{"id":3582,"date":"2023-01-18T10:00:00","date_gmt":"2023-01-18T07:00:00","guid":{"rendered":"https:\/\/tatd.org.tr\/toksikoloji\/?p=3582"},"modified":"2023-01-17T20:21:43","modified_gmt":"2023-01-17T17:21:43","slug":"turkiyenin-toksikoloji-haritasi-2022","status":"publish","type":"post","link":"https:\/\/tatd.org.tr\/toksikoloji\/2023\/01\/18\/turkiyenin-toksikoloji-haritasi-2022\/","title":{"rendered":"T\u00fcrkiye\u2019nin Toksikoloji Haritas\u0131 2022"},"content":{"rendered":"\n

Zehirlenmeler \u00fclkemizde \u00e7o\u011fu merkezde, acil servis ba\u015fvurular\u0131n\u0131n ortalama y\u00fczde %1-4\u2019\u00fcn\u00fc olu\u015fturmaktad\u0131r. 40 ya\u015f alt\u0131 \u00f6l\u00fcmlerin %5-6\u2019s\u0131 direkt zehirlenme nedeniyle olurken, yakla\u015f\u0131k %21\u2019i \u00f6zk\u0131y\u0131m nedeniyle ger\u00e7ekle\u015fmektedir. Acil t\u0131p uzmanlar\u0131, her ge\u00e7en g\u00fcn daha kalabal\u0131k acil servislerde, d\u00fcnyada ger\u00e7ekle\u015fen sava\u015flar, pandemiler, afetler nedeniyle farkl\u0131 toplumsal problemlerin yans\u0131mas\u0131yla kar\u015f\u0131 kar\u015f\u0131ya kalmaktad\u0131r. Bu kalabal\u0131k acil servislerde, \u00fclkemizde ne t\u00fcr zehirlenme olaylar\u0131yla kar\u015f\u0131 kar\u015f\u0131ya oldu\u011fumuzu bilmek, \u00f6zellikle nadir g\u00f6r\u00fclen, \u00f6l\u00fcmc\u00fcl olabilen zehirlenme hastalar\u0131n\u0131n y\u00f6netimindeki zorluklar\u0131n acil servis, hastane, il ve \u00fclke baz\u0131nda iyile\u015ftirilebilmesini sa\u011flamak, hem \u00e7al\u0131\u015fan,  hem de hasta g\u00fcvenli\u011fi a\u00e7\u0131s\u0131ndan \u00f6nemlidir. Bu konuyu irdeleyecek olursak;<\/p>\n\n\n\n

Soru 1)<\/strong> D\u00fcnyada ve \u00fclkemizde son y\u0131llarda suistimal edilen yayg\u0131n madde tipleri nelerdir? \u00dclkemiz ve acil servislerimiz i\u00e7in ne t\u00fcr riskler olu\u015fturmaktad\u0131r?<\/p>\n\n\n\n

