Zehirlenmeler
Özet
Zehirlenmeler ciddi ve yaşamı tehdit eden bir durum olması nedeni ile yakın takip ve tedavi edilmelidir. Klinik belirtiler; zehirin miktarına, maruz kalma süresine, metabolik özelliklerine, metabolitlerinin toksik olmasına ve tedavinin başlama zamanına göre değişkenlik gösterir. Zehirlenme tedavisine genel yaklaşım; semptomatik, destekleyici, zehiri uzaklaştırmaya yönelik uygulamaları ve antidot tedavisini içerir. Zehirlenmiş bir hastanın yoğun bakım takibinde de etkenin absorbsiyonunun azaltılması, eliminasyonun artırılması ve olumsuz etkilenen organ ve sistem fonksiyonlarının desteklenmesi gerekir. Bu amaçla spesifik antidotlar kullanılır ve gereğinde ekstrakorporeal kan pürifikasyon yöntemleri uygulanarak, zehirlenme sebebi olan etken maddeler dolaşımdan uzaklaştırılmaya çalışılır.
Referanslar
Karabıyık L. Zehirlenmede özel durumlar. Şenoğlu N, editör. Olgularla Yoğun Bakım protokolleri.1. Baskı. Ankara: Nobel Tıp Kitapevleri; 2019. p.977
Dart RC Ed. Medical Toxicology 3rded. Lipincott Williams and Wilkins.2014
Goldfrank LR et al Eds. Goldfrank’ s Toxicologic Emergencies, 9th ed. McGraw-Hill,2010
Mokhlesi B,Leiken JB,MurrayP,Corbridge TC.Adult toxıcology in critical care part1:general approach to intocicated patient chest 2003 123(2):577-92
Holstege CP,Borek HA. Toxidromes. Critical Care Clin2012;28(4):479-98.
Mégarbane B, Oberlin M, Alvarez JC, Balen F,Beaune S, Bédry J, et al. Ann. Management of pharmaceutical and recreational drug poisoning. Intensive Care. 2020 ;10:157-87.
Tintinalli JE et al .Tintinalli’s Emergency medicine Acomprhensive study guide 8th edition Mc Graw Hill Companies,2010
Aki ES, Alessai j. General approach to poisoned patient. poisoning in the Modern Worldnew Tricks for an Old Dog? 2019.
Levine M, Brooks DE, Truitt CA, Wolk Bj, Boyer EW, Ruha AM. Toxicology in the ıCU: part 1: general overview and approachto treatment. Chest. 2011;140(3): 795‐806.
Altınyazar V. psikiyatride sık karşılaşılan toksik sendromlar. Psikiyatride Güncel Yaklaşımlar. 2010;2(4):532-71.
Rasimas j, Sinclair CM. Assessment and management of toxidromes in the critical care unit. Crit Care Clin. 2017;33:521-41.
Lott EL, jones EB. Cholinergic Toxicity. ın: Statpearls [ınternet]. Treasure ısland (FL): Statpearls publishing; 2020.
Karabıyık L. Zehirlenmede özel durumlar. Şenoğlu N, editör. Olgularla Yoğun Bakım protokolleri. 1. Baskı. Ankara: Nobel Tıp Kitapevleri; 2019. p.978
Sulaj Z, prifti E, Demiraj A, Strakosha A. Early clinical outcome of acute poisoning cases treated in intensive care unit. Med Arch. 2015;69(6):400-4.
Orsini J, Din N, Elahi E, Gomez A, Rajayer S, Malik R, et al. Clinical and epidemiological characteristics of patients with acute drug intoxication admitted to ICU. J Community Hosp Intern Med perspect. 2017; 7(4):202-7.
Mudan A, Love JS, Greenwood JC, Stickley C, Zhou VL, Shofer FS, et al. The management of the poisoned patient using a novel emergency department-based resuscitation and critical care unit (ResCCU). Am J Emerg Med. 2020;38(10):2070-3.
