. TurkHij Den BiyolDerg 2013;70(2)75-102.
• Tulunay M, Cuhruk H Dreisbach’ın zehirlenme el kitabı.13.Baskı, Ankara: Güneş Kitabevi, 2003:123- 32.
• Çeliker A, Özkaya G, Nemutlu N, Hıncal F.A ten yearanalysis of pesticidepoisoningcases of Hacettepe drug and poisoninformationcenter. 5 th International Congress of TurkishSociety of Toxicology; October 30- November 2, Antalya-Turkey, 2003.
• Duman ES, AA, Pembe O, Fatih S. Fatalpoisonings in the Aegeanregion of Turkey. Vet Hum Toxicol 2003; 45: 106-8.
• Yayci N, Baser L, İnanıcı MA, Cantürk G, Çolak B, Karapirli M. Acutepesticidepoisoningrelateddeaths in Turkey. Vet Hum Toxicol 2004; 46: 342- 44.
• Fedakar R, Türkmen, N. Fatalpoisonings in the South Marmara region of Turkey, 1996-2003. Eur J Gen Med 2008; 5: 1-8.
• Johnson MK, Jacobsen D, Meredith TJ, et al. Evaluation of antidotes for poisoning by organophosphorus pesticides. Emerg Med 2000; 12:22-37.
• Pope CN. Organophosphorus pesticides: Do they all have the same mechanism of toxicity? J Toxicol Environ Health B Crit Rev 1999; 2:161-81. 9. Sams C, Mason HJ, Rawbone R.
• Evidenceforthe activation of
• organophosphatepesticidesbycytochromes P450 3A and 2D6 in humanlivermicrosomes. ToxicolLett 2000; 116:217-21.
• US EPA Office of Pesticide Programs. FY 2002 Annual Report. Washington, DC: USEnvironmentalProtectionAgency.
• Erişim:http://www.epa.gov/oppfead1/annual
• /2002/2002annualreport.pdf.
• Robey WC, Meggs WJ. Insecticides, Herbicides and Rodenticides. In: Tintinalli JE, Kelen GD, Stapczynski JS, eds. EmergencyMedicine: a ComprehensiveStudy Guide.6th Edn. McGraw-HillCo, New York, 2004;1134-43.
• Sungur M, Guven M. Intensive care management of organophosphate insecticide poisoning. Crit Care 2001; 5:211-5.
• Kraliedd L, Baker D, Marrs TC. Organophosphate-inducedintermediatesedrome: aetiology and relationshipswithmyopathy. ToxicolRev 2006,25(1):1-14.
• Guven M, Bayram F, Unluhizarci K, Kelestimur F. Endocrine changes in patients with acute organophosphate poisoning. Hum ExpToxicol 1999; 18:598-01.
• Namba T, Nolte CT, Jackrel J, Grob D. Poisoning due to organophosphate insecticides. Acute and chronic manifestations. Am J Med 1971; 50:475-92.
• Johnson MK, Jacobsen D, Meredith TJ, et al. Evaluation of antidotes for poisoning by organophosphorus pesticides. Emerg Med 2000; 12:22-37. 17. Worek F, Koller M, Thiermann H,
• SziniczL.Diagnosticaspects of
• organophosphatepoisoning.Toxicology 2005;214:182–9. 18. Butera R, Locatelli C, Barretta S.
• Secondaryexposure to malathion in
• emergencydepartmenthealthcareworkers. ClinToxicol 2002;40: 386.
• Robenshtok E, Luria S, Tashma Z, Hourvitz A. Adverse reaction to atropine and the treatment of organophosphate intoxication. Isr Med Assoc J 2002; 4:535-9.
• Eddleston M, Szinicz L, Eyer P, Buckley N. Oximes in acuteorganophosphoruspesticidepoisoning: a systematicreview of clinicaltrials. QJM 2002; 95: 275-83.
• Shannon MW, Borron SW, Burns M. Haddad and Winchester'sClinical Management of Poisonings and DrugOverdose. Saunders; Elsevier, 2007.
• Kassa J. Review of oximes in the antidotal treatment of poisoning by organophosphorus nerve agents. J ToxicolClinToxicol 2002; 40:803-16. 23. Eddleston M, Buckley NA, Eyer P, Dawson AH. Management of acuteorganophosphoruspesticidepoisoning.Lancet 2008; 371(16): 597-07.
• Pajoumand A, Shadnia S, Rezaie A, Abdi M, Abdollahi M. Benefits of magnesiumsulfate in the management of acutehumanpoisoningbyorganophosphorusinsecticides. Hum ExpToxicol 2004; 23: 565- 9.
• Kiss Z, Fazekas T. Organophosphates and torsade de pointes ventricular tachycardia. J RoySoc Med 1983; 76:983-4.
• Guven M, Sungur M, Eser B, Sari I, Altuntas F. The effects of freshfrozenplasma on cholinesteraselevels and outcomes in patients withorganophosphatepoisoning. J ToxicolClinToxicol 2004; 42: 617-23.
• Raushel FM. Bacterialdetoxification of organophosphatenerveagents. CurrOpinMicrobiol 2002; 5: 288-95.
• Buccafusco JJ, Aronstam RS. Clonidine protection from the toxicity of soman, an organophosphate acetylcholinesterase inhibitor, in the mouse. J PharmacolExpTher 1986; 239:43-7.
• Clement JG, Filbert M. Antidote effect of sodium fluoride against organophosphate poisoning in mice. Life Sci 1983;32: 1803-10.