Semptomdan Tanıya Organofosfat İntoksikasyonu

Abstract

Zehirlenme olguları acil servislerde sıkça karşılaşılan önemli bir sağlık sorunudur. Zehirlenmelere akut süreçte müdahalede gecikme artmış mortalite ve morbiditeye neden olabilir. Organik fosfor bileşikleri tüm dünyada yaygın olarak tarımda, evlerde, bahçelerde, veterinerlikte ve kimyasal silah yapımında kullanılmaktadır. Yılda yaklaşık 3 milyon insan organofosfatlara maruz kalmakta ve 300 bine yakını ölmektedir. Olgumuzda daha önce bilinen hastalığı olmayan jeneralize tonik klonik nöbet geçirme sonrası acile başvuran 13 yaşında kız hasta sunulmuştur. Hastanın zehirlenme öyküsü olmamasına rağmen klinik ve laboratuvar bulgularının organofosfat intoksikasyonu özellikleri taşıması nedeniyle verilen atropin ve pralidoksim tedavilerine dramatik cevap alınmıştır. Hasta daha sonradan intihar amaçlı böcek ilacı içtiğini itiraf etmiştir. Acil servise başvurularda özellikle daha önceden sağlıklı çocuklarda abdominal kramplar, lakrimasyon ve salivasyon artışı, solunum sıkıntısı, aritmi, anksiyete, nöbet, bilinç bulanıklığı görülmesi durumunda organofosfat zehirlenmeleri akla gelmelidir.

Keywords

• Kolinerjik semptomlar, Nöbet, Organofosfat zehirlenmesi

Organophosphate Poisoning from Symptoms to Diagnosis

Abstract

Poisoning is an important health problem that is common in emergency services. Delay in intervention in the acute process of poisoning can lead to increased mortality and morbidity. Organic phosphorus compounds are widely used in agriculture, in houses, in gardens, in veterinary medicine and in chemical weapons production all around the world. Approximately 3 million people are exposed to organophosphates per year and nearly 300 thousand die. We present a 13-year-old previously healthy girl with generalized tonic clonic seizures. Although there was no pertinent poisoning history, the diagnosis was made based on the clinical signs and the dramatic response to atropine and pralidoxime treatments. After the resolution of the symptoms, the patient confessed that she had attempted suicide with an insecticide. Emergency organophosphate intoxication should be considered especially if abdominal cramps, increased lacrimation and salivation, respiratory distress, arrhythmia, anxiety, seizure, and decreased consciousness are observed in previously healthy children

Keywords

• Cholinergic symptoms, Seizure, Organophosphate poisoning

References

1. Refik Saydam Hıfzıssıhha Merkezi Başkanlığı - Ulusal Zehir Danışma Merkezi verileri. www.journalagent.com/turkhijyen/pdfs/ THDBD_66_3_29_58.pdf, 2008
2. Robey WC, Meggs WJ. Insecticides, Herbicides and Rodenticides. In: Tintinalli JE, Kelen GD, Stapczynski JS, (eds). Emergency Medicine: A Comprehensive Study Guide. 6th (ed). New York: McGraw-Hill Co, 2004:1134–43.
3. Eyer P. The role of oximes in the management of organophospho- rus pesticide poisoning. Toxicol Rev 2003;22:165-90.
4. Eddleston M, Phillips MR. Self poisoning with pesticides. BMJ 2004;328:42.
5. Sidell FR. Soman and sarin. Clinical manifestations and treat- ment of accidental poisoning by organophosphates. ClinToxicol 1974;7:1.
6. Eddleston M, Buckley NA, Eyer P. Dawson AH. Medical management of acute organophosphorus pesticide poisoning. Lancet 2008;371:597–607.
7. Peter JV, Sudarsan TI, Moran JL, Clinical features of organophosphate poisoning: A review of different classification systems and approaches. Indian J Crit Care Med 2014;18:735-45.
8. Sahin I, Onbasi K, Sahin H, Karakaya C, Ustun Y, Noyan T. The prevalence of pancreatitis in organophosphate poisonings. Hum Exp Toxicol 2002;21:175–7.

9. Worek F, Koller M, Thiermann H, Szinicz L. Diagnostic aspects of organophosphate poisoning. Toxicology 2005;214:182–9.
10. Eddleston M, Chowdhury FR. Pharmacological treatment of organophosphorus insecticide poisoning: The old and the (possible) new. Br J Clin Pharmacol 2016;81:462-70.
11. Buckley NA, Eddleston M, Li Y, Bevan M, Robertson J. Oximes for acute organophosphate pesticide poisoning. Cochrane Database Syst Rev 2011;16:CD005085.