Vale JA,KuligK,American academy of Clinical Toxicology,Europan Association of posion Centers and Clinical toxicologisti position paper,gastric lavage.J Toxicol Clin 2004;42:933
Donkor J,ArmenianP,HartmanIN,Vohra R.Analysis of Gastric Lavage Reported to a Statewide poision Control System . The Journal of Emergency medicine 2016;51:394-400
Chyka PA,Winbery SL.Quality improvment process in adherence to gastric decontamination guıdlines for poison exposures as recommended by a posion control center.. Qual Manag Health care 2006;15:263-7
Proudfoot AT,KrenzelokEP,Vale JA,position paper on ürine alkalization,J toxicol 2004 42:1-26
Zhonghua Yi Xue Za Zhi.Effects of hemoperfüzyon on the patient with acute toxication 2013;10:2742-4
Brent J, Wallace KL,Burkhart KK,PhilippsSD,Donovan JW.Critical Care Toxicology.Elsevier Mosby 2005 Philadelphia.p1 1-181
Sidell FR.Clinical effects of organophosphorus cholinesterase inhibitors.J Appl toxicol 1994;14:111
Buckley NA, Eddleston M.Li Y,et al.Oximes for acute organophosphate pesticide poisoning.Cochrane Database Syst Rev 2011 CD005085
Mitchell,ST.NewComprehensive Amatoxin Mushroom Poisoning TreatmentProtocol.Clin Tox 2010;48:628
Zhang J,Zhang Y,Peng Z,et al.Experience of treatment of Amantia phalloides-ınduced Fulminant Liver Failure with MARS and Therapeutic Plasma Exchange.ASAIO J 2014;60:407
Tarık O. Alkol zehirlenmeleri.Turkiye Klinikleri J Emerg Med-Special topics.2016;2(1):38-43
Beatty L,Green R,Magee K,Zed P.A systematic review of ethanol and fomepizol use in toxic alcohol ingestions. Emergency Medicine İnternational 2013;2013:14
Barceloux DG,Bond GR,KrenzelokEP,et al .Amerıcan Academy of Clinical Toxicology practice guidlines on the treatment of methanol poisoning.Jtoxicol Clin Toxicol 2002;40:415
Zakharov s, et al. Intermittent hemodialysis is superior to continuous veno-venous hemodialysis/hemodiafiltration to eliminate methanol and formate during treatment for methanol poisoning. Kidney International.
Türkiye Karbonmonoksit Zehirlenmelerinin Önlenmesi Programı ve Eylem Planı (2015-2018). T.C. Sağlık Bakanlığı Türkiye Halk Sağlığı Kurumu, Yayın No:994. Ankara,2015
Rose JJ, Wang L, Xu Q, McTiernan CF, Shiva S, Tejero J, et al. Carbon monoxide poisoning: Pathogenesis, management, and future directions of therapy. Am J Respir Crit CareMed. 2017;195(5):596-606.
Varrassi M, Di Sibio A, Gianneramo C, Perri M, Saltelli G, Splendiani A, et al. Advanced neuroimaging of carbon monoxide poisoning. Neuroradiol J. 2017;30(5):461-9.
Culnan DM, Craft-Coffman B, Bitz GH, Capek KD, Tu Y, Lineaweaver WC, et al. Carbon monoxide and cyanide poisoning in the burned pregnant patient: An indication for hyperbaric oxygen therapy. Ann Plast Surg. 2018;80(3 Suppl 2): S106-S112.
Shimazu T. Pathophysiology, myths and mysteries of acute carbon monoxide poisoning.Chudoku Kenkyu. 2006;19:23-33
Ozyurt A, Karpuz D, Yucel A, et al. Effects of acute carbon monoxide poisoning on ECG and echocardiographic parameters in children. Cardiovasc Toxicol. 2017;17(3):326-34.
Hampson NB,Dunford RD,Kramer CC,Norkool DM.Selecton criteria utılızed for hyperbaric oxygen treatmnet of carbon monoxide poisoning.J Emergency Med.1995;13:227
Love J,Howell J,Litovitz T,Klein Schwartz W. Acute beta blocker overdose:factors associated with the developmen of cardiovascular morbidity.J Toxicol Clin Toxicol2000,38(3):275-281
Doepker B,Healy W,Cortez E,Adkins E.High-dose insulin and intravenous lipid emulsion therapy for cardiogenic shock induced by intentional calcium-channel blocker and Bblocker overdose :a case series.J Emerg med.2014,46(4):486-490
St-Onge,Maude,et al.”Experts consensus recommendations for managementn of calcıum channel blocker poisoning in adult”.Critical care medicine (2017),45:306-15
Murray L,Daly F,Little M,Cadoğan M.Toxicology Handbook(second edition)Elsevier,2011
Çiftçi E, Aydın S. Toxicological evaluation of digital glycosides in congestive heart failure. fABAd j pharm Sci. 2018;43:263-77.
Bronstein AC, Spyker DA, Cantilena LR jr,Green j, Rumack BH, Heard SE. 2006 Annual Report of the American Association of Poison Control Centers’ national Poison Data System (nPDS). Clin Toxicol (Phila).2007;45:815-917.
Park KS. Evaluation and management of caustic injuries from ingestion of acid or alkaline substances. Clin Endosc. 2014;47 :301- 7.
Contini S, Scarpignato C. Caustic injury of the upper gastrointestinal tract: a comprehensive review. World j Gastroenterol. 2013;19:3918-30
Chibishev A, Simonovska n, Shikole A. Postcorrosive Postcorrosive injuries of upper gastrointestinal tract. Prilozi. 2010;31:297-316.
