ACİL SERVİSTE ORGANOFOSFAT ZEHİRLENMESİ OLAN HASTALARIN DEĞERLENDİRİLMESİ: İKİ MERKEZLİ RETROSPEKTİF BİR ÇALIŞMA

Year 2024, Volume: 7 Issue: 2, 87 - 92, 04.06.2024

Abdussamed Vural , Turgut Dolanbay , Levent Şahin , Mustafa Cihan Altay , Hayri Canbaz

https://doi.org/10.26650/JARHS2024-1404063

Abstract

Amaç: Organofosfatların (OF) küresel tarımda pestisit olarak yaygın kullanımı hem gelişmekte olan hem de sanayileşmiş ülkelerde önemli sağlık riskleri oluşturmaktadır. Yutma, mesleki temas ve intihar girişimleri yoluyla maruz kalma, yüksek morbidite ve mortaliteye yol açmaktadır. Bu çalışma, acil servislere başvuran 18 yaş ve üzeri yetişkin hastaların demografik, klinik ve laboratuvar özelliklerini retrospektif olarak analiz etmeyi amaçlamaktadır.

Gereç ve Yöntem: Çalışma, Niğde Ömer Halisdemir Üniversitesi Eğitim ve Araştırma Hastanesi, Acil Tıp Kliniği ve Kafkas Üniversitesi Sağlık Uygulama ve Araştırma Hastanesi, Acil Tıp Kliniği tarafından gerçekleştirilen iki merkezli retrospektif bir analizdir. Demografik bilgiler, klinik ayrıntılar ve laboratuvar parametreleri dahil olmak üzere hasta verileri kaydedilmiştir. Analizler rutin kan testlerini, psödokolinesteraz düzeylerini ve elektrokardiyografi bulgularını kapsamaktadır. Çalışmaya 15 Haziran 2020 ile 15 Haziran 2023 tarihleri arasında OF zehirlenmesi (uluslararası hastalık sınıflandırması (ICD) kodu T60.0) tanısı alan hastalar dahil edilmiştir.

Bulgular: Çalışmaya dahil edilme ve dışlanma kriterlerini karşılayan 24 hasta dahil edilmiştir. Hastaneye yatış oranı %91,7 olup sadece %4,2’si entübasyon gerektirmiştir. Hastane içi mortalite görülmemiştir. Psödokolinesteraz düzeyleri pH, bikarbonat, anyon açığı ile negatif; CRP ile pozitif korelasyon göstermiştir. Hastanede kalış süresi Glasgow koma skalası (GKS), pH, bikarbonat ile negatif; anyon açığı ile pozitif korelasyon göstermiştir.

Sonuç: Bu retrospektif, iki merkezli çalışma, acil servislere OF zehirlenmesi ile başvuran yetişkin hastaların demografik profilleri, klinik bulguları ve tedavi sonuçları hakkında kapsamlı bilgiler sunmaktadır. Çalışmamızda organofosfat zehirlenmelerinin çoğu kaza sonucu meydana gelmiştir Bu açıdan, organofosfat zehirlenmelerini önlemek için fabrikalarda ve çiftliklerde güvenlik ekipmanları, güvenli tarım koşulları, tehlikeli maddelere sınırlı erişim, acil durum eğitimi, halk sağlığı kampanyaları ve güvenli iş uygulamaları sağlamak önemlidir. Ayrıca bu çalışma, GKS, pH ve HCO3 gibi klinik parametrelerin değerlendirilmesinin hastaneye yatış şiddeti ve süresinin öngörülmesindeki öneminin altını çizmektedir.

Keywords

Organofosfatlar, zehirlenme, ölüm, biyokimyasal belirteçler

EVALUATION OF PATIENTS WITH ORGANOPHOSPHATE POISONING IN THE EMERGENCY DEPARTMENT: A RETROSPECTIVE TWO-CENTER STUDY

Abstract

Objective: The widespread use of organophosphates (OP) as pesticides in global agriculture, pose significant health risks in both developing and industrialized nations. Exposure through ingestion, occupational contact, and suicide attempts leads to high morbidity and mortality. This study will retrospectively analyze the demographic, clinical, and laboratory characteristics of adult patients aged 18 years and older who presented to emergency departments.

Material and Methods: The study is a two-center retrospective analysis of the Niğde Ömer Halisdemir University Training and Research Hospital, Clinic of Emergency Medicine and Kafkas University Health Practice and Research Hospital, Clinic of Emergency Medicine. Patient data, including demographics, clinical details, and laboratory parameters, were recorded. Analysis covered routine blood tests, pseudocholinesterase levels, and electrocardiography findings. Patients diagnosed with OP poisoning (international classification of diseases (ICD) code T60.0) between 15 June 2020 and 15 June 2023 were included in the study.

Results: The study included 24 patients meeting inclusion and exclusion criteria. Oral exposure (41.7%) and inhalation (25%) were common routes. The hospitalization rate was 91.7%, with only 4.2% requiring intubation. No in-hospital mortality occurred. Pseudocholinesterase levels correlated negatively with pH, bicarbonate, anion gap and positively with c-reactive protein (CRP). Duration of hospital stays was negatively correlated with Glasgow coma scale (GCS), pH, bicarbonate, and positively correlated with the anion gap.

Conclusion: This retrospective, two-center study provides comprehensive insights into the demographic profiles, clinical manifestations, and treatment outcomes of adult patients presenting with OP poisoning in emergency departments. In our study, most organophosphate poisonings were accidental. In this respect, it is important to provide safety equipment, safe farming conditions, limited access to hazardous substances, emergency education, public health campaigns and safe work practices in factories and farms to prevent organophosphate poisoning. Furthermore, this study underlines the importance of assessment of clinical parameters such as GCS, pH and HCO3 in predicting the severity and duration of hospitalization.

Keywords

Organophosphates, poisoning, mortality, biochemicals markers

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