Karbonmonoksit Kaynaklarının ve Meteorolojik Değişikliklerin Karbonmonoksit Zehirlenmelerine Etkisi: Retrospektif Çalışma

Yıl 2020, Cilt: 3 Sayı: 1, 1 - 4, 20.02.2020

Duygu Yılmaz Umut Çavuş Sinan Yıldırım Bahar Gülcay Çat Gözde Besi Onur Yılmaz Mehtap Kaynakçı

Öz

Amaç: Karbonmonoksid (CO) zehirlenmelerine, özellikle soğuk
havalarda olmak üzere acil servis birimlerinde sıklıkla karşılaşılır.
Çalışmamızda, bazı meteorolojik faktörlerin CO zehirlenmesinin kaynakları ile
ilişkisini araştırdık.

Yöntem: Retrospektif gözlemsel çalışmamızda, son üç yılda acil servise
CO zehirlenmesi ile başvuran 1153 hastayı dahil edildi. Bölgenin atmosferik
basıncı, rüzgarın yönü ve hızı, nem düzeyi ve hava sıcaklığı değerleri ve CO
zehirlenme tipi karşılaştırıldı.

Bulgular: Hastaların yaş ortalaması 39,5±16,3; kadın cinsiyet %65,7
(n=761) idi. CO kaynağının kaynağı en sık doğalgaz ısıtıcıları (n=628; %54,4);
daha sonra ocak (n=393; %34,1), şofben (n=94; %8,4) ve yangındı (n=38; %3,3).
En sık görülen rüzgar yönü kuzey-kuzeydoğu yönü (poyraz)idi. Atmosferik basınç
tüm zehirlenme tiplerinde benzerdi. Yangınlarda nem düzeyleri istatistiksel
anlamlı düşüktü ve hava sıcaklığı anlamlı yüksekti. Rüzgar hızı yangın tipinde
en hızlı ve şofben tipinde en yavaştı.

Sonuç: Karbonmonoksid zehirlenmeleri ciddi morbidite ve mortaliteye
neden olabilen acil servis başvuru nedenlerindendir. Başlıca nedeni ev
ısıtıcılarıdır. Risk altındaki insanlar CO zehirlenmeleri hakkında ve önemli
meteorolojik değişikliklerde ısıtıcaların riskleri hakkında
bilgilendirilmelidir. Zehirlenme bulguları görüldüğünde acil servise
başvurulmalıdır.

Anahtar Kelimeler

atmosferik basınç, CO zehirlenmesi, sıcaklık, rüzgar, yangın

The Effect of Carbonmonoxide Sources and Meteorologic Changes in Carbonmonoxide Intoxication: A Retrospective Study

Öz

Objective: Carbon monoxide (CO)
poisoning is frequently seen in emergency departments (ED) especially in cold
weather. We investigated the relationship of some of the meteorological
factors with the sources of CO poisoning.

Methods: In this
retrospective observational study, we included 1153 patients who were admitted
to ED due to CO poisoning in a three year period. Atmospheric pressure, wind
direction and speed, humidity level and air temperature of the region at
exposure time were compared with CO poisoning type.

Results: Mean age of the
patients was 39.5±16.3; females were 65.7% (n=761) of the patients. Most
frequent source of CO was natural gas heaters (n=628; 54.4%); others were
stove (n=393; 34.1%), geyser (n=94; 8.4%) and blaze (n=38; 3.3%). Most
frequent direction of the wind was North-North-East (euroclydon). Atmospheric
pressure was similar in all of the poisoning types; in blaze, humidity levels
was significantly lower, air temperature was significantly higher. Wind speed
was faster in blaze and slowest in geyser type poisoning.

Conclusion: Carbon monoxide
poisoning is an important cause of emergency visits which can result in
serious morbidity or mortality. Main sources are home heating systems. People
should be informed about the risks of these heaters and symptoms of CO
poisoning and also in case of important meteorological changes. They should
apply to an ED in case of occurrence of intoxication symptoms.