Lusong MAA, Timbol ABG, Tuazon DjS. Management of esophageal caustic injury. World j Gastrointest Pharmacol Ther. 2017;8(2):90-8.
Coronel G, De Lusong M. Sucralfate for the prevention of esophageal stricture formation in corrosive esophagitis: an open label, randomized controlled trial. Endoscopy. 2011;43 (Suppl 1):A42.
Hall AH, jacquemin D, Henny D, Mathieu L, josset P, Meyer B. Corrosive substances ingestion: a review. Critical Reviews in Toxicology. 2019;49(8):637-69
Referanslar
Karabıyık L. Zehirlenmede özel durumlar. Şenoğlu N, editör. Olgularla Yoğun Bakım protokolleri.1. Baskı. Ankara: Nobel Tıp Kitapevleri; 2019. p.977
Dart RC Ed. Medical Toxicology 3rded. Lipincott Williams and Wilkins.2014
Goldfrank LR et al Eds. Goldfrank’ s Toxicologic Emergencies, 9th ed. McGraw-Hill,2010
Mokhlesi B,Leiken JB,MurrayP,Corbridge TC.Adult toxıcology in critical care part1:general approach to intocicated patient chest 2003 123(2):577-92
Holstege CP,Borek HA. Toxidromes. Critical Care Clin2012;28(4):479-98.
Mégarbane B, Oberlin M, Alvarez JC, Balen F,Beaune S, Bédry J, et al. Ann. Management of pharmaceutical and recreational drug poisoning. Intensive Care. 2020 ;10:157-87.
Tintinalli JE et al .Tintinalli’s Emergency medicine Acomprhensive study guide 8th edition Mc Graw Hill Companies,2010
Aki ES, Alessai j. General approach to poisoned patient. poisoning in the Modern Worldnew Tricks for an Old Dog? 2019.
Levine M, Brooks DE, Truitt CA, Wolk Bj, Boyer EW, Ruha AM. Toxicology in the ıCU: part 1: general overview and approachto treatment. Chest. 2011;140(3): 795‐806.
Altınyazar V. psikiyatride sık karşılaşılan toksik sendromlar. Psikiyatride Güncel Yaklaşımlar. 2010;2(4):532-71.
Rasimas j, Sinclair CM. Assessment and management of toxidromes in the critical care unit. Crit Care Clin. 2017;33:521-41.
Lott EL, jones EB. Cholinergic Toxicity. ın: Statpearls [ınternet]. Treasure ısland (FL): Statpearls publishing; 2020.
Karabıyık L. Zehirlenmede özel durumlar. Şenoğlu N, editör. Olgularla Yoğun Bakım protokolleri. 1. Baskı. Ankara: Nobel Tıp Kitapevleri; 2019. p.978
Sulaj Z, prifti E, Demiraj A, Strakosha A. Early clinical outcome of acute poisoning cases treated in intensive care unit. Med Arch. 2015;69(6):400-4.
Orsini J, Din N, Elahi E, Gomez A, Rajayer S, Malik R, et al. Clinical and epidemiological characteristics of patients with acute drug intoxication admitted to ICU. J Community Hosp Intern Med perspect. 2017; 7(4):202-7.
Mudan A, Love JS, Greenwood JC, Stickley C, Zhou VL, Shofer FS, et al. The management of the poisoned patient using a novel emergency department-based resuscitation and critical care unit (ResCCU). Am J Emerg Med. 2020;38(10):2070-3.
Vale JA,KuligK,American academy of Clinical Toxicology,Europan Association of posion Centers and Clinical toxicologisti position paper,gastric lavage.J Toxicol Clin 2004;42:933
Donkor J,ArmenianP,HartmanIN,Vohra R.Analysis of Gastric Lavage Reported to a Statewide poision Control System . The Journal of Emergency medicine 2016;51:394-400
Chyka PA,Winbery SL.Quality improvment process in adherence to gastric decontamination guıdlines for poison exposures as recommended by a posion control center.. Qual Manag Health care 2006;15:263-7
Proudfoot AT,KrenzelokEP,Vale JA,position paper on ürine alkalization,J toxicol 2004 42:1-26
Zhonghua Yi Xue Za Zhi.Effects of hemoperfüzyon on the patient with acute toxication 2013;10:2742-4
Brent J, Wallace KL,Burkhart KK,PhilippsSD,Donovan JW.Critical Care Toxicology.Elsevier Mosby 2005 Philadelphia.p1 1-181
Sidell FR.Clinical effects of organophosphorus cholinesterase inhibitors.J Appl toxicol 1994;14:111
Buckley NA, Eddleston M.Li Y,et al.Oximes for acute organophosphate pesticide poisoning.Cochrane Database Syst Rev 2011 CD005085
Mitchell,ST.NewComprehensive Amatoxin Mushroom Poisoning TreatmentProtocol.Clin Tox 2010;48:628
Zhang J,Zhang Y,Peng Z,et al.Experience of treatment of Amantia phalloides-ınduced Fulminant Liver Failure with MARS and Therapeutic Plasma Exchange.ASAIO J 2014;60:407
Tarık O. Alkol zehirlenmeleri.Turkiye Klinikleri J Emerg Med-Special topics.2016;2(1):38-43
Beatty L,Green R,Magee K,Zed P.A systematic review of ethanol and fomepizol use in toxic alcohol ingestions. Emergency Medicine İnternational 2013;2013:14
Barceloux DG,Bond GR,KrenzelokEP,et al .Amerıcan Academy of Clinical Toxicology practice guidlines on the treatment of methanol poisoning.Jtoxicol Clin Toxicol 2002;40:415
Zakharov s, et al. Intermittent hemodialysis is superior to continuous veno-venous hemodialysis/hemodiafiltration to eliminate methanol and formate during treatment for methanol poisoning. Kidney International.