D\u00fcnya uyu\u015fturucu haritas\u0131na bakt\u0131\u011f\u0131m\u0131zda, \u00fclkemiz jeopolitik konumu nedeniyle maalesef k\u00fcresel uyu\u015fturucu trafi\u011finin anayollar\u0131 \u00fczerinde bulunmaktad\u0131r. T\u00fcm d\u00fcnyada, sadece intraven\u00f6z madde ba\u011f\u0131ml\u0131 say\u0131s\u0131n\u0131n 11.2 milyon oldu\u011fu tahmin edilmektedir. Buna di\u011fer suistimal yollar\u0131 da eklendi\u011finde (oral, intranazal, inhalasyon vb.) maalesef say\u0131 olduk\u00e7a artmaktad\u0131r. Geli\u015fmekte olan kalabal\u0131k n\u00fcfuslu \u00fclkelerde, madde kullan\u0131m\u0131 giderek artmaktad\u0131r. Ayr\u0131ca ya\u015fad\u0131\u011f\u0131m\u0131z Covid 19 pandemisi i\u015fsizlik, yoksulluk, e\u011fitimde aksama, ya\u015fanan ruhsal s\u0131k\u0131nt\u0131lar nedeniyle madde ba\u011f\u0131ml\u0131l\u0131\u011f\u0131 riskinde art\u0131\u015fa katk\u0131da bulunmu\u015ftur. T\u00fcrkiye genelinde y\u00fcr\u00fct\u00fclen TURBAHAR (T\u00fcrkiye Ba\u011f\u0131ml\u0131l\u0131k Risk Profili ve Ruh Sa\u011fl\u0131\u011f\u0131 Haritas\u0131 Projesi, 2019) \u00e7al\u0131\u015fmas\u0131 verilerine g\u00f6re, \u00fclkemizde 18 ya\u015f \u00fcst\u00fc tek tip madde kullan\u0131m oran\u0131n\u0131n ortalama %4.5 oldu\u011fu bildirilmi\u015ftir. D\u00fcnya uyu\u015fturucu haritas\u0131na bak\u0131ld\u0131\u011f\u0131nda, metamfetamin t\u00fcrevlerinin trafi\u011fi ve kullan\u0131m\u0131na dikkat \u00e7ekilmi\u015ftir. Emniyet Genel M\u00fcd\u00fcrl\u00fc\u011f\u00fc, Narkotik Su\u00e7larla M\u00fccadele Daire Ba\u015fkanl\u0131\u011f\u0131\u2019n\u0131n verilerine gore, (T\u00fcrkiye Uyu\u015fturucu Raporu ve Narkolog verileri) 2020 ve 2021 y\u0131llar\u0131nda neredeyse her ilimizde metamfetamin t\u00fcrevlerine rastlan\u0131lmaktad\u0131r. 2015-2019 y\u0131llar\u0131nda, k\u00fcresel boyutta ele ge\u00e7irilen Amfetamin Tipi Sit\u00fcm\u00fclanlar\u0131n, %72\u2019si metamfetamin, %19\u2019u amfetamin ve %4\u2019\u00fc ecstasy<\/em>\u2019dir. \u00d6n\u00fcm\u00fczdeki d\u00f6nemin en b\u00fcy\u00fck tehdidinin bu madde olaca\u011f\u0131 d\u00fc\u015f\u00fcn\u00fclmektedir. Narkotik Su\u00e7larla M\u00fccadele Daire Ba\u015fkanl\u0131\u011f\u0131, metamfetaminin yaratt\u0131\u011f\u0131 sa\u011fl\u0131k sorunlar\u0131n\u0131n yan\u0131nda, toplumsal g\u00fcvenlik zaafiyetine neden olabilece\u011fi konusunda vatanda\u015flar\u0131 uyarabilmek i\u00e7in kaynaklar yay\u0131nlam\u0131\u015ft\u0131r. Metamfetamin, eksite deliryum tablosuna yol a\u00e7arak, kolluk kuvvetleri ve acil servis \u00e7al\u0131\u015fanlar\u0131 i\u00e7in kontrol alt\u0131na al\u0131nmas\u0131 g\u00fc\u00e7 tablolara yol a\u00e7abilirler. Ki\u015filerde sempatomimetik bulgular\u0131n yan\u0131s\u0131ra (takipne, a\u015f\u0131r\u0131 terleme, ajitasyon, ta\u015fikardi, hipertansiyon, hipertermi) polise itaatsizlik, s\u00fcrekli a\u011f\u0131r fiziksel aktiviteye ra\u011fmen yorulmama, ola\u011fan d\u0131\u015f\u0131 insan\u00fcst\u00fc g\u00fc\u00e7 gibi, kontrol alt\u0131na al\u0131nmas\u0131nda ciddi zorluk ya\u015fanan semptomlara yol a\u00e7maktad\u0131r. Bu konuda acil servis g\u00fcvenli\u011finin, \u00e7al\u0131\u015fan ve di\u011fer hastalar i\u00e7in sa\u011flanmas\u0131, gerekli \u00f6nlemlerin planlanmas\u0131 gerekmektedir.<\/p>\n\n\n\n

