Bir eğitim ve araştırma hastanesi acil servisine zehirlenme ile başvuran adli olguların değerlendirilmesi

Yıl 2020, Cilt: 34 Sayı: 3, 106 - 113, 15.12.2020

Fatih Hitami Usluoğulları Ahmet Naziroğlu Miraç Özdemir Mehmet Akif İnanıcı

https://izlik.org/JA56FL73ME

Öz

AMAÇ: Zehirlenmeler toplumda yaşayan insanların tümünde görülebilen ve aynı zamanda önlenebilen bir sağlık problemidir. Çalışmamızda epidemiyolojik olarak elde edeceğimiz verileri inceleyip sonuçlarımızı Türkiye’den ve diğer ülkelerden verilerle karşılaştırarak, uluslararası literatüre katkı sağlamayı amaçladık. YÖNTEM: Çalışmamızda, bir eğitim ve araştırma hastanesi acil servisine başvuran zehirlenme vakalarının demografik, etiyolojik ve klinik özellikleri retrospektif olarak incelenmiştir. BULGULAR: Çalışmamıza dahil edilen 468 hasta acil serviste adli raporu tutulan olguların %0,7’sini oluşturmaktadır. Olguların yaş ortalaması 28,16’dır ve erkekler tüm olguların %54,6’sını oluşturmaktadır. En sık üç zehirlenme sebebi ilaçlar %44 , uyuşturucu maddeler %39,9 ve karbonmonoksit %8,7 ile zehirlenmedir. Zehirlenmelerin %43’ü intihar amaçlı olup bu hastalarda kadın/erkek oranı: 2,8 bulundu. İlaçla zehirlenen hastalarda en sık çoklu ilaç %55,5 zehirlenme tipi görülürken, %28,7 ile duygudurum düzenleyici ilaçlara bağlı zehirlenme ikinci sırada tespit edildi. Hastaların %79,5’inin tedavisinin acil serviste yapıldığı, hastaneye yatırılan hastaların %4,9’u servislerde, %6,4’ü yoğun bakımda izlendiği, 3 %0,6 olgunun ise ölümle sonuçlandığı tespit edildi. SONUÇ: Elde ettiğimiz veriler daha önce yapılan çalışmalar ile uyumlu olarak zehirlenmelerin genel olarak, gençlerde, yaz mevsiminde, ilaçlarla daha fazla gerçekleştiği, farklı olarak ise son dönemde erkekler arasında uyuşturucu madde kullanımı sonrası acil servise başvurma oranlarının arttığı bu yüzden intihar dışı yollarla zehirlenmelerin daha yüksek oranda olduğu bulunmuştur

Anahtar Kelimeler

Zehirlenme , Acil servis , İntihar

Evaluation of forensic cases of poisoning admitted to the emergency department of a training and research hospital

https://izlik.org/JA56FL73ME

Öz

INTRODUCTION: We aimed to contribute to international literature by examining the data obtained from our epidemiological study and comparing them with data from Turkey and other countries. METHODS: In our study, the demographic, etiological, and clinical features of poisoning cases that applied to an emergency department of a training and research hospital were retrospectively analyzed. RESULTS: The 468 patients included in our study constitute 0.7% of cases in which forensic reports are kept in the emergency department. The average age of cases was 28.16, and men accounted for 54.6% of all cases. The three most common causes of poisoning were medications 44% , drugs 39.9% , and carbon monoxide poisoning 8.7% . Forty-three percent of poisonings were suicidal in which the female/male ratio was 2:8. The use of multiple medications was observed most frequently 55.5% in patients with medication poisoning, while poisoning related to mood stabilizing medications was second with 28.7%. Treatment of 79.5% was administered in the emergency room, 4.9% were hospitalized and monitored in services, 6.4% in intensive care, and three 0.6% cases resulted in death. CONCLUSION: The data we have obtained in this study, in accordance with other studies, showed that poisonings are generally more common among young people, in the summer, with medications. Distinctively, it was found that the rate of men who admitted to emergency department for poisoning by drug usage is increasing, and the rate of non-suicidal poisoning is getting higher in respect to this.

