İnsektisit zehirlenmeleri ve Türkiye’deki durumun değerlendirilmesi

Yıl 2013, Cilt: 70 Sayı: 2, 75 - 102, 01.06.2013

Gülru Özkaya Ayçe Çeliker Belma Koçer Giray

Öz

İnsektisitler, hem tarımsal üretimin artırılmasında hem de ev ve toplum sağlığında çok önemli bir yere sahiptir. Ancak üretim, ambalajlama ya da kullanımları sırasında gerekli özenin gösterilmemesi ya da intihar gibi suistimale bağlı olarak, kazai, kasti veya mesleki temas nedeniyle ciddi zehirlenmelere hatta bazen ölümlere yol açabilmektedirler. Tüm dünyada olduğu gibi ülkemizde de insektisitlerle zehirlenme olgularına sıklıkla rastlanmaktadır. Bu çalışmanın ilk bölümünde ülkemizde pazarlanmakta olan insektisit grupları olan organofosfatlar, organoklorlular, piretrinler ve piretroidler, amitraz ve diğer insektisitlerin avermektinler, dietil-m-toluamid DEET ve neonikotinik asit türevleri genel özellikleri, toksik etkileri, zehirlenme tanı ve tedavi yaklaşımları konusundaki bilgiler sunulmuştur. İkinci bölümde ise Türkiye’de pestisit / insektisit zehirlenmelerinin epidemiyolojisi ve tedavi yaklaşımları konusunda ilaç ve zehir bilgi merkezleri, adli tıp enstitüleri, üniversitelerin adli tıp ana bilim dalları, üniversite hastaneleri, devlet hastaneleri veya sağlık merkezleri tarafından bildirilmiş olan çalışma örnekleri değerlendirilerek Türkiye genelini kapsayan tablonun oluşturulmasına katkıda bulunulması hedeflenmiştir. Bu raporların değerlendirilmesinde en sıklıkla olguların organofosfatlı bileşiklere maruziyet sonucunda geliştiği, özellikle intiharlarda olmak üzere kadınların daha duyarlı olduğu belirlenmiştir. Gelişmiş ülkelerde rastlanılmamakla birlikte, Türkiye’de esas olarak veterinerlikte kullanılan bir ilaç olmasına karşın, insektisit olarak da bazı ürünleri bulunan amitrazla, özellikle çocukluk çağında zehirlenme olgularına ait çok sayıda kayıt bulunması dikkat çekicidir. Diğer taraftan, yasaklanmış organoklorlu bileşiklerle zehirlenme olgularına rastlanmış olması da toplumsal ve düzenleyici kuruluşlar düzeyinde önlem ve denetimlerin yetersizliğini düşündürmektedir. Çalışmanın son bölümünde, ülkemizde insektisitlerin tarımsal üretim, saklama ya da istemli veya diğer şekillerde tüketimleri ile ilgili olarak ortaya çıkan sonuçlar ve bu ürünlerin doğru ve güvenli üretimi ve tüketimine yönelik olarak ve zehirlenmelere karşı alınması gereken önlemlere ilişkin öneriler sıralanmıştır

Anahtar Kelimeler

İnsektisit, organofosfatlı insektisitler, organoklorlu insektisitler, piretroidler, insektisit zehirlenmeleri

Evaluation of insecticide poisoning and the cases in Turkey

Öz

Insecticides have a great importance in the increase of agricultural productivity and maintaining of public health. However, they can cause serious poisoning cases and even deaths at times due to accidental, intentional or occupational exposures. Thus insecticide poisoning cases are encountered frequently in Turkey as well as throughout the world. The first part of this review focused on the toxicological profiles of various insecticide groups organophosphates, organochlorine insecticides, pyrethrines, pyrethroids, amitraz and other insectides avermectines, diethyl-m-toluamid DEET and neonicotinik acid derivatives , and diagnosis and treatment of poisoning with those insecticides marketed in Turkey. In the second part, the studies on insecticide poisonings which were conducted in Drug and Poison Centers, Institutes of Forensic Science, Departments of Forensic Medicine, University and State Hospitals and Medical Centers in Turkey were evaluated with the aim of contributing the whole picture of the situation in Turkey. In review of these reports it was found that the most frequently occurred cases resulted from exposures with organophosphate compounds, and females were more vulnerable than males. It is noteworthy that there are numerous reports in Turkey regarding poisoning cases with amitraz, which was used mostly as a veterinary drug, especially in children despite no cases in the developed

