Sociodemographic features of organophosphate poisonings and the relationship between time of pralidoxime administration and mortality

Year 2013, , 549 - 554, 01.12.2013

Mehmet Nezir Güllü Ali Kemal Kadiroğlu Murat Orak Mehmet Üstündağ Mehmet Emin Yılmaz

https://doi.org/10.5798/diclemedj.0921.2013.04.0331

Abstract

Objective: Organophosphates are commonly used in agriculture and mostly lead to intoxication. In this study, we examined the sociodemographic features, clinical findings, and the relationship between time to treatment with pralidoxime and mortality in patients with organophosphate poisoning treated in our clinic. Methods: We retrospectively examined hospital records of 179 patients who were managed for organophosphate poisoning in our clinic, between January 2001 and November 2009. Sociodemographic data, clinical findings, laboratory results, complications during follow-up, and outcomes were recorded. The patients were grouped as died and survived, and comparison of sociodemographic and clinical features, laboratory results, and treatment outcomes were performed. Results: Among 179 patients, 133 (74.3%) were female, 46 (25.6%) were male and mean age was 27.1+11.7 years. Fifteen (8.3%) patients died. Illiteracy rate among those who died was 66.6%, while it was 30.4% in those who survived. Among those who died, 13 (86.6%) had nicotinic and 14 (93.3%) had CNS signs. Assessment of cases by the time to PAM administration revealed mortality rates of 4.47% (n=6), 19.4 % (n=7), and 22.2% (n=2) for the first 3 hours (n= 134), 3-6 hours (n=36), and after 6 hours (n=9), respectively. Conclusion: A great majority of patients presenting with organophosphate poisoning were of low educational status, which was linked with mortality, indicates the importance of education. In addition, mortality rate was lower in patients who were administered PAM at an earlier period in the treatment process, suggesting the role of early PAM administration in reducing mortality.

Keywords

Organophosphate, pralidoxime, mortality

Organofosfat zehirlenmelerinin sosyodemografik özellikleri ve pralidoksim verilme zamanı ile mortalite arasındaki ilişki

Abstract

Amaç: Organofosfatlı ilaçlar tarım sektöründe sıklıkla kullanılmaktadır ve ilaç zehirlenmelerinde önemli bir yer tutmaktadır. Bu çalışmada, kliniğimizde takip edilen organofosfat zehirlenme vakalarının sosyodemografik verileri, klinik bulguları ve pralidoksim (PAM) tedavisine başlanma zamanı ile mortalite arasındaki ilişki araştırıldı. Yöntemler: Çalışma kapsamında Ocak 2001 - Kasım 2009 tarihleri arasında Dicle Üniversitesi Tıp Fakültesi İç Hastalıkları Kliniği\'nde organofosfat zehirlenmesi nedeni ile takip edilen 179 hastanın dosyaları geriye dönük olarak incelendi. Hazırlanan standart çalışma formlarına; sosyodemografik veriler, klinik bulgular, laboratuvar verileri, takip esnasında gelişen komplikasyonlar ve tedavi sonuçları kaydedildi. Hastalar ölen ve sağ kalan hastalar şeklinde gruplandırılarak sosyodemografik, klinik, laboratuvar sonuçları ve tedavi sonuçları karşılaştırıldı. Bulgular: Çalışmaya alınan 179 hastanın 133 (%74,3)\'ü kadın, 46 (%25,6)\'sı erkek ve yaş ortalamaları 27,13+11,68 idi. Hastalarımızın 15'i (% 8,3) öldü. Ölen hastalarımızda okur-yazar olmama oranı % 66,6 iken sağ kalan hastalarda bu oran %30,4 idi. Ölen hastaların 13'ünde (% 86,6) nikotinik, 14'ünde (% 93,3) SSS bulguları görülürken, sağ kalanların 76'sında (% 46,3) nikotinik ve 62'sinde (% 37,8) SSS bulguları görüldü. PAM verilme zamanına göre hastalar değerlendirildiğinde; ilk 3 saatte (n=134), 3-6 saatte (n=36) ve 6 saatten sonra (n=9) olup, bu saatlere göre PAM tedavisi verilenlerin mortalite oranları sırasıyla; % 4,47 (n=6), % 19,4 (n=7), % 22,2 (n=2) olduğu tespit edildi. Sonuçlar: Organofosfat zehirlenmesi ile başvuran hastaların büyük çoğunluğunun eğitim düzeyinin düşük olup mortalite ile ilişkili bulunması eğitimin önemini göstermektedir. Ayrıca PAM tedavisi erken verilenlerde mortalite oranı daha düşük bulunmuş olup, PAM tedavisine erken başlanması mortaliteyi azaltmada önemlidir.

Keywords

Organofosfat, pralidoksim, mortalite

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