Klorprifos Zehirlenmesini Takiben Gelişen Intermediate Sendromda Geç ve Aralıklı Oksim Tedavisi: Olgu Sunumu

Yıl 2015, Cilt: 12 Sayı: 3, 383 - 388, 30.12.2015

Başak Ceyda Meco Melek Tulunay, Esra Özayar Şaban Yalçın Şirali Oba Necmettin Ünal Mehmet Oral

Öz

İntermediate sendrom (İMS) proksimal ekstremite ve solunum kaslarında, boyun fleksorlarında ve kranial
sinirlerde zayıflıkla karakterizedir. Etyolojiyi açıklamak için birkaç hipotez geliştirilmiştir (nöromusküler
bileşke disfonksiyonu, yetersiz veya geç oksim tedavisi, asetilkolinesterazın uzamış ve ciddi inhibisyonu).
Klorprifos düşük toksisiteyle ilişkili organofosfattır. Klorprifosa sekonder İMS çok nadirdir. 56 yaşında
erkek hastada klorprifos oral alımından sonra gelişen İMS'u sunuyoruz. Başlangıçta kolinerjik sendrom
belirtileri gösteren hastada ikinci günde mental ve respiratuar durumu kötüleşip İMS'u düşündüren derin
motor paralizi gelişti. Hastaya ventilatör desteği gerekti. Pralidoksim geç (oral alımdan 52 saat sonra) ve 23 günde aralıklı olarak verilebildi. Hastanın takiplerinde ventilatör ilişkili pnömoni ve septik şok gelişmesine
rağmen 32. gününde taburcu edildi. Bu olgu klorprifos intoksikasyonlarıyla gelen hastalarda İMS riski
olduğunu göstermektedir.

Anahtar Kelimeler

Zehirlenmeler, Klorprifos, Oksimler

Late and Interrupted Oxime Therapy In An Intermediate Syndrome Following Chlorpyrifos Poisoning: Case Report

Öz

Intermediate syndrome (IMS) is characterized by weakness of proximal limb and respiratory muscles, neck
flexors, and cranial nerves. Several hypothesis have been developed to explain its etiology (neuromuscular
junction disfunction, inadequate or late oxime therapy, prolonged and severe inhibition of
acetylcholinesterase). Chlorpyrifos is a organophosphate with relatively low toxicity. IMS secondary to
chlorpyrifos is very rare. We report a case of 56-year-old man who developed an IMS after chlorpyrifos
ingestion. Although he presented with cholinergic symptoms initially, his mental and respiratory status
deteriorated and profound motor paralysis consistent with IMS occurred on the second day. The patient
required ventilatory support. Pralidoxime could only be administered late (52 hours post-ingestion), and
intermittently for 23 days. The course of the patient was complicated with ventilator-associated pneumonia
and septic shock, but after 32 days he was discharged. This case suggests that patients suffering from
chlorpyrifos intoxication can be under the risk of IMS. 

Anahtar Kelimeler

Poisoning, Chlorpyrifos, Oximes

Kaynakça

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