            Madde al\u0131m\u0131na ba\u011fl\u0131 \u00f6l\u00fcmler incelendi\u011finde, 2017\u2019ye kadar sentetik kannaboidler \u00f6n planda iken, son y\u0131llarda metamfetamine ve uyar\u0131c\u0131 \u00f6zelli\u011fi olan di\u011fer maddelerde art\u0131\u015f g\u00f6r\u00fclmekte ve adli t\u0131p verileri incelendi\u011finde, \u00e7oklu madde al\u0131mlar\u0131na ba\u011fl\u0131 \u00f6l\u00fcmlerin \u00f6n planda oldu\u011fu tespit edilmektedir. \u00d6zellikle farkl\u0131 uyar\u0131c\u0131 maddelerin birarada al\u0131nmas\u0131 durumunda, sempatomimetik sendrom geli\u015fmekte, kardiyotoksisite ve n\u00f6rotoksisite nedeniyle ani \u00f6l\u00fcm s\u0131kl\u0131\u011f\u0131 olduk\u00e7a artmaktad\u0131r.<\/p>\n\n\n\n

2018-2023 Uyu\u015fturucu ile M\u00fccadele Eylem Plan\u0131nda (UMEP) \u201cAt\u0131k Sularda Uyu\u015fturucu Madde Miktar\u0131n\u0131n Tespit Edilmesinin Sa\u011flanmas\u0131na\u201d y\u00f6nelik \u00e7al\u0131\u015fmalara ba\u015flanm\u0131\u015f ve ilgili payda\u015flarla yayg\u0131nla\u015ft\u0131r\u0131lmas\u0131 ama\u00e7lanm\u0131\u015ft\u0131r. Bu kapsamda, 15.02.2018 tarihli Ba\u011f\u0131ml\u0131l\u0131kla M\u00fccadele Y\u00fcksek Kurulu Karar\u0131 uyar\u0131nca at\u0131k su analiz \u00e7al\u0131\u015fmas\u0131n\u0131n, T\u00fcrkiye Ye\u015filay Cemiyeti sorumlulu\u011funda olmak \u00fczere Adli T\u0131p Kurumu, \u0130\u00e7i\u015fleri Bakanl\u0131\u011f\u0131 ve Sa\u011fl\u0131k Bakanl\u0131\u011f\u0131 i\u015f birli\u011finde yap\u0131lmas\u0131na karar verilmi\u015ftir. D\u00fcnyada ki farkl\u0131 b\u00fcy\u00fck kentlerdeki sonu\u00e7larla, \u0130stanbul ve Adana\u2019n\u0131n kar\u015f\u0131la\u015ft\u0131r\u0131lmas\u0131 a\u015fa\u011f\u0131da g\u00f6r\u00fclmektedir.<\/p>\n\n\n

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Soru 2)<\/strong> Ulusal Zehir Dan\u0131\u015fma Merkezi (UZEM) 2014-2020 y\u0131llar\u0131 aras\u0131ndaki verileri yay\u0131nlad\u0131. Acil servislerimiz i\u00e7in dikkat \u00e7eken veriler nelerdir?<\/p>\n\n\n\n

