Toluen maruziyeti sonucu gelişen uçucu madde koklamaya bağlı ani ölüm sendromunun muhtemel biyolojik mekanizmaları

Toluene bağlı ani koklama ölüm sendromu; toluen so- lunmasının ölümcül bir sonucudur ki bu durum giderek bü- yüyen bir sosyal sorundur. Toluen’e maruziyet stimülan ajan olarak ya da endüstride kullanımı şeklinde yaygın olsa da toluene bağlı ani ölümün biyolojik mekanizmaları hakkında sınırlı bilgi vardır. En dramatiği kalp üzerine olmak üzere to- luenin birçok organ üzerine toksik etkisinin olduğu bilinmek- tedir. Ani ölüm toluenin kalp üzerine doğrudan toksik etkile- ri sonucu gelişen ventriküler taşiaritmi ya da ciddi bradikardi neticesinde doğrudan gelişebilir. Bu madde aynı zamanda kardiyomyopati, miyokardit ve miyokard infaktüsü gibi ani ölümle yakından ilişkili hastalıklara neden olabilir. Toluenin akciğerler, böbrekler, sinir sistemi ve kemik iliği gibi toluene bağlı ani ölüm mekanizmasına katkıda bulanabilecek organ- lar üzerine toksik etkileri vardır. Sonuç olarak, bu derlemede toluene bağlı ani ölümün maddenin kalp ve birçok organ üzerine toksik etkilerin karmaşık bir kombinasyonu sonucu geliştiği tartışılmıştır.

Possible biological mechanısms of sudden sniffing death syndrome due to toluene exposure

Sudden sniffing death syndrome due to toluene ex- posure is an outcome of the progressive social problem of intentional substance inhalation abuse. There is limited evi- dence about the biological mechanisms of toluene-induced sudden death, although toluene exposure is prevalent as a volatile solvent used in industrial settings. Toluene is known to possess toxic effects on many organs, most dramatically on the heart. Sudden death may result directly from ven- tricular tachyarrhythmias and severe bradycardia due to the cardiac toxicities of toluene. Toluene may also result in car- diomyopathy, myocarditis, and myocardial infarction, all of which are known to be associated with sudden death. In addition to its toxicity on the heart, this solvent is also toxic to the lungs, kidneys, nervous system, and bone marrow, which may contribute to the mechanism of sudden sniffing death due to toluene exposure. For these reasons, toluene- induced sudden death is discussed in this paper as a comp- lex combination of the toxicities of toluene to the heart and other organs.

