Karbonmonoksit ile İlgili Ölümlerin Adli ve Epidemiyolojik Değerlendirilmesi: Türkiye’nin Güneyinden On Yıllık Otopsi Çalışmas

Yıl 2025, Cilt: 39 Sayı: 3, 309 - 317, 28.12.2025

Mehmet Ali Yildiz , Cemyiğit Deveci , Mehmet Atılgan

https://doi.org/10.61970/adlitip.1834679

Öz

Amaç: Karbonmonoksit (CO) zehirlenmesi, dünya genelinde önemli ve önlenebilir bir ölüm nedeni olmaya devam etmektedir. Bu çalışmanın amacı, Antalya, Türkiye’de otopsisi yapılan ölümcül CO zehirlenmesi vakalarının epidemiyolojik, toksikolojik ve adli özelliklerini değerlendirmektir.
Gereç Ve Yöntem: 2011 ile 2020 yılları arasında Antalya’da gerçekleştirilen 8.649 otopsi arasında, CO zehirlenmesi tanısı konulan 105 olgu retrospektif olarak incelenmiştir. Olgulara ait yaş, cinsiyet, mevsimsel dağılım, olayın gerçekleştiği yer, COHb düzeyleri, otopsi bulguları ve toksikolojik analiz sonuçları değerlendirilmiştir. COHb düzeyleri, moleküler absorbsiyon spektrofotometrisi yöntemiyle ölçülmüştür. İstatistiksel analizlerde Mann–Whitney U, Fisher’s Exact ve Spearman korelasyon testleri kullanılmıştır.
Bulgular: 105 olgunun 68’i (%64,8) erkek, 37’si (%35,2) kadındı. Ölümlerin çoğunluğu kış mevsiminde (%56,2) ve konut ortamında (%71,4) gerçekleşmiştir. Katı yakıtla çalışan sobalar, CO maruziyetinin en yaygın kaynağı olarak saptanmıştır (%30,5). Ortalama COHb düzeyi %56,5 olup, yaşlı bireylerde ve kronik hastalığı bulunanlarda anlamlı olarak daha düşük seviyeler tespit edilmiştir (p<0,05). Olguların %19,1’inde CO zehirlenmesine geniş yanıklar da eşlik etmiştir. COHb düzeyleri, yaş ile ters yönde korelasyon göstermiş; eşlik eden hastalığı veya termal yaralanması olan olgularda daha düşük bulunmuştur.
Sonuç: Ölümcül CO zehirlenmesi, özellikle yetersiz havalandırılan ortamlarda kullanılan katı yakıtlı sobalarla ilişkili olarak hâlâ büyük ölçüde önlenebilir bir halk sağlığı sorunu olmaya devam etmektedir. Postmortem COHb tayini, tanı açısından en güvenilir yöntemdir. Kamu spotları, yapısal güvenlik önlemlerinin iyileştirilmesi ve multidisipliner iş birliği, CO’ya bağlı ölümlerin azaltılmasında temel unsurlardır.

Anahtar Kelimeler

Karbonmonoksit zehirlenmesi , Karboksihemoglobin , Adli otopsi , Postmortem bulgular , Toksikoloji , Halk sağlığı

Forensic and Epidemiological Evaluation of Carbonmonoxide-Related Deaths: A Ten-Year Autopsy Study from Southern Turkiye

Öz

Aim: Carbon monoxide (CO) poisoning remains a significant and preventable cause of accidental deaths worldwide. This study aims to evaluate the epidemiological, toxicological, and forensic characteristics of fatal CO poisoning cases that underwent autopsy in Turkiye.
Methods: A retrospective review was conducted on 105 autopsy cases diagnosed with CO poisoning among 8,649 autopsies performed between 2011 and 2020 at the Antalya. Data regarding age, sex, seasonality, origin of the incident, COHb levels, autopsy findings, and toxicological results were analyzed.
Results: Of the 105 cases, 68 (64.8%) were male and 37 (35.2%) were female. The majority of deaths occurred in winter (56.2%) and within residential settings (71.4%). Solid-fuel stoves were the most common source of CO exposure (30.5%). The mean COHb level was 56.5%, with significantly lower levels observed in elderly individuals and those with chronic illnesses (p<0.05). In 19.1% of cases, CO poisoning was accompanied by extensive burns. COHb levels correlated inversely with age and were lower in cases with comorbid conditions and thermal injury.
Conclusion: Fatal CO poisoning remains a largely preventable public health concern, particularly associated with solid-fuel stoves in poorly ventilated environments. Postmortem COHb quantification remains the most reliable diagnostic tool. Public education, structural safety improvements, and multidisciplinary collaboration are essential to reduce CO-related fatalities.