\u00d6ncelikle UZEM\u2019in verileri bildirim yoluyla elde edilmektedir. Bunu belirtmekte fayda var. UZEM\u2019e bildirilen vakalara dayanan istatistiklerle veriler olu\u015fturulmaktad\u0131r. Veriler incelendi\u011finde, zehirlenmelerin en s\u0131k nedeninin, \u00f6zk\u0131y\u0131m ama\u00e7l\u0131 oral yolla ila\u00e7 al\u0131m\u0131 oldu\u011fu g\u00f6r\u00fclmektedir. Oral yolla en s\u0131k insan sa\u011fl\u0131\u011f\u0131 \u00fcr\u00fcnleri (%70.69), ev kimyasallar\u0131 (%9), tar\u0131m kimyasallar\u0131n\u0131n(%4.2) bildirildi\u011fi dikkati \u00e7ekmektedir. Tar\u0131m kimyasal\u0131 bildirimlerinin, son y\u0131llarda artmakta oldu\u011fu g\u00f6r\u00fclm\u00fc\u015ft\u00fcr. Tar\u0131m kimyasallar\u0131n\u0131n akut maruziyetleri yan\u0131nda, kronik maruziyete sebep olan tar\u0131m ilac\u0131 kal\u0131nt\u0131lar\u0131, sebze ve meyve ihracat\u0131nda olduk\u00e7a \u00f6nemli bir noktad\u0131r. Tar\u0131m kimyasallar\u0131 ile ilgili UZEM\u2019de olduk\u00e7a ayr\u0131nt\u0131l\u0131 veriler mevcuttur. Akut maruziyetlerin, kimyasal tipleri de\u011ferlendirildi\u011finde, en s\u0131k birinci s\u0131rada warfarin t\u00fcrevi rodentisitler dikkati \u00e7ekerken, 3. s\u0131rada organik fosfatlar\u0131n yer ald\u0131\u011f\u0131 g\u00f6r\u00fclmektedir. Rodentisitlerin baz\u0131 t\u00fcrleri olduk\u00e7a mortal zehirlenmelere yol a\u00e7maktad\u0131r. \u00dclkemizde kullan\u0131lmas\u0131 yasak olan, striknin gibi t\u00fcrlere ba\u011fl\u0131 zehirlenmelerin, \u00f6zellikle \u0130\u00e7 Anadolu B\u00f6lgesi\u2019nden bildirildi\u011fi yay\u0131nlar mevcuttur. Ba\u015fka bir t\u00fcr rodentisit olan, Al\u00fcminyum fosfid\u2019te \u00e7ok mortal zehirlenmelere yol a\u00e7maktad\u0131r. Ulusal yay\u0131nlara bak\u0131ld\u0131\u011f\u0131nda Akdeniz B\u00f6lgesi\u2019nden bildirilmi\u015f akut mortal zehirlenmelere ek olarak, T\u00fcrkiye\u2019nin her b\u00f6lgesinden bildirilen kazara ya da \u00f6zk\u0131y\u0131m ama\u00e7l\u0131 al\u00fcminyum fosfit zehirlenmelerine ait yay\u0131nlar mevcuttur. Her ne kadar tar\u0131m kimyasallar\u0131n\u0131n sat\u0131\u015f\u0131na, Tar\u0131m Bakanl\u0131\u011f\u0131 taraf\u0131ndan denetim kontrol uygulansa da, ki\u015filerin bilin\u00e7siz kullan\u0131m\u0131 ve suistimali zehirlenmelere yol a\u00e7maya devam etmektedir. <\/p>\n\n\n\n

UZEM raporunda, maruz kal\u0131nan zehirlenme ajanlar\u0131na bak\u0131ld\u0131\u011f\u0131nda, dikkat \u00e7eken bir maddenin de siyan\u00fcr oldu\u011fu izlenmi\u015ftir. 2019 y\u0131l\u0131nda 132 siyan\u00fcr zehirlenme vakas\u0131 bildirilmi\u015ftir. Bu hastalar\u0131n bak\u0131m\u0131nda, ilk yard\u0131m\u0131nda olay yerinden ba\u015flayarak acil servislerde, ki\u015fisel koruyucu ekipmanlar\u0131n kullan\u0131m\u0131 olduk\u00e7a \u00f6nem arzetmektedir. \u0130nhalasyon yoluyla ciddi zehirlenmelere yol a\u00e7abilen bu ajan, \u00e7ok h\u0131zl\u0131 mortal zehirlenmelere sebebiyet verebilir. Antidot temininde h\u0131z \u00f6nemlidir. Ulusal zehir dan\u0131\u015fma merkezinden zehirlenme bildirimi ile beraber antidot sa\u011flanmas\u0131 i\u00e7in gerekli i\u015flemler ba\u015flat\u0131lmal\u0131d\u0131r. B\u00f6lge ve il bazl\u0131 antidote temin merkezleri mevcuttur. Bu merkezlerden siyanokit temin edilebilir.<\/p>\n\n\n\n

Soru 3)<\/strong> \u00dclkemizde zehirlenme kaynakl\u0131 \u00f6l\u00fcmler incelendi\u011finde kar\u015f\u0131m\u0131za \u00e7\u0131kan etkenler nelerdir?<\/p>\n\n\n\n

40 ya\u015f alt\u0131 \u00f6l\u00fcm nedenlerine bak\u0131ld\u0131\u011f\u0131nda, yakla\u015f\u0131k %21\u2019inin \u00f6zk\u0131y\u0131m, %5-6\u2019s\u0131n\u0131n zehirlenmeye ba\u011fl\u0131 \u00f6l\u00fcmler oldu\u011fu bilinmektedir. \u00c7ocuklarda zehirlenmeye ba\u011fl\u0131 \u00f6l\u00fcm nedenleri incelendi\u011finde, karbonmonoksit zehirlenmeleri ve ila\u00e7lara ba\u011fl\u0131 \u00f6l\u00fcmler, ilk s\u0131ralarda yer al\u0131rken, insektisitler, mantar zehirlenmeleri ve y\u0131lan \u0131s\u0131r\u0131klar\u0131 s\u0131ras\u0131yla gelen nedenler olmaktad\u0131r.<\/p>\n\n\n\n

