UZAMIŞ HEMOLİZ VE AKUT BÖBREK YETERSİZLİĞİ İLE PREZENTE OLAN BİR BAKIR SULFAT ZEHİRLENMESİ OLGUSU

Abstract

Bakır sulfat, sebzelerin, meyvelerin ve tahıl ürünlerinin bakteriyel ve fungal hastalıklarının kontrolü için kullanılan bir fungusiddir. Çok küçük miktarları dahi toksiktir. Akut toksisitesinde hemolitik anemi, akut tubuler nekroz, hepatotoksisite ve rabdomyoliz gelişir. Ellibeş yaşında bir erkek hasta midede yanma, bulantı, kusma ve epigastrik ağrı yakınmaları ile başvurdu. İntihar amacıyla oral bakır sulfat alımına bağlı hemolitik anemi, akut böbrek yetersizliği, hepatotoksisite (sadece artmış AST) ve rabdomyoliz saptandı. İdrar miktarı 3-4 L/gün olarak seyretti. D-penisilamin (900 mg/gün) başlandı. Metabolik asidoz kaydedildi. Yirmi günde 9 kez hemodiyaliz uygulandı. Serum ve idrarda artmış bakır düzeyleri ve yüksek methemoglobinemi düzeylerinde yavaş yavaş azalma gözlendi (210 µg/dl→92 µg/dl, 98 µg/24 saat →62 µg/24 saat, 2,1%→1,6%, sırasıyla). İdrardaki ürik asid, fosfor ve bikarbonat düzeyleri normaldi. Hemolizin 15. gününden itibaren gerilemeye başlayan anemi 30.günde tamamen düzeldi. Azot retansiyonunun üçüncü haftanın sonunda da gerilememesi üzerine böbrek biyopsisi yapıldı. Akut tubuler nekroz gösterildi. Böbrek fonksiyonu 30. günde normale döndü.

Keywords

• Bakır sulfat, zehirlenme, akut böbrek yetersizliği

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