Şebnem ÇALKAVUR, Hasan AĞIN, Rana İŞGÜDER, Özgür OLUKMAN, Mustafa BAK

Organik fosfor ve karbamat intoksikasyonu saptanan 30 vaka

Amaç: Çalışmamızda, iki yıllık bir süreç içerisinde organik fosfor ve karbamat intoksikasyonu tanısı alan vakalara ait deneyimlerimizin aktarılması amaçlanmıştır. Yöntem: Ocak 2000-Aralık 2001 tarihleri arasında hastanemize başvuran ve organik fosfor karbamat intoksikasyonu tanısı alan vakalar, demografik veriler, klinik bulgular, laboratuar değerleri ve prognoz açısından incelenmiştir. Bulgular: Organik fosfor veya karbamat intoksikasyonu tanısı alan 30 vakanın 15'i (% 50) erkek, 15'i (% 50) kız olup, yaşları 1-15 yıl (ort.7±5.1) arasında değişmekteydi. Alınan toksik maddenin 23 vakada (% 77) organik fosfor, 7 vakada (% 23) karbamat içerdiği tespit edildi. Tüm vaka-ların 14'ü (% 47) hafif, 10'u (% 33) orta, 6'sı (% 20) ağır düzeyde intoksikasyon olarak değerlendirildi. Organofosfat ve karbamat intoksikasyonu tanısı alan 30 vakanın 26'sının (% 87) tamamen iyileştiği, 4'ünün ise (% 13) kaybedildiği saptandı. Vakaların intoksikasyon düzeyi ile serum psödokolinesteraz (PKE) değerleri arasında bir ilişki olmadığı, serum PKE değerinin intoksikasyon düzeyini yansıtmadığı, ancak kaybedilen vakalarda bu değerin daha düşük saptanmış olması nedeniyle hastanın prognozu konusunda fikir verebileceği sonucuna varıldı. Sonuç: Hayatı tehdit edici olabilen organik fosfor ve karbamat intoksikasyonunda, öncelikle bu tanıdan şüphelenmek ve ardından erken tanı ve tedavi hayat kurtarıcı niteliktedir.

Anahtar Kelimeler:

Karbamatlar, Zehirlenme, Fosforik asit esterleri, Psödokolinesteraz, Geriyedönük çalışma, Çocuk

Thirty cases with organophosphate and carbamate poisonong

Aim: The aim of this study is to transmit our experience about the cases diagnosed as organophosphate and carbamate intoxication during a period of two years. Methods: The pediatric patients with carbamate or organophosphate poisoning admitted to the Department of Pediatric Emergency, between January 2000-December 2001 were evaluated with demographic data, clinical symptoms, laboratory findings and prognosis. Results: Thirty cases with carbamate or organophosphate poisoning (15 males and 15 females) were aged from 1 to 15 years (mean 7.0±5.06). The toxic matter was containing organophosphate in 23 of the cases and carbamate in 7 children. The severity of poisoning was graded for each patient. Fourteen of the patients (47 %) had mild, 10 patients (33 %) had moderate poisoning and 6 patients (20 %) were determined as severe poisoning. Twenty-six of 30 patients (87 %) exhibited complete clinical recovery but four patients died. Severity of intoxication did not correlate with serum cholinesterase level of the cases. Serum cholinesterase levels did not reflect the severity of the intoxication but in the lost cases these levels were lower so it was concluded that these levels could give an idea about the patients' prognosis. Conclusion: In life-threatening carbamate and organophosphate poisoning, a high index of suspicion and early treatment would be life saving.

Keywords:

Carbamates, Poisoning, Phosphoric Acid Esters, Pseudocholinesterase, Retrospective Studies, Child,

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