Anahtar Kelimeler

Carbon monoxide poisoning , Carboxyhemoglobin , Forensic autopsy , Postmortem findings , Toxicology , Public health

Kaynakça

• Hartzell GE. Overview of combustion toxicology. Toxicology 1996;115(1–3):7–23.
• Hess DR. Inhaled carbon monoxide: from toxin to therapy. Respir Care 2017;62(10):1333–42.
• Chiew AL, Buckley NA. Carbon monoxide poisoning in the 21st century.Crit Care 2014;18(2):221.
• Mattiuzzi C, Lippi G. Worldwide epidemiology of carbon monoxide poisoning. Hum Exp Toxicol 2020;39(4):387–92.
• Kinoshita H, Türkan H, Vucinic S, et al. Carbon monoxide poisoning. Toxicol Rep 2020;7:169–73.
• Williams SV, Close R, Piel FB, et al. Characterising Carbon Monoxide Household Exposure and Health Impacts in High- and Middle-Income Countries-A Rapid Literature Review, 2010-2024. Int J Environ Res Public Health 2025;22(1):110.
• Diltoer MW, Colle IO, Hubloue I, et al. Reversible cardiac failure in an adolescent after prolonged exposure to carbon monoxide. Eur J Emerg Med 1995;2(4):231–5.
• Yoshida M, Adachi J, Watabiki T, et al. A study on house fire victims: age, carboxyhemoglobin, hydrogen cyanide and hemolysis. Forensic Sci Int 1991;52(1):13–20.
• Dinis-Oliveira RJ, Carvalho F, Magalhães T, et al. Postmortem changes in carbon monoxide poisoning. Clin Toxicol (Phila) 2010;48(7):762–3.
• Findlay GH. Carbon monoxide poisoning: optics and histology of skin and blood. Br J Dermatol 1988;119(1):45–51.
• Parks J, Worth HG. Carboxyhemoglobin determination by second-derivative spectroscopy. Clin Chem 1985;31(2):279–81.
• Khadem-Rezaiyan M, Afshari R. Carbon monoxide poisoning in northeast of Iran. J Forensic Leg Med 2016;41:1–4.
• Dirlik M, Bostancioglu B. Deaths due to carbon monoxide poisoning in Aydin, western Turkey. Death Stud 2017;41(4):246–50.
• Janík M, Ublová M, Kučerová Š, et al. Carbon monoxide-related fatalities: a 60-year single institution experience. J Forensic Leg Med 2017;48:23–9.
• Karapirli M, Kandemir E, Akyol S, et al. Forensic and clinical carbon monoxide (CO) poisonings in Turkey: a detailed analysis. J Forensic Leg Med 2013;20(2):95–101.
• Ketenci HC, Kocoglu E, Turkmen N, et al. An Evaluation of the Autopsy Cases of Carbon Monoxide Poisoning in Trabzon Between 2009-2016. Bull Leg Med 2018;23(3):174–9.
• Turkmen Inanir N, Akgoz S. Deaths Due to Carbonmonoxide Poisonings Autopsied in Bursa. J For Med 2005;19(2):20–5.
• Turkoglu A, Tokdemir M, Sen M, et al. Assessment of Autopsied Cases of Deaths due to Carbonmonoxide Poisoning between 2006-2012, in Elazığ. Bull Leg Med 2012;17(1):21–6. 17(1): p. 21-26.
• Uysal C, Celik S, Duzgun Altuntas A, et al. Carbon monoxide-related deaths in Ankara between 2001 and 2011. Inhal Toxicol 2013;25(2):102–6.
• Wang LL, Zhang M, Zhang W, et al. A retrospective study of poisoning deaths from forensic autopsy cases in northeast China (Liaoning). J Forensic Leg Med 2019;63:7–10.
• Yetis Y, Karbeyaz K, Gunes A. 20-Year Analysis of Deaths Due to Carbon Monoxide Poisoning in Eskisehir. J Health Sci Adiyaman Univ 2017;3(1):396–406.
• Canturk N, Basbulut AZ, Canturk G, et al. Evaluation of the Autopsy Cases Carbon Monoxide Poisonings in Ankara Between 2002-2006. J For Med 2008;22(1):25–30.
• Chen F, Ye Y, Wei Q, et al. Non-fire related carbon monoxide poisoning in Sichuan, China: a 9-year study (2008–2016). Iran J Public Health 2019;48(3):458–64.
• Li F, Chan HC, Liu S, et al. Carbon monoxide poisoning as a cause of death in Wuhan, China: a retrospective six-year epidemiological study (2009–2014). Forensic Sci Int 2015;253:112–8.
• Can G, Sayılı U, Aksu Sayman Ö, et al. Mapping of carbon monoxide related death risk in Turkey: a ten-year analysis based on news agency records. BMC Public Health 2019;19(1):9.
• Hosseininejad SM, Aminiahidashti H, Goli Khatir I, et al. Carbon monoxide poisoning in Iran during 1999–2016: a systematic review and meta-analysis. J Forensic Leg Med 2018;53:87–96.
• Kocakaya M, Aydın B, Turla A, et al. Cases of carbon monoxide poisoning consulted Ondokuz Mayıs University, Hospital of Medical Faculty in 2004. Eurasian J Pulmonol. 2007;9(1): 11-16.
• Nielsen PR, Gheorghe A, Lynnerup N. Forensic aspects of carbon monoxide poisoning by charcoal burning in Denmark, 2008–2012: an autopsy-based study. Forensic Sci Med Pathol 2014;10(3):390–4.
• Boumba VA, Vougiouklakis T. Evaluation of the methods used for carboxyhemoglobin analysis in postmortem blood. Int J Toxicol 2005;24(4):275–81.
• Sheikhazadi A, Saberi Anary SH, Ghadyani MH. Nonfire carbon monoxide-related deaths: a survey in Tehran, Iran (2002–2006). Am J Forensic Med Pathol 2010;31(4):359–63.