Anahtar Kelimeler

Insectides, organophosphates, organochlorine insecticides, pyrethroides, poisoning of insectides

Kaynakça

• Klaassen CD. Doull’s Toxicology, The basic science of poisons. New York: McGraw-Hill, 2001; 763-
• Kwong TC. Organophosphate biochemistry and clinical toxicology. Ther Drug Monit, 2002; 24:144-9. pesticides:
• Karalliedde LD, Edwards P, Marrs TC. Variables influencing the toxic response to organophosphates in humans. Food Chem Toxicol, ; 41:1-13.
• Güven M. Organik fosfor zehirlenmeleri. Yoğun Bakım Dergisi, 2004; 4(2):113-21.
• Moretto A. Experimental and clinical toxicology of anticholinesterase agents. Toxicol Lett, 1998; :509-13.
• Costa LG. Current issues in organophosphate toxicology. Clin Chim Acta, 2006; 366:1-13.
• Demirdöğen B. Organophosphate pesticide poisonings and the role of serum paraoxonase 1 (PON1) enzyme in organophosphate metabolism. Turk Hij Den Biyol Derg, 2010; 67: 97-112.
• Klasco RK. POISINDEX® System. Thomson Reuters, Greenwood Village, Colorado: vol. 148 expires, ; 6. Rusyniak DE, Nanagas KA. Organophosphate poisoning. Semin Neurol, 2004; 24: 197-204.
• Kamanyire R, Karalliedde L. Organophosphate toxicity and occupational exposure. Occup Med (Lond), 2004; 54:69-75.
• Shannon MW, Borron SW, Burns M. Haddad and Winchester's Clinical Management of Poisonings and Drug Overdose. Saunders; Elsevier, 2007.
• Eddleston M, Buckley NA, Eyer P, Dawson AH. Management of acute organophosphorus pesticide poisoning. Lancet, 2008; 16; 371: 597-607.
• Bairy KL, Vidyasagar S, Sharma A, Sammad V. Controversies in the management of organophosphate pesticide poisoning. Indian J Pharmacol, 2007; 39: 71-4.
• Eddleston M, Szinicz L, Eyer P, Buckley N. Oximes in acute organophosphorus pesticide poisoning: a systematic review of clinical trials. QJM, 2002; : 275-83.
• Buckley NA, Eddleston M, Li Y, Bevan M, Robertson J. Oximes for acute organophosphate pesticide poisoning. Cochrane Database Syst Rev, 2011; 2: CD005085.
• Leibson T, Lifshitz M. Organophosphate and carbamate poisoning: review of the current literature and summary of clinical and laboratory experience in southern Israel. Isr Med Assoc J, ; 10: 767-70.
• Pajoumand A, Shadnia S, Rezaie A, Abdi M, Abdollahi M. Benefits of magnesium sulfate in the management of acute human poisoning by organophosphorus insecticides. Hum Exp Toxicol, ; 23: 565-9.
• Guven M, Sungur M, Eser B, Sari I, Altuntas F. The effects of fresh frozen plasma on cholinesterase levels and outcomes in patients with organophosphate poisoning. J Toxicol Clin Toxicol, 2004; 42: 617-23.
• Raushel FM. Bacterial detoxification of organophosphate nerve agents. Curr Opin Microbiol, 2002; 5: 288-95.
• Turusov V, Rakitsky V, Tomatis L. Dichlorodiphenyltrichloroethane (DDT): ubiquity, persistence, and risks. Environ Health Perspect, ; 110:125-8.
• Dağlıoğlu N. İnsan cilt altı yağ dokusunda organoklorlu pestisitlerin kalıntı düzeylerinin tesbiti. Doktora Tezi, Çukurova Üniversitesi Sağlık Bilimleri Enstitüsü, 2009.
