Başak Ceyda MECO, Melek TULUNAY, , Esra ÖZAYAR, Şaban YALÇIN, Şirali OBA, Necmettin ÜNAL, Mehmet ORAL

Klorprifos Zehirlenmesini Takiben Gelişen Intermediate Sendromda Geç ve Aralıklı Oksim Tedavisi: Olgu Sunumu

İntermediate sendrom (İMS) proksimal ekstremite ve solunum kaslarında, boyun fleksorlarında ve kranial sinirlerde zayıflıkla karakterizedir. Etyolojiyi açıklamak için birkaç hipotez geliştirilmiştir (nöromusküler bileşke disfonksiyonu, yetersiz veya geç oksim tedavisi, asetilkolinesterazın uzamış ve ciddi inhibisyonu). Klorprifos düşük toksisiteyle ilişkili organofosfattır. Klorprifosa sekonder İMS çok nadirdir. 56 yaşında erkek hastada klorprifos oral alımından sonra gelişen İMS'u sunuyoruz. Başlangıçta kolinerjik sendrom belirtileri gösteren hastada ikinci günde mental ve respiratuar durumu kötüleşip İMS'u düşündüren derin motor paralizi gelişti. Hastaya ventilatör desteği gerekti. Pralidoksim geç (oral alımdan 52 saat sonra) ve 23 günde aralıklı olarak verilebildi. Hastanın takiplerinde ventilatör ilişkili pnömoni ve septik şok gelişmesine rağmen 32. gününde taburcu edildi. Bu olgu klorprifos intoksikasyonlarıyla gelen hastalarda İMS riski olduğunu göstermektedir.

Anahtar Kelimeler:

Zehirlenmeler, Klorprifos, Oksimler

Late and Interrupted Oxime Therapy In An Intermediate Syndrome Following Chlorpyrifos Poisoning: Case Report

Intermediate syndrome (IMS) is characterized by weakness of proximal limb and respiratory muscles, neck flexors, and cranial nerves. Several hypothesis have been developed to explain its etiology (neuromuscular junction disfunction, inadequate or late oxime therapy, prolonged and severe inhibition of acetylcholinesterase). Chlorpyrifos is a organophosphate with relatively low toxicity. IMS secondary to chlorpyrifos is very rare. We report a case of 56-year-old man who developed an IMS after chlorpyrifos ingestion. Although he presented with cholinergic symptoms initially, his mental and respiratory status deteriorated and profound motor paralysis consistent with IMS occurred on the second day. The patient required ventilatory support. Pralidoxime could only be administered late (52 hours post-ingestion), and intermittently for 23 days. The course of the patient was complicated with ventilator-associated pneumonia and septic shock, but after 32 days he was discharged. This case suggests that patients suffering from chlorpyrifos intoxication can be under the risk of IMS.

Keywords:

Poisoning, Chlorpyrifos, Oximes,

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