ACİL SERVİSTE ORGANOFOSFAT ZEHİRLENMESİ OLAN HASTALARIN DEĞERLENDİRİLMESİ: İKİ MERKEZLİ RETROSPEKTİF BİR ÇALIŞMA

Yıl 2024, , 87 - 92, 04.06.2024

Abdussamed Vural , Turgut Dolanbay , Levent Şahin , Mustafa Cihan Altay , Hayri Canbaz

https://doi.org/10.26650/JARHS2024-1404063

Öz

Amaç: Organofosfatların (OF) küresel tarımda pestisit olarak yaygın kullanımı hem gelişmekte olan hem de sanayileşmiş ülkelerde önemli sağlık riskleri oluşturmaktadır. Yutma, mesleki temas ve intihar girişimleri yoluyla maruz kalma, yüksek morbidite ve mortaliteye yol açmaktadır. Bu çalışma, acil servislere başvuran 18 yaş ve üzeri yetişkin hastaların demografik, klinik ve laboratuvar özelliklerini retrospektif olarak analiz etmeyi amaçlamaktadır.

Gereç ve Yöntem: Çalışma, Niğde Ömer Halisdemir Üniversitesi Eğitim ve Araştırma Hastanesi, Acil Tıp Kliniği ve Kafkas Üniversitesi Sağlık Uygulama ve Araştırma Hastanesi, Acil Tıp Kliniği tarafından gerçekleştirilen iki merkezli retrospektif bir analizdir. Demografik bilgiler, klinik ayrıntılar ve laboratuvar parametreleri dahil olmak üzere hasta verileri kaydedilmiştir. Analizler rutin kan testlerini, psödokolinesteraz düzeylerini ve elektrokardiyografi bulgularını kapsamaktadır. Çalışmaya 15 Haziran 2020 ile 15 Haziran 2023 tarihleri arasında OF zehirlenmesi (uluslararası hastalık sınıflandırması (ICD) kodu T60.0) tanısı alan hastalar dahil edilmiştir.

Bulgular: Çalışmaya dahil edilme ve dışlanma kriterlerini karşılayan 24 hasta dahil edilmiştir. Hastaneye yatış oranı %91,7 olup sadece %4,2’si entübasyon gerektirmiştir. Hastane içi mortalite görülmemiştir. Psödokolinesteraz düzeyleri pH, bikarbonat, anyon açığı ile negatif; CRP ile pozitif korelasyon göstermiştir. Hastanede kalış süresi Glasgow koma skalası (GKS), pH, bikarbonat ile negatif; anyon açığı ile pozitif korelasyon göstermiştir.

Sonuç: Bu retrospektif, iki merkezli çalışma, acil servislere OF zehirlenmesi ile başvuran yetişkin hastaların demografik profilleri, klinik bulguları ve tedavi sonuçları hakkında kapsamlı bilgiler sunmaktadır. Çalışmamızda organofosfat zehirlenmelerinin çoğu kaza sonucu meydana gelmiştir Bu açıdan, organofosfat zehirlenmelerini önlemek için fabrikalarda ve çiftliklerde güvenlik ekipmanları, güvenli tarım koşulları, tehlikeli maddelere sınırlı erişim, acil durum eğitimi, halk sağlığı kampanyaları ve güvenli iş uygulamaları sağlamak önemlidir. Ayrıca bu çalışma, GKS, pH ve HCO3 gibi klinik parametrelerin değerlendirilmesinin hastaneye yatış şiddeti ve süresinin öngörülmesindeki öneminin altını çizmektedir.

Anahtar Kelimeler

Organofosfatlar, zehirlenme, ölüm, biyokimyasal belirteçler

EVALUATION OF PATIENTS WITH ORGANOPHOSPHATE POISONING IN THE EMERGENCY DEPARTMENT: A RETROSPECTIVE TWO-CENTER STUDY

Öz

Objective: The widespread use of organophosphates (OP) as pesticides in global agriculture, pose significant health risks in both developing and industrialized nations. Exposure through ingestion, occupational contact, and suicide attempts leads to high morbidity and mortality. This study will retrospectively analyze the demographic, clinical, and laboratory characteristics of adult patients aged 18 years and older who presented to emergency departments.

Material and Methods: The study is a two-center retrospective analysis of the Niğde Ömer Halisdemir University Training and Research Hospital, Clinic of Emergency Medicine and Kafkas University Health Practice and Research Hospital, Clinic of Emergency Medicine. Patient data, including demographics, clinical details, and laboratory parameters, were recorded. Analysis covered routine blood tests, pseudocholinesterase levels, and electrocardiography findings. Patients diagnosed with OP poisoning (international classification of diseases (ICD) code T60.0) between 15 June 2020 and 15 June 2023 were included in the study.

Results: The study included 24 patients meeting inclusion and exclusion criteria. Oral exposure (41.7%) and inhalation (25%) were common routes. The hospitalization rate was 91.7%, with only 4.2% requiring intubation. No in-hospital mortality occurred. Pseudocholinesterase levels correlated negatively with pH, bicarbonate, anion gap and positively with c-reactive protein (CRP). Duration of hospital stays was negatively correlated with Glasgow coma scale (GCS), pH, bicarbonate, and positively correlated with the anion gap.

Conclusion: This retrospective, two-center study provides comprehensive insights into the demographic profiles, clinical manifestations, and treatment outcomes of adult patients presenting with OP poisoning in emergency departments. In our study, most organophosphate poisonings were accidental. In this respect, it is important to provide safety equipment, safe farming conditions, limited access to hazardous substances, emergency education, public health campaigns and safe work practices in factories and farms to prevent organophosphate poisoning. Furthermore, this study underlines the importance of assessment of clinical parameters such as GCS, pH and HCO3 in predicting the severity and duration of hospitalization.

