Nezihat Rana DİŞEL, Zeynep KEKEÇ, Ayça AÇIKALIN

Organofosfat Zehirlenmesini Taklit Eden Alkol Yoksunluğu

Kişisel koruyucu önlemler alınmadığında mesleki zehirlenmeye neden olabilen organofosfatlar, Türkiye"nin güneyindeki tarım bölgelerinde sıkça kullanılan insektisitlerdir. Bu nedenle, bu bölgenin sağlık çalışanlarınca tanınması kolay olan bu kolinerjik zehirlenmenin klasik klinik bulguları miyozis, sekresyonlarda artma, bradikardi ve fasikülasyonlardır. Alkolizme bağlı hastalık ve durumlardan olan mental ve sosyal uyum problemleri, koma, zehirlenme, yoksunluk ve deliryum tremens, kronik alkolizmi olan hastaların hastane ziyaretlerinin sık sebeplerindendir. Bu yazıda, aslında alkol yoksunluğu iken benzer semptomlar nedeniyle organofosfat zehirlenmesi tanı ve tedavisi alıp, deliryum tremense ilerleyen bir olgu sunulmuştur.

Anahtar Kelimeler:

Alkol yoksunluğu, deliryum tremens, organofosfat, zehirlenme

Alcohol Withdrawal Mimicking Organophosphate Poisoning

Organophosphates, which can cause occupational poisoning due to inappropriate personal protective measures, are widely used insecticides in agricultural regions of southern Turkey. Therefore, the classical clinical findings of this cholinergic poisoning are myosis, excessive secretions, bradicardia and fasciculations are easy to be recognized by local medical stuff. Diseases and conditions related to alcoholism such as mental and social impairments, coma, toxicity, withdrawal, and delirium are frequent causes of emergency visits of chronic alcoholic patients. Here we present a case diagnosed and treated as organophosphate poisoning although it was an alcohol withdrawal in the beginning and became delirium tremens, due to similar symptoms.

Keywords:

Alcohol withdrawal, delirium tremens, organophosphate, poisoning,

PDF

___

http://www.drugabuse.gov/drugs-abuse/alcohol Chang PH, Steinberg MB. Alcohol Withdrawal. Med Clin North Am. 2001;85:1191-212.
Mayo-Smith MF, Beecher LH, Fischer TL, Gorelick DA, Guillaume JL, Hill A, et all. Working Group on the Management of Alcohol Withdrawal Delirium, Practice Guidelines Committee, American Society of Addiction Medicine. Management of alcohol withdrawal delirium. An evidence-based practice guideline. Arch Intern Med. 2004;164:1405-12. Bernstein E, Bernstein JA, Fernandez WG, D’Onofrio G. Alcohol and other drugs of abuse. In Tintinalli’s Emergency Medicine: A Comprehensive Study Guide, 7th ed. Mc-Graw Hill and ACEP. 2011;1967
Lieber CS. Medical disorders of alcoholism. N Engl J Med. 1995;333:1058-65.
Hamilton RJ. Substance Withdrawal. In Goldfrank’s Toxicologic Emergencies, 7th ed. Mc-Graw Hill. 2002;1059-74.
Kosten TR, O’Connor PG. Management of Drug and Alcohol Withdrawal. NEJM. 2003;348:1786-95.
McCowan C, Marik P: Refractory delirium tremens treated with propofol: a case series. Crit Care Med. 2000;28:1781.
Saitz R: Clinical Practice. Unhealthy alcohol use. N Engl J Med. 2005;352:596.
Robey WC III, Meggs WJ. Pesticides. In Tintinalli's Emegency Medicine: a comprehensive study guide.7th ed. McGraw-Hill and ACEP. 2011;129730