• Purdue MP, Hoppin JA, Blair A, Dosemeci M, Alavanja MC. Occupational exposure to organochlorine insecticides and cancer incidence in the Agricultural Health Study. Int J Cancer, Evangelista de Duffard AM, Duffard R. Behavioral toxicology, risk assessment, and chlorinated hydrocarbons. Environ Health Perspect, 1996; (2): 353-60.
• Crinnion WJ. Chlorinated pesticides: threats to health and importance of detection. Altern Med Rev, 2009; 14: 347-59.
• Weselak M, Arbuckle TE, Foster W. Pesticide exposures and developmental outcomes: the epidemiological evidence. J Toxicol Environ Health B Crit Rev, 2007; 10: 41-80.
• Ellenhorn MJ, Barceloux, DG. Medical Toxicology, Diagnosis and treatment of human poisoning. Michigan Universty: Elsevier, 1988; 1067-81.
• Rogan WJ, Chen A. Health risks and benefits of bis(4-chlorophenyl)-1,1,1-trichloroethane (DDT). Lancet, 2005; 366: 763-73.
• Beard J. DDT and human health. Sci Total Environ, ; 355: 78-89.
• Bradberry SM, Cage SA, Proudfoot AT, Vale JA. Poisoning due to pyrethroids. Toxicol Rev, 2005; : 93-106.
• Proudfoot AT. Poisoning due to pyrethrins. Toxicol Rev, 2005; 24: 107-13.
• Yilmaz HL, Yildizdas DR. Amitraz poisoning, an emerging problem: epidemiology, clinical features, management, and preventive strategies. Arch Dis Child, 2003; 88: 130-4.
• Caksen H, Odabas D, Arslan S, Akgun C, Atas B, Akbayram S, Tuncer O. Report of eight children with amitraz intoxication. Hum Exp Toxicol, 2003; : 95-7.
• Aydin K, Per H, Kurtoglu S, Poyrazoglu MH, Narin N, Aslan D. Amitraz poisoning in children. Eur J Pediatr, 2002; 161: 349-50.
• Ulukaya S, Demirag K, Moral AR. Acute amitraz intoxication in human. Intensive Care Med, 2001; : 930-3.
• Avsarogullari L, Ikizceli I, Sungur M, Sozuer E, Akdur O, Yucei M. Acute amitraz poisoning in adults: clinical features, laboratory findings, and management. Clin Toxicol (Phila), 2006; 44: 23.
• Sung YF, Huang CT, Fan CK, Lin CH, Lin SP. Avermectin intoxication with coma, myoclonus, and polyneuropathy. Clin Toxicol (Phila), 2009; : 686-8.
• Yen TH, Lin JL. Acute poisoning with emamectin benzoate. J Toxicol Clin Toxicol, 2004; 42: 61.
• Soyuncu S, Oktay C, Berk Y, Eken C. Abamectin intoxication with coma and hypotension. Clin Toxicol (Phila), 2007; 45: 299-300.
• Chung K, Yang CC, Wu ML, Deng JF, Tsai WJ. Agricultural avermectins: an uncommon but potentially fatal cause of pesticide poisoning. Ann Emerg Med, 1999; 34: 51-7.
• Flake ZA, Hinojosa JR, Brown M, Crawford P. Clinical inquiries. Is DEET safe for children? J Fam Pract, 2005; 54: 468-9.
• Adanır T. İmidakloprid intoksikasyonu. Türk Anest Rean Der, 2007; 35: 443-6.
• Karatas AD. Severe central nervous system depression in a patient with acute imidacloprid poisoning. Am J Emerg Med, 2009; 27(9): 5-7.
• Mohamed F, Gawarammana I, Robertson TA, Roberts MS, Palangasinghe C, Zawahir S, et al. Acute human self-poisoning with imidacloprid compound: a neonicotinoid insecticide. PLoS One, 2009; 4: 5127.
• TC Sağlık Bakanlığı Sağlık İstatistikleri Yıllığı. RSHMB, Ankara, 2010.
• Kimya Sanayii Özel İhtisas Komisyonu, Tarım ilaçları çalışma grubu raporu. Ankara: DPT, 2006.