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1- Ögel K, Yücel H, Aksoy A: İstanbul’da sokakta ya- şayan çocukların özellikleri. Yeniden Bilimsel Araş- tırma Raporları. Yayın no: 7. İstanbul, 2004.
2- Öğel K, Taner S, Eke C, Erol B: İstanbul’da Onuncu Sınıf Öğrencileri Arasında Tütün, Alkol ve Madde Kullanım Yaygınlığı Raporu. Yeniden Yayın no. 15. İstanbul, 2005.
3- Öğel K, Tamar D: Ruhsal Bozukluklar Epidemiyolo- jisi: Alkol ve madde kullanım bozuklukları epide- miyolojisi. Ege Psikiatri Sürekli Yayınları, 2000, p 124.
4- Davies B, Thorley A, O’Connor D: Progression of addiction carriers in young adult solvent misusers. Br Med J (Clin Res Ed) 1985;290:109-110.
5- McGarvey EL, Clavet GJ, Mason W, Waite D. Ado- lescent inhalant abuse: environments of use. Am J Drug Alcohol Abuse 1999;25:731-41.
6- Flanagan RJ, Ives RJ. Volatile substance abuse. Bull Narc 1994;46:49-78.
7- Bass M. Sudden sniffing death. JAMA 1970;212: 2075-9.
8- Adgey AA, Johnston PW, McMechan S. Sudden cardiac death and substance abuse. Resuscitation 1995; 29:219-21.
9- Monitoring the future survey release. Smoking among teenagers decreases sharply and increase in ecstasy use slows. U.S. Department of Health and Human Services HHS News; 2001.
10- Inhalant abuse. American Academy of Pediatrics, Committee on Substance Abuse and Committee on Native American Child Health. Pediatrics 1996; 97:420-3.
11- Carabez A, Sandoval F, Palma L: Ultrastructural changes of tissues produced by inhalation of thin- ner in rats. Microsc Res Tech 1998; 40:56-62.
12- Meadows R, Verghese A. Medical complications of glue sniffing. South Med J 1996; 89:455-62.
13- Halifeoglu I, Canatan H, Ustundag B, Ilhan N, Inanc F. Effect of thinner inhalation on lipid pe- roxidation and some antioxidant enzymes of pe- ople working with paint thinner. Cell Biochem Funct. 2000;18:263-7.
14- Hool LC. Reactive oxygen species in cardiac signal- ling: from mitochondria to plasma membrane ion channels. Clin Exp Pharmacol Physiol 2006;33:146- 51.
15- Garbe TR, Yukawa H. Common solvent toxicity: au- toxidation of respiratory redox-cyclers enforced by membrane derangement. Z Naturforsch [C] 2001; 56:483-91.
16- Akar FG, Aon MA, Tomaselli GF, O’Rourke B. The mitochondrial origin of postischemic arrhythmias. J Clin Invest 2005;115:3527-35.
17- Akisu M, Mir S, Genc B, Cura A. Severe acute thin- ner intoxication. Turk J Pediatr 1996; 38:223-5.
18- Aono J, Takimoto E, Komatsu T, Takeda A, Ueda W, Hirakawa M. Anesthetic care of a patient intoxica- ted with thinner. Masui 1990;39:388-90.
19- Zee-Cheng CS, Mueller CE, Gibbs HR Toluene sniffing and severe sinus bradycardia. Ann Intern Med 1985;103:482.
20- Vural M, Ogel K. Dilated Cardiomyopathy Associa- ted with Toluene Abuse. Cardiology 2006;105:158- 161.
21- Cunningham SR, Dalzell GW, McGirr P, Khan MM: Myocardial infarction and primary ventricular fib- rillation after glue sniffing. Br Med J (Clin Res Ed) 1987;294:739--740.
22- Carder JR, Fuerst RS. Myocardial infarction after toluene inhalation. Pediatr Emerg Care 1997; 13:117-119.
23- Hussain TF, Heidenreich PA, Benowitz N. Recur- rent non-Q-wave myocardial infarction associated with toluene abuse. Am Heart J 1996; 131:615- 616.
24- Gustavsson P, Plato N, Hallqvist J, et al. A populati- on-based case-referent study of myocardial infar- ction and occupational exposure to motor exha- ust, other combustion products, organic solvents, lead, and dynamite. Stockholm Heart Epidemio- logy Program (SHEEP) Study Group. Epidemiology 2001;12:222-8.
25- Wiseman MN, Banim S: ‘Glue sniffer’s’ heart? BMJ (Clin Res Ed) 1987; 294:739.
26- Knight AT, Pawsey CG, Aroney RS, Lawrence JR, Jo- nes DB, Newland RC: Upholsterers’ glue associa- ted with myocarditis, hepatitis, acute renal failure and lymphoma. Med J Aust 1991;154:360-362.
27- Kirk LM, Anderson RJ, Martin K. Sudden death from toluene abuse. Ann Emerg Med 1984;13:68- 69.
28- Tee RD, Cullinan J, Burge SP, Newman Taylor AJ. Specific IgE to isocyanates: a useful diagnos- tic role in occupational asthma. J Clin Immunol 1998;101:709-15.
29- Koga T, Kawazu T, Iwashita K, Yahata R. Pulmonary hyperinflation and respiratory distress following solvent aspiration in a patient with asthma: expe- ctoration of bronchial casts and clinical improve- ment with high-frequency chest wall oscillation. Respir Care 2004; 49:1335-8.
30- Fabbri LM, Danieli D, Crescioli S, Bevilacqua P, Meli S, Saetta M, Mapp CE. Fatal asthma in a su- bject sensitized to toluene diisocyanate. Am Rev Respir Dis 1988; 137:1494-8.
31- Bharati S, Lev M. Conduction system findings in sudden death in young adults with a history of bronchial asthma. J Am Coll Cardiol 1994; 23:741-6.
32- Gupta RK, van der Meulen J, Johny KV. Oliguric acute renal failure due to glue-sniffing. Case re- port. Scand J Urol Nephrol 1991; 25:247-50.
33- Batlle DC, Sabatini S, Kurtzman NA. On the mec- hanism of toluene-induced renal tubular acidosis. Nephron 1988; 49:210-8.
34- Aydin K, Sencer S, Demir T, Ogel K, Tunaci A, Mi- nareci O. Cranial MR findings in chronic tolue- ne abuse by inhalation. Am J Neuroradiol 2002; 23:1173-9.
35- Paul M, Schafers M, Kies P, Acil T, Schafers K, Bre- ithardt G, Schober O, Wichter T. Impact of sym- pathetic innervation on recurrent life-threatening arrhythmias in the follow-up of patients with idio- pathic ventricular fibrillation. Eur J Nucl Med Mol Imaging 2006;33:866-70.
36- Issa ZF, Zhou X, Ujhelyi MR, Rosenberger J, Bhakta D, Groh WJ, Miller JM, Zipes DP. Thoracic spinal cord stimulation reduces the risk of ischemic ven- tricular arrhythmias in a postinfarction heart failu- re canine model. Circulation 2005; 111:3217-20.
37- Fricchione GL, Vlay SC. Psychiatric aspects of pati- ents with malignant ventricular arrhythmias. Am J Psychiatry. 1986;143:1518-26.
38- Byrne A, Kirby B, Zibin T, Ensminger S. Psychiatric and neurological effects of chronic solvent abuse. Can J Psychiatry. 1991; 36:735-8.
39- Goldbloom D, Chouinard G.Schizophreniform psychosis associated with chronic industrial tolu- ene exposure: case report. J Clin Psychiatry 1985; 46:350-1.
40- Empana JP, Jouven X, Lemaitre RN, Sotoodehnia N, Rea T, Raghunathan TE, Simon G, Siscovick DS. Clinical depression and risk of out-of-hospital car- diac arrest. Arch Intern Med 2006;166:195-200.
41- Hatta K, Takahashi T, Nakamura H, Yamashiro H, Asukai N, Yonezawa Y. Hypokalemia and agitation in acute psychotic patients. Psychiatry Res 1999; 86:85-8.
42- Lindstrom E, Farde L, Eberhard J, Haverkamp W.QTc interval prolongation and antipsychotic drug treatments: focus on sertindole. Int J Neu- ropsychopharmacol 2005; 8:615-29.
43- Young DM. Risk factors for hypothermia in psychi- atric patients. Ann Clin Psychiatry. 1996; 8:93-7.
44- Bennett ME, Walters ST, Miller JH, Woodall WG. Re- lationship of early inhalant use to substance use in college students. J Subst Abuse 2000;12: 227-40.
45- Young SJ, Longstaffe S, Tenenbein M. Inhalant abuse and the abuse of other drugs. Am J Drug Alcohol Abuse 1999;25:371-5.