Ayçe ÇELİKER, Gülru ÖZKAYA, Belma KOÇER-GİRAY

İnsektisit zehirlenmeleri ve Türkiye’deki durumun değerlendirilmesi

İnsektisitler, hem tarımsal üretimin artırılmasındahem de ev ve toplum sağlığında çok önemli bir yeresahiptir. Ancak üretim, ambalajlama ya da kullanımlarısırasında gerekli özenin gösterilmemesi ya da intihargibi suistimale bağlı olarak, kazai, kasti veya meslekitemas nedeniyle ciddi zehirlenmelere hatta bazenölümlere yol açabilmektedirler. Tüm dünyada olduğu gibiülkemizde de insektisitlerle zehirlenme olgularına sıklıklarastlanmaktadır. Bu çalışmanın ilk bölümünde ülkemizdepazarlanmakta olan insektisit grupları olan organofosfatlar,organoklorlular, piretrinler ve piretroidler, amitraz ve diğerinsektisitlerin (avermektinler, dietil-m-toluamid (DEET) veneonikotinik asit türevleri) genel özellikleri, toksik etkileri,zehirlenme tanı ve tedavi yaklaşımları konusundaki bilgilersunulmuştur. İkinci bölümde ise Türkiye’de pestisit /insektisit zehirlenmelerinin epidemiyolojisi ve tedaviyaklaşımları konusunda ilaç ve zehir bilgi merkezleri, adltıp enstitüleri, üniversitelerin adli tıp ana bilim dalları,üniversite hastaneleri, devlet hastaneleri veya sağlıkmerkezleri tarafından bildirilmiş olan çalışma örneklerideğerlendirilerek Türkiye genelini kapsayan tablonunoluşturulmasına katkıda bulunulmasıhedeflenmiştir.Bu raporların değerlendirilmesinde en sıklıkla olgularınorganofosfatlı bileşiklere maruziyet sonucunda geliştiği,özellikle intiharlarda olmak üzere kadınların daha duyarlıolduğu belirlenmiştir. Gelişmiş ülkelerde rastlanılmamaklabirlikte, Türkiye’de esas olarak veterinerlikte kullanılanbir ilaç olmasına karşın, insektisit olarak da bazıürünleri bulunan amitrazla, özellikle çocukluk çağındazehirlenme olgularına ait çok sayıda kayıt bulunmasdikkat çekicidir. Diğer taraftan, yasaklanmış organoklorlubileşiklerle zehirlenme olgularına rastlanmış olması datoplumsal ve düzenleyici kuruluşlar düzeyinde önlem vedenetimlerin yetersizliğini düşündürmektedir. Çalışmanınson bölümünde, ülkemizde insektisitlerin tarımsal üretim,saklama ya da istemli veya diğer şekillerde tüketimleriile ilgili olarak ortaya çıkan sonuçlar ve bu ürünlerindoğru ve güvenli üretimi ve tüketimine yönelik olarak ve zehirlenmelere karşı alınması gereken önlemlere ilişkin öneriler sıralanmıştır.

Evaluation of insecticide poisoning and the cases in Turkey

Insecticides have a great importance in the increase of agricultural productivity and maintaining of public health. However, they can cause serious poisoning cases and even deaths at times due to accidental, intentional or occupational exposures. Thus insecticide poisoning cases are encountered frequently in Turkey as well as throughout the world. The first part of this review focused on the toxicological profiles of various insecticide groups (organophosphates, organochlorine insecticides, pyrethrines, pyrethroids, amitraz and other insectides (avermectines, diethyl-m-toluamid (DEET) and neonicotinik acid derivatives), and diagnosis and treatment of poisoning with those insecticides marketed in Turkey. In the second part, the studies on insecticide poisonings which were conducted in Drug and Poison Centers, Institutes of Forensic Science, Departments of Forensic Medicine, University and State Hospitals and Medical Centers in Turkey were evaluated with the aim of contributing the whole picture of the situation in Turkey. In review of these reports it was found that the most frequently occurred cases resulted from exposures with organophosphate compounds, and females were more vulnerable than males. It is noteworthy that there are numerous reports in Turkey regarding poisoning cases with amitraz, which was used mostly as a veterinary drug, especially in children despite no cases in the developed countries. On the other hand, poisoning cases with banned organochlorine insecticides have been thought to be caused by the insufficiency of necessary measures and controls that have not been taken by regulatory authorities and manufacturers. The conclusions on consumption of insecticides in agricultural production, storing, and intentional or other modes, and recommendations on the correct and safe production and use of insecticides, along with the protective measures to be taken against poisonings with these compounds, were listed in the last part of the review.

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