• Lapatto-Reiniluoto O, Kivisto KT, Pohjola-Sintonen S, Luomanmaki K, Neuvonen PJ. A prospective study of acute poisonings in Finnish hospital patients. Hum Exp Toxicol, 1998; 17: 307-11.
• Burillo-Putze G, Munne P, Duenas A, Pinillos MA, Naveiro JM, Cobo J, Alonso J. National multicentre study of acute intoxication in emergency departments of Spain. Eur J Emerg Med, 2003; 10: 101-4.
• Bronstein AC, Spyker DA, Cantilena LR, Jr., Green JL, Rumack BH, Giffin SL. 2009 Annual Report of the American Association of Poison Control Centers' National Poison Data System (NPDS): th Annual Report. Clin Toxicol (Phila), 2010; 48: 1178.
• Proudfoot AT. Poisoning with amitraz. Toxicol Rev, ; 22: 71-4.
• Gunnell D, Eddleston M, Phillips MR, Konradsen F. The global distribution of fatal pesticide self- poisoning: systematic review. BMC Public Health, ; 7: 357.
• FAO. International code of conduct on the distribution and use of pesticides. Rome, Italy, Kalkan S, Erdogan A, Aygoren O, Capar S, Tuncok Y. Pesticide poisonings reported to the drug and poison information center in Izmir, Turkey. Vet Hum Toxicol, 2003; 45: 50-2.
• Daglioglu N, Akcan R, Gulmen MK, Yener F, Efeoglu P. Pesticide intoxications in Cukurova, Turkey: three years analysis. Hum Exp Toxicol, ; 30: 1892-5.
• Hincal F, Hincal AA, Sarikayalar F, Cevik N, Kinik E. Self poisoning in children: a ten year survey. J Toxicol Clin Toxicol, 1987; 25: 109-20.
• Ozkose Z, Ayoglu F. Etiological and demographical characteristics of acute adult poisoning in Ankara, Turkey. Hum Exp Toxicol, 1999; 18: 614-8.
• Andıran N, Sarıkayalar, F. İhsan Doğramacı Çocuk Hastanesinde son altı yılda izlenen akut zehirlenmeler. Katkı Pediatri Dergisi, 2001; 22: 408.
• Goksu S, Yildirim C, Kocoglu H, Tutak A, Oner U. Characteristics of acute adult poisoning in Gaziantep, Turkey. J Toxicol Clin Toxicol, 2002; : 833-7.
• Guloglu C, Kara IH. Acute poisoning cases admitted to a university hospital emergency department in Diyarbakir, Turkey. Hum Exp Toxicol, 2005; 24: 49-54.
• Baydin A, Yardan T, Aygun D, Doganay Z, Nargis C, Incealtin O. Retrospective evaluation of emergency service patients with poisoning: a year study. Adv Ther, 2005; 22: 650-8.
• Akbaba M, Nazlican E, Demirhindi H, Sutoluk Z, Gokel Y. Etiological and demographical characteristics of acute adult poisoning in Adana, Turkey. Hum Exp Toxicol, 2007; 26: 401-6.
• Demircan A, Kahveci F, Engindeniz Z, Kıyıcı M, Girgin NK, Ercan I, Tekçe H, et al. Analysis of acute adult poisoning cases among patients admitted to the emergency department in Bursa, Turkey. FABAD J Pharm Sci, 2007; 32: 7-14.
• Tomruk Ö, Öğüt S, Çetin N. Assessment of the pesticide poisoning admitted to emergency medicine. JAEM, 2009; 8: 33-7.
• Aji DY. Türkiye'de çocuk zehirlenmeleri. Türk Pediatri Arşivi, 1998; 33: 154-8.
• Akbay-Öntürk Y, Uçar B. Eskişehir bölgesinde çocukluk çağı zehirlenmelerinin retrospektif değerlendirilmesi. Çocuk Sağlığı ve Hastalıkları Dergisi, 2003; 46:103-13.
• Öner N, İnan M, Vatansever Ü, Turan Ç, Çeltik C, Küçükuğurluoğlu Y, Duran R, Karasalihoğlu S. Trakya bölgesinde çocuklarda görülen zehirlenmeler. Türk Pediatri Arşivi, 2004; 39: 25