Türkiye Karbonmonoksit Zehirlenmelerinin Önlenmesi Programı ve Eylem Planı (2015-2018). T.C. Sağlık Bakanlığı Türkiye Halk Sağlığı Kurumu, Yayın No:994. Ankara,2015
Rose JJ, Wang L, Xu Q, McTiernan CF, Shiva S, Tejero J, et al. Carbon monoxide poisoning: Pathogenesis, management, and future directions of therapy. Am J Respir Crit CareMed. 2017;195(5):596-606.
Varrassi M, Di Sibio A, Gianneramo C, Perri M, Saltelli G, Splendiani A, et al. Advanced neuroimaging of carbon monoxide poisoning. Neuroradiol J. 2017;30(5):461-9.
Culnan DM, Craft-Coffman B, Bitz GH, Capek KD, Tu Y, Lineaweaver WC, et al. Carbon monoxide and cyanide poisoning in the burned pregnant patient: An indication for hyperbaric oxygen therapy. Ann Plast Surg. 2018;80(3 Suppl 2): S106-S112.
Shimazu T. Pathophysiology, myths and mysteries of acute carbon monoxide poisoning.Chudoku Kenkyu. 2006;19:23-33
Ozyurt A, Karpuz D, Yucel A, et al. Effects of acute carbon monoxide poisoning on ECG and echocardiographic parameters in children. Cardiovasc Toxicol. 2017;17(3):326-34.
Hampson NB,Dunford RD,Kramer CC,Norkool DM.Selecton criteria utılızed for hyperbaric oxygen treatmnet of carbon monoxide poisoning.J Emergency Med.1995;13:227
Love J,Howell J,Litovitz T,Klein Schwartz W. Acute beta blocker overdose:factors associated with the developmen of cardiovascular morbidity.J Toxicol Clin Toxicol2000,38(3):275-281
Doepker B,Healy W,Cortez E,Adkins E.High-dose insulin and intravenous lipid emulsion therapy for cardiogenic shock induced by intentional calcium-channel blocker and Bblocker overdose :a case series.J Emerg med.2014,46(4):486-490
St-Onge,Maude,et al.”Experts consensus recommendations for managementn of calcıum channel blocker poisoning in adult”.Critical care medicine (2017),45:306-15
Murray L,Daly F,Little M,Cadoğan M.Toxicology Handbook(second edition)Elsevier,2011
Çiftçi E, Aydın S. Toxicological evaluation of digital glycosides in congestive heart failure. fABAd j pharm Sci. 2018;43:263-77.
Bronstein AC, Spyker DA, Cantilena LR jr,Green j, Rumack BH, Heard SE. 2006 Annual Report of the American Association of Poison Control Centers’ national Poison Data System (nPDS). Clin Toxicol (Phila).2007;45:815-917.
Park KS. Evaluation and management of caustic injuries from ingestion of acid or alkaline substances. Clin Endosc. 2014;47 :301- 7.
Contini S, Scarpignato C. Caustic injury of the upper gastrointestinal tract: a comprehensive review. World j Gastroenterol. 2013;19:3918-30
Chibishev A, Simonovska n, Shikole A. Postcorrosive Postcorrosive injuries of upper gastrointestinal tract. Prilozi. 2010;31:297-316.
Lusong MAA, Timbol ABG, Tuazon DjS. Management of esophageal caustic injury. World j Gastrointest Pharmacol Ther. 2017;8(2):90-8.
Coronel G, De Lusong M. Sucralfate for the prevention of esophageal stricture formation in corrosive esophagitis: an open label, randomized controlled trial. Endoscopy. 2011;43 (Suppl 1):A42.
Hall AH, jacquemin D, Henny D, Mathieu L, josset P, Meyer B. Corrosive substances ingestion: a review. Critical Reviews in Toxicology. 2019;49(8):637-69