Anahtar Kelimeler

CO intoxication, atmospheric pressure, humidity, temperature, wind

Kaynakça

• Cruickshank W. Some observations on different hydrocarbonates and combinations of carbone with oxygen, etc. in reply to some of Dr. Priestley's late objections to the new system of chemistry. Journal of Natural Philosophy, Chemistry and the Arts. 1801;5:1-9.
• Phin N. Carbon monoxide poisoning (acute). Clinical Evidence. 2005;13:1732-1743.
• Tikuisis P, Kane DM, McLellan TM, Buick F, Fairburn SM. Rate of formation of carboxyhemoglobin in exercising humans exposed to carbon monoxide. J Appl Physiol (1985). 1992;72(4):1311-1319.doi:10.1152/jappl.1992.72.4.1311
• Cooper CE, Brown GC. The inhibition of mitochondrial cytochrome oxidase by the gases carbon monoxide, nitric oxide, hydrogen cyanide and hydrogen sulfide: chemical mechanism and physiological significance. Journal of Bioenergetics and Biomembranes. 2008;40(5):533-539.doi:10.1007/s10863-008-9166-6
• Choi IS. Carbon monoxide poisoning: systemic manifestations and complications. Journal of Korean Medical Science. 2001;16(3):253-261.doi: 10.3346/jkms.2001.16.3.253
• Lippi G, Rastelli G, Meschi T, Borghi L, Cervellin G. Pathophysiology, clinics, diagnosis and treatment of heart involvement in carbon monoxide poisoning. Clinical Biochemistry. 2012;45(16-17):1278-1285.doi:10.1016/j.clinbiochem.2012.06.004
• Cervellin G, Comelli I, Rastelli G, Picanza A, Lippi G. Initial blood lactate correlates with carboxyhemoglobin and clinical severity in carbon monoxide poisoned patients. Clinical Biochemistry. 2014;47(18):298-301.doi:10.1016/j.clinbiochem.2014.09.016
• Blumenthal I. Carbon monoxide poisoning. Journal of the Royal Society of Medicine. 2001;94(6):270-272.
• Piantadosi CA. Carbon monoxide poisoning. Undersea& Hyperbaric Medicine: Journal of the Undersea and Hyperbaric Medical Society, Inc. 2004;31(1):167-177.
• Henretig FM, Calello DP, Burns MM, O'Donnell KA, Osterhoudt KC. Predictable, preventable, and deadly: Epidemic carbon monoxide poisoning after storms. American Journal of Public Health. 2018;108(10):1320-1321.doi:10.2105/AJPH.2018.304619
• Du T, Zhang Y, Wu JS, et al. Domicile-related carbon monoxide poisoning in cold months and its relation with climatic factors. The American Journal of Emergency Medicine. 2010;28(8):928-932.doi:10.1016/j.ajem.2009.06.019
• Baum CR. What's new in pediatric carbon monoxide poisoning? Clin Ped Emerg Med. 2008;9(1):43-46.doi:10.1016/j.cpem.2007.11.002
• Keles A, Demircan A, Kurtoglu G. Cabon monoxide poisonig: how many patients do we miss? Eur J Emerg Med. 2008;15:154-157.doi:10.1097/MEJ.0b013e3282efd519
• Aslan Ş, Erol MK, Karcıoğlu Ö, Meral M, Çakır Z, Katırcı Y. The investigation of ischemic myocardial damage in patients with carbon monoxide poisoning. Anatol J Cardiol. 2005;5(3):189-193.
• Besli GE, Ergüven M, Karadoğan M, Yılmaz Ö. Carbon monoxide poisoning in children. Eurasian Journal of Emergency Medicine. 2009;9(1):26-30.
• Akkose Ş, Turkmen N, Bulut M, Akgoz S, Işcimen R, Eren B. An analysis of carbon monoxide poisoning in Bursa, Turkey. East Mediterr Health J. 2010;16:101-106.
• Uysalol M, Uysalol EP, Saraçoğlu GV, Kayaoğlu S. A retrospective analysis of pediatric patients admitted to the pediatric emergency service for carbon monoxide intoxication. Balkan Medical Journal. 2011;28(3):237-243.doi:10.5174/tutfd.2010.03766.1
• Wilson RC, Saunders PJ, Smith G. An epidemiological study of acute carbon monoxide poisoning in the West Midlands. Occupational and Environmental Medicine. 1998;55(11):723-728.doi:10.1136/oem.55.11.723
• Ait El Cadi M, Khabbal Y, Idrissi L. Carbon monoxide poisoning in Morocco during 1999-2007. J Forensic Leg Med. 2009;16:385-387.doi:10.1016/j.jflm.2009.01.017
• Mendoza JA, Hampson NB. Epidemiology of severe carbon monoxide poisoning in children. Undersea&Hyperbaric Medicine: Journal of the Undersea and Hyperbaric Medical Society, Inc. 2006;33:439-446.
• Metin S, Yıldız Ş, Çakmak T, Demirbaş Ş. Frequency of carbon monoxide poisoning in Turkey in 2010. TAF Prev Med Bull. 2011;10(5):587-592.
• Daley WR, Smith A, Paz-Argandona E, Malilay J, McGeehin M. An outbreak of carbon monoxide poisoning after a major ice storm in Maine. The Journal of Emergency Medicine. 2000;18(1):87-93.doi:10.1016/S0736-4679(99)00184-5
• Ghim M, Severance HW. Ice storm-related carbon monoxide poisonings in North Carolina: a reminder. Southern Medical Journal. 2004;97(11):1060-1065. doi:10.1097/01.SMJ.0000144614.38668.60
• Wrenn K, Conners GP. Carbon monoxide poisoning during ice storms: a tale of two cities. The Journal of Emergency Medicine. 1997;15(4):465-467.doi:10.1016/s0736-4679(97)00074-7
• Carbon monoxide related deaths. United States, 1999-2004. MMWR. Morbidity and Mortality Weekly Report. 2007;56(50):1309-1312.
• Nonfatal, unintentional, non fire-related carbon monoxide exposures. United States, 2004-2006. MMWR. Morbidity and Mortality Weekly Report. 2008;57(33):896-899.