Anahtar Kelimeler

Poisoning , Emergency department , Suicide

Kaynakça

• Wax PM. Historical principles and perspectives. In: Gold- frank LR, Flomenbaum NE, Lewin NA, Howland MA, Hoffman RS, Nelson LS, editors. Goldfrank’s Toxicologic Emergencies. th ed. New York: McGraw-Hill; 2002, P:1-17.
• Ozen C. Forensic Medicine Textbook. 3rd. edition. [in Turk- ish] Istanbul: Istanbul University Publications, 1983:259-303.
• Gabor D, Kelen J, Stapczynski S. In Judith E. Tintinally, MD, MS, Editor. Emergency Medicine. A Comprehensive Study Guide. 6th ed. NewYork: McGraw Hill; 2004.p.1015-22.
• Pinar A, Fowler J, Bond GR. Acute poisoning in Izmir, Turkey- a pilot epidemiologic study. J Toxicol Clin Toxicol 1993;31:593-601.
• Goksu S, Yildirim C, Kocoglu H, Tutak A, Oner U. Character- istics of acute adult poisoning in Gaziantep, Turkey. J Toxicol Clin Toxicol. 2002;40 7 :833-7.
• Kotwica M, Czerczak S. Acute poisoning registered since : trends and characteristics. Analysis of the files collected in the National Poison Information Centre, Lodz, Poland. Int J Occup Med Environ Health 2007;20:38-43.
• Staikowsky F, Theil F, Mercadier P, Candella S, Benais JP. Change in profile of acute self drug-poisonings over a 10-year period. Hum Exp Toxicol 2004;23:507-11.
• MacNamara AF, Riyat MS, Quinton DN. The changing profile of poisoning and its management. J R Soc Med 1996;89:608-10.
• Ayan M, Başol N, Karaman T, Taş U, Esen M. Retrospective evaluation of emergency service patients with poisoning : A 20 month study. The Journal of Academic Emergency Medicine :146-50.
• Kurtoğlu S. Intoxications. Kayseri: Erciyes University Pub- lications. 1992.
• Hanssens Y, Deleu D, Taqi A. Etiologic and demographic characteristics of poisoning a prospective hospital-based study in Oman. J Toxicol Clin Toxicol 2001;39 4 :371-80.
• Litovitz TL, Klein-Schwardz W, Caravati EM. Annual report of the American Association of Poison Control Centers toxic ex- posure surveillance system. Am J Emerg Med 1999;17 5 :435-87.
• Viccellio P. Handbook of Medical Toxicology. 1 st ed. Bos- ton : Little Brown and Company, 1993.
• Ozkose Z, Ayoglu F. Etiological and demographical charac- teristics of acute adult poisoning in Ankara, Turkey. Hum Exp Toxicol 1999;18:614–8.
• Yeşil O, Akoğlu H, Onur Ö, Güneysel Ö. Retrospective evalu- ation of poisoning patients in the emergency department. Mar- mara Medical Journal 2008;21 1 ;26-32.
• Dal O, Kavak H, Akay S, Ünlüer E, Aksay E Retrospective evaluation of poisoning patients in the emergency department. Journal of Contemporary Medicine 2013;3 1 :22-7.
• Deniz T, Kandiş H, Saygun M. Evaluation of intoxication cases applied to emergency department of Kirikkale Uni- versity Hospital. Journal of Duzce University Medical Faculty ;11 2 :15-20.
• Kaya S, Kararmaz A, Karaman H, Turhanoğlu S. The retro- spective analyze of poisoning cases in intensive care unit. Dicle Medical Journal 2006;33:242-4.
• Kavalcı C, Durukan P, Çevik Y, Özer M, İkizceli İ. Analyses of intoxication cases: One-year experience of a new hospital. Turk J Emerg Med 2006;6:163-6.
• Mauri MC, Cerveri G, Volonteri LS. Parasuicide and drug self-poisoning: analysis of the epidemiological and clinical variables of the patients admitted to the Poisoning Treatment Centre CAV , Niguarda General Hospital, Milan. Clin Pract Epi- demiol Ment Health 2005;1 1 :5.
• Polewka A, Pach J, Zieba A. A trial for the complex risk as- sessment of repeated suicide predictors in patients after sui- cidal poisoning attemps, hospitalized in Deparment of Clinical Toxicology in Karakow. Przegl Lek 2001;58 4 :325-9.
• Jacobsen D, Frederichsen PS, Knutsen KM, Sİrum Y, Tal- seth T, Ødegaard OR. A prospective study of 1212 cases of acute poisoning: General epidemiology. Human Toxicology ;3 2 :93-106.
• Islambulchilar M, Islambulchilar Z, Kargar-Maher MH. Acute adult poisoning cases admitted to a university hospital in Tabriz, Iran. Human & Experimental Toxicology 2009;28.4:185-90.
• Liu Y, Wolf LR, Zhu W. Epidemiology of adult poisoning at China Medical University J Toxicol Clin Toxicol 1997;35:175-80.
• Mowry JB, Spyker DA, Brooks DE, McMillan N, Schauben JL. 2014 Annual Report of the American Association of Poison Control Centers National Poison Data System NPDS : 32nd Annual Report. Clinical toxicology, 2015;53 10 :962-1147.
• Jick SS, Dean AD, Jick H. Antidepressants and suicide. BMJ ;54:215-8.
• Teicher MH, Glod C, Cole JO. Emergence of intense suicidal preoccupation during fluoxetine treatment. The American journal of psychiatry 1990;147 2 :207.
• Sari Dogan F, Ozaydin V, Varisli B, Incealtin O, Ozkok Z. The analysis of poisoning cases presented to the emergency department within a one-year period. Turk J Emerg Med ;14 4 :160-4.
• Zeren C, Karakus A, Celik MM, Arica V, Tutanc M, Arslan MM. Evaluation of Intoxication Cases Applying to the Emer- gency Department of Medical School Hospital. J Acad Emerg Med 2012;11 1 :31-4.
• Baydin A, Erenler AK. Workplace violence in emergency de- partment and its effects on emergency staff. Int J Emerg Ment Health 2014;16 2 :66-8.
• Bhanji F, Donoghue AJ, Wolff MS, Flores GE, Halamek LP, Berman JM. Part 14: Education: 2015 American Heart Asso- ciation Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2015;132 18 Suppl 2 :S56173.
• Baydin A, Prof A. Of emergency service patients with poi- soning : A 3-year study. Advances in therapy 2005;22 6 :650-8.
• Reith DM, Whyte I, Carter G, McPherson M, Carter N. Risk factors for suicide and other deaths following hospital treated self-poisoning in Australia. Australian and New Zealand Jour- nal of Psychiatry 2004;38.7:520-5.
• Viertel A, Weidmann E, Brodt HR. Cases of acute poisoning admitted to a medical intensive care unit. Dtsch Med Wochen- schr 2001;126 42 :1159-63.
• Juarez AG, Castanon JA, Perez AJ, Montoya MA. Clinical and epidemiological characteristics of severe poisoning in a adult population admitted to an intensive care unit. Gac Med Mex 1999;135 6 : 669-75.