Alaattin YILDIZ, Işın KILIÇASLAN, Kerim GÜLER, Tufan TÜKEK, Sezai VATANSEVER, Seyit Mehmet KAYACAN, Vakkur AKKAYA, Osman ERK

A case of copper sulfate intoxication that is presented with prolonged hemolysis and acute renal failure

Bakır sulfat, sebzelerin, meyvelerin ve tahıl ürünlerinin bakteriyel ve fungal hastalıklarının kontrolü için kullanılan bir fungusiddir. Çok küçük miktarları dahi toksiktir. Akut toksisitesinde hemolitik anemi, akut tubuler nekroz, hepatotoksisite ve rabdomyoliz gelişir. Ellibeş yaşında bir erkek hasta midede yanma, bulantı, kusma ve epigastrik ağrı yakınmaları ile başvurdu.İntihar amacıyla oral bakır sulfat alımına bağlı hemolitik anemi, akut böbrek yetersizliği, hepatotoksisite (sadece artmış AST) ve rabdomyoliz saptandı. İdrar miktarı 3-4 L/gün olarak seyretti. D-penisilamin (900 mg/gün) başlandı. Metabolik asidoz kaydedildi. Yirmi günde 9 kez hemodiyaliz uygulandı.Serum ve idrarda artmış bakır düzeyleri ve yüksek methemoglobinemi düzeylerinde yavaş yavaş azalma gözlendi (210 µg/dl→92 µg/dl, 98 µg/24 saat →62 µg/24 saat, 2,1%→1,6%, sırasıyla). İdrardaki ürik asid, fosfor ve bikarbonat düzeyleri normaldi. Hemolizin 15. gününden itibaren gerilemeye başlayan anemi 30.günde tamamen düzeldi. Azot retansiyonunun üçüncü haftanın sonunda da gerilememesi üzerine böbrek biyopsisi yapıldı. Akut tubuler nekroz gösterildi. Böbrek fonksiyonu 30. günde normale döndü.

Uzamış hemoliz ve akut böbrek yetersizliği ile prezente olan bir bakır sulfat zehirlenmesi olgusu

Copper sulfate is a fungicide used for the control of bacterial and fungal diseases of vegetables, fruits, and grain products. Even a very small quantity is toxic. Its acute toxicity leads to hemolytic anemia, acute tubular necrosis, hepatotoxicity, and rhabdmyolysis. A55 year old man was hospitalized with nausea, vomiting and epigastric pain. We found hemolytic anemia, acute renal failure, hepatotoxicity (only an increase in AST) and rhabdomyolysis as a consequence of oral copper sulfate intake for suicidal purposes. The amount of urine was 3-4 L/day. D-penicillamine (900 mg/day) was started. Metabolic acidosis was recorded. Hemodialysis was performed 9 times in twenty days. Increased copper levels in serum and urine and methemoglobinemia levels decreased gradually (210 µg/dl→92 µg/dl, 98 µg/24 hour→62 µg/24 hours, 2.1%→1.6%, in the order given). Uric acid, phosphorus and bicarbonate levels were at normal levels in the urine. Anemia started to decrease on the 15th day of hemolysis and it recovered on day 30. Since nitrogen retention did not regress at the end of week three, renal biopsy was performed. Acute tubular necrosis was detected in the biopsy. The renal functions returned to normal levels on day 30. As result although renal function is normal, hemodialysis treatment together with chelating agent should be performed at an early stage in such patients.

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