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

Year 2007, Volume: 70 Issue: 2, 47 - 50, 14.11.2011

Seyit Mehmet Kayacan Sezai Vatansever Vakur Akkaya Osman Erk Tufan Tükek İşın Kılıçaslan Alaattin Yıldız Kerim Güler Seyit Kayacan At All.

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

References

• Aaseth J, Benov L, Ribarov S. Mercaptodextran: A new copper chelator and scavenger of oxygen radicals. Zhongguo Yao Li Xue Bao 1990; 11:363-367.
• Aaseth J, Skaug V, Alexander J. Haemolytic activity of copper as influenced by chelating agents, albumine and chromium. Ac- ta Pharmacol Toxicol (Copenh) 1984; 54:304-310.
• Agarwal BN, Bray SH, Bercz P, Plotzker R, Labovitz E. Ineffec- tiveness of hemodialysis in copper sulphate poisoning. Nephron 1975; 15:74-77.
• Agarwal SK, Tiwari SC, Dash SC. Spectrum of poisoning requ- iring haemodialysis in a tertiary care hospital in India. Int J Artif Organs 1993; 16:20-22.
• Ahasan HA, Chowdhury MA, Azhar MA, Rafiqueuddin AK. Copper sulphate poisoning. Trop Doct 1994; 24:52-53.
• Bhowmik D, Mathur R, Bhargava Y, Dinda AK, Agarwal SK, Tiwari SC, Dash SC. Chronic interstitial nephritis following pa- renteral copper sulfate poisoning. Renal Failure 2001; 23:731- 735.
• Chugh KS, Sharma BK, Singhal PC, Das KC, Datta BN. Acute renal failure following copper sulphate intoxication. Postgrad Med J 1977; 53:18-23.
• Clayton, G. D. and Clayton, F. E. Eds. Patty's Industrial Hygiene and Toxicology, Third Edition. Vol. 2: Toxicology. John Wiley and Sons, New York, NY, 1981; pp.10-24.
• Dargan PI, Giles LJ, Wallace CI, House IM, Thomson AH, Be- ale RJ, Jones AL. Case report: severe mercuric sulphate poiso- ning treated with 2,3-dimercaptopropane-1-sulphonate and ha- emodiafiltration. Crit Care 2003; 7:1-6.
• Faure A, Mathon L, Poupelin JC, Allaouchiche B, Chassard D. Acute cupric sulfate intoxication: pathophysiology and therapy about a case report. Ann Fr Anesth Reanim 2003; 22:557-559.
• Hocher B, Keller F, Krause PH, Gollnick H, Oelkers W. Inters- titial nephritis with reversible renal failure due to a copper-con- taining intrauterine contraceptive device. Nephron 1992; 61:111- 113.
• James LP, Stowe CD, Argao E. Gastric injury following copper sulfate ingestion. Pediatr Emerg Care 1999; 15:429-431.
• Liu J, Kashimura S, Hara K, Zhang G. Death following cupric sulfate emesis. J Toxicol Clin Toxicol 2001; 39:161-163.
• Lund ME, Banner W Jr, Clarkson TW, Berlin M. Treatment of acute methylmercury ingestion by hemodialysis with N- acetylcysteine (Mucomyst) infusion and 2,3-dimercaptopropane sulfonate. J Toxicol Clin Toxicol 1984; 22:31-49.
• National Institute for Occupational Safety and Health. Registry of Toxic Effects of Chemical Substances. Cincinnati, OH, 1981; 86:10-23.
• National Research Council. Drinking Water and Health. Nati- onal Academy Press Washington, DC, 1977; 88:10-22.
• New York State Department of Health. Chemical Fact Sheet: Copper Sulfate. Bureau of Toxic Substances Management. Al- bany, NY, 1984, pp.10-26.
• Takeda T, Yukioka T and Shimazaki S. Cupric sulfate intoxicati- on with rhabdomyolysis, treated with chelating agents and blo- od purification. Intern Med 2000; 39:253-255.
• Toet AE, van Dijk A, Savelkoul TJ, Meulenbelt J. Mercury kine- tics in a case of severe mercuric chloride poisoning treated with dimercapto-1-propane sulphonate (DMPS). Hum Exp Toxicol 1994; 13:11-16.
• U.S. National Library of Medicine. Hazardous Substances Data- bank. Bethesda, MD, 1995, pp.10-19.
• Walsh FM, Crosson FJ, Bayley M, McReynolds J, Pearson BJ. Acute copper intoxication. Pathophysiology and therapy with a case report. Am J Dis Child 1977; 131:149-151.
• Yang CC, Wu ML, Deng JF. Prolonged hemolysis and methe- moglobinemia following organic copper fungicide ingestion. Vet Hum Toxicol 2004; 46:321-323.