• Erkal S, Safak S. An evaluation of the poisoning accidents encountered in children aged 0-6 years in Kirikkale. Turk J Pediatr, 2006; 48: 294-300.
• Ozturk MA, Kelestimur F, Kurtoglu S, Guven K, Arslan D. Anticholinesterase poisoning in Turkey- clinical, laboratory and radiologic evaluation of cases. Hum Exp Toxicol, 1990; 9(5): 273-9.
• Aygun D, Doganay Z, Altintop L, Guven H, Onar M, Deniz T, Sunter T. Serum acetylcholinesterase and prognosis of acute organophosphate poisoning. J Toxicol Clin Toxicol, 2002; 40(7): 903-10.
• Kara IH, Guloglu C, Karabulut A, Orak M. Sociodemographic, clinical, and laboratory features of cases of organic phosphorus intoxication who attended the Emergency Department in the Southeast Anatolian Region of Turkey. Environ Res, 2002; 88(2): 82-8.
• Sahin HA, Sahin I, Arabaci F. Sociodemographic factors in organophosphate poisonings: a prospective study. Hum Exp Toxicol, 2003; 22(7): 53.
• Ozer C, Kuvandik G, Gokel Y, Duru M, Helvaci MR. Clinical presentation and laboratory findings of organic phosphorus poisoning. Adv Ther, 2007; (6): 1321-9.
• Kavalci C, Durukan P, Ozer M, Cevik Y, Kavalci G. Organophosphate poisoning due to a wheat bagel. Intern Med, 2009; 48(2): 85-8.
• Karatas AD, Aygun D, Baydin A. Characteristics of endosulfan poisoning: a study of 23 cases. Singapore Med J, 2006; 47(12): 1030-2.
• Durukan P, Ozdemir C, Coskun R, Ikizceli I, Esmaoglu A, Kurtoglu S, Guven M. Experiences with endosulfan mass poisoning in rural areas. Eur J Emerg Med, 2009; 16(1): 53-6.
• Orak M, Üstündağ M, Özhasenekler A, Altuncı YA, Güloğlu C, Tamam Y. Factors affecting mortality in endosulfan ingestion with suicidal intent. JAEM, 2010: 158-60.
• Yaramis A, Soker M, Bilici M. Amitraz poisoning in children. Hum Exp Toxicol, 2000; 19(8): 3.
• Ertekin V, Alp H, Selimoglu MA, Karacan M. Amitraz poisoning in children: retrospective analysis of 21 cases. J Int Med Res, 2002; 30(2): 203-5.
• Atabek ME, Aydin K, Erkul I. Different clinical features of amitraz poisoning in children. Hum Exp Toxicol, 2002; 21(1): 13-6.
• Demirel Y, Yilmaz A, Gursoy S, Kaygusuz K, Mimaroglu C. Acute amitraz intoxication: retrospective analysis of 45 cases. Hum Exp Toxicol, 2006; 25(10): 613-7.
• Sataloğlu N, Aydın, B., Turla, A. Pestisit zehirlenmeleri. TSK Koruyucu Hekimlik Bülteni, ; 6(3): 169-74.
• Thundiyil JG, Stober J, Besbelli N, Pronczuk J. Acute pesticide poisoning: a proposed classification tool. Bull World Health Organ, 2008; (3): 205-9.
• Litchfield MH. Estimates of acute pesticide poisoning in agricultural workers in less developed countries. Toxicological reviews, 2005; 24(4): 8.
• Damalas CA, Georgiou EB, Theodorou MG. Pesticide use and safety practices among Greek tobacco farmers: a survey. Int J Environ Health Res, 2006; 16(5): 339-48.
• Ozucelik DN, Karcioglu O, Topacoglu H, Fowler JR. Toxicity following unintentional DDT ingestion. J Toxic Clin Toxicol, 2004; 42(3): 299-303.
• Kalyoncu M, Dilber E, Okten A. Amitraz intoxication in children in the rural Black Sea region: analysis of forty-three patients. Hum Experimental Toxicol, 2002; 21(5): 269-72.