Anahtar Kelimeler

Organophosphates, poisoning, mortality, biochemicals markers

Kaynakça

• Mukherjee S, Gupta RD. Organophosphorus Nerve Agents: Types, Toxicity, and Treatments. J Toxicol 2020;2020:3007984. google scholar
• Eddleston M, Karalliedde L, Buckley N, Fernando R, Hutchinson G, Isbister G, et al. Pesticide poisoning in the developing world--a minimum pesticides list. Lancet 2002;360(9340):1163-7. google scholar
• Murray D, Wesseling C, Keifer M, Corriols M, Henao S. Surveillance of pesticide-related illness in the developing world: putting the data to work. Int J Occup Environ Health 2002;8(3):243-8. google scholar
• Suratman S, Edwards JW, Babina K. Organophosphate pesticides exposure among farmworkers: pathways and risk of adverse health effects. Rev Environ Health 2015;30(1):65-79. google scholar
• King AM, Aaron CK. Organophosphate and carbamate poisoning. Emerg Med Clin North Am 2015;33(1):133-51. google scholar
• Richardson KJ, Schwinck JL, Robinson MV. Organophosphate poisoning. Nurse Pract 2021;46(7):18-21. google scholar
• Marrs TC. Organophosphate poisoning. Pharmacol Ther 1993;58(1):51-66. google scholar
• Satar S, Seydaoglu G, Akpinar A, Sebe A, Karakoc E, Gumusay U, et al. Trends in acute adult poisoning in a ten-year period in Turkey: factors affecting the hazardous outcome. Bratisl Lek Listy 2009;110(7):404-11. google scholar
• Slavica V, Dubravko B, Milan J. Acute organophosphate poisoning: 17 years of experience of the National Poison Control Center in Serbia. Toxicology 2018;409:73-9. google scholar
• Robb EL, Regina AC, Baker MB. Organophosphate Toxicity. [Updated 2023 Nov 12]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. https://www.ncbi.nlm.nih. gov/books/NBK470430/ google scholar
• Amir A, Raza A, Qureshi T, Mahesar GB, Jafferi S, Haleem F, et al. Organophosphate Poisoning: Demographics, Severity Scores and Outcomes From National Poisoning Control Centre, Karachi. Cureus 2020;12(5):e8371. google scholar
• Senanayake N, de Silva HJ, Karalliedde L. A scale to assess severity in organophosphorus intoxication: POP scale. Hum Exp Toxicol 1993;12(4):297-9. google scholar
• Jokanovic M. Medical treatment of acute poisoning with organophosphorus and carbamate pesticides. Toxicol Lett 2009;190(2):107-15. google scholar
• Wu AH, McKay C, Broussard LA, Hoffman RS, Kwong TC, Moyer TP, et al. National Academy of Clinical Biochemistry Laboratory Medicine. National academy of clinical biochemistry laboratory medicine practice guidelines: recommendations for the use of laboratory tests to support poisoned patients who present to the emergency department. Clin Chem 2003;49(3):357-79. google scholar
• Thiermann H, Szinicz L, Eyer P, Zilker T, Worek F. Correlation between red blood cell acetylcholinesterase activity and neuromuscular transmission in organophosphate poisoning. Chem Biol Interact 2005;157-158:345-7. google scholar
• Eyer P. The role of oximes in the management of organophosphorus pesticide poisoning. Toxicol Rev 2003;22(3):165-90. google scholar
• von Mach MA, Weilemann LS, von Landenberg P. Pseudocholinesterase activity in organophosphate poisoning after storage of unseparated blood samples at room temperature for 3 weeks. Clin Chem 2005 ;51(10):1907-8. google scholar
• Reddy BS, Skaria TG, Polepalli S, Vidyasagar S, Rao M, Kunhikatta V, et al. Factors associated with outcomes in organophosphate and carbamate poisoning: a retrospective study. Toxicol Res 2020;36(3):257-66. google scholar
• Worek F, Thiermann H, Wille T. Oximes in organophosphate poisoning: 60 years of hope and despair. Chem Biol Interact 2016;259(Pt B):93-8. google scholar
• Gupta R, Parmar M. Pralidoxime. [Updated 2023 May 1]. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2023. https://www.ncbi.nlm.nih.gov/books/NBK558908/ google scholar
• Ke X, Zhi S, Zheng D, Hong G, Zhao G, Li M, et al. Analyses on relevant factors of the prognosis of patients with acute organophosphate poisoning. Zhonghua Lao Dong Wei Sheng Zhi Ye Bing Za Zhi 2015;33(3):186-9. google scholar
• Conner KR, Wiegand TJ, Gorodetsky R, Schult RF, Kaukeinen K. Poisoning Severity Associated with a Range of Medications in Suicide Attempts by Ingestion. Suicide Life Threat Behav 2019;49(3):635-42. google scholar
• Bryan CJ, Hitschfeld MJ, Palmer BA, Schak KM, Roberge EM, Lineberry TW. Gender differences in the association of agitation and suicide attempts among psychiatric inpatients. Gen Hosp Psychiatry 2014;36(6):726-31. google scholar
• Maguen S, Skopp NA, Zhang Y, Smolenski DJ. Gender differences in suicide and suicide attempts among US Army soldiers. Psychiatry Res 2015;225(3):545-9. google scholar
• Kim E, Kim HJ, Lee DH. The characteristics and effects of suicide attempters’ suicidality levels in gender differences. Heliyon 2023;9(6):e16662. google scholar