Yeti\u015fkinlerde ise \u00f6l\u00fcme sebebiyet verebilen, \u015fok ve akut organ yetmezli\u011fi yapan zehirlenme nedenlerine bak\u0131ld\u0131\u011f\u0131nda, metil alkol zehirlenmeleri, kardiyovask\u00fcler ila\u00e7 a\u015f\u0131r\u0131 al\u0131mlar\u0131, tar\u0131m kimyasallar\u0131, karbonmonoksit zehirlenmeleri ilk s\u0131ralarda yer almaktad\u0131r. Son y\u0131llarda zehirlenmelere ba\u011fl\u0131 yeti\u015fkin \u00f6l\u00fcmleri incelendi\u011finde, metil alkol zehirlenmelerinin \u00f6n planda oldu\u011fu, takiben tar\u0131m kimyasallar\u0131, ila\u00e7lar (KVS ila\u00e7lar\u0131, parasetamol, kol\u015fisin vb.), karbomonoksit, mantar zehirlenmeleri oldu\u011fu g\u00f6r\u00fclmektedir. Metil alkol zehirlenmelerinde, bu hastalar\u0131n hastane acil servislerinden hemodiyalize eri\u015fim s\u00fcrelerini k\u0131saltacak, il ve hastane baz\u0131nda olu\u015fturulan algoritmalar, hayat kurtar\u0131c\u0131 olup kal\u0131c\u0131 k\u00f6rl\u00fck gibi sekel oranlar\u0131n\u0131 da olduk\u00e7a azaltacakt\u0131r.<\/p>\n\n\n\n

Karbonmonoksit zehirlenmeleri t\u00fcm d\u00fcnyada oldu\u011fu gibi \u00fclkemizde de halen \u00e7ok mortal sonu\u00e7lar do\u011furabilen bir nedendir. \u00dclkemizde 2013-2017 y\u0131llar\u0131 aras\u0131nda mortalite h\u0131z\u0131n\u0131n en y\u00fcksek oldu\u011fu \u015fehirler Manisa ve Bal\u0131kesir olarak bildirilmi\u015f olup, tablo a\u015fa\u011f\u0131da verilmi\u015ftir. Endikasyonu olan hastalarda, hiperbarik oksijen merkezlerine ula\u015f\u0131m mortaliteyi ve kal\u0131c\u0131 sekelleri \u00f6nleyecektir. Mekanik ventilasyon ihtiyac\u0131 olan, a\u011f\u0131r komat\u00f6z karbonmonoksit zehirlenmesi olan hastalarda ise, ekstrakorporeal \u00e7\u0131kar\u0131m metodu olarak eritrosit aferezi uygulanm\u0131\u015f vakalarda, bildirilen iyi sonu\u00e7lar mevcuttur.  <\/p>\n\n\n

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4)<\/strong> \u00dclkemizde venomu olan canl\u0131lara ba\u011fl\u0131 zehirlenmelere bakt\u0131\u011f\u0131m\u0131zda,<\/p>\n\n\n\n

Venomu olan canl\u0131lara ba\u011fl\u0131 zehirlenme vakalar\u0131ndan, 2019 y\u0131l\u0131nda UZEM\u2019e bildirilen 3560 vaka oldu\u011funu g\u00f6r\u00fcyoruz. T\u00fcrkiye\u2019nin her b\u00f6lgesinde bu vakalara rastlansa da, Akdeniz, G\u00fcneydo\u011fu Anadolu B\u00f6lgesi ve Ege B\u00f6lgesi\u2019nde s\u0131kl\u0131\u011f\u0131 daha fazlad\u0131r. Bu vakalar\u0131n neredeyse tamam\u0131 bahar ve yaz aylar\u0131nda kar\u015f\u0131m\u0131za \u00e7\u0131kmaktad\u0131r. Genellikle ilk s\u0131ray\u0131 akrep sokmalar\u0131 al\u0131rken, 2. s\u0131rada y\u0131lan \u0131s\u0131r\u0131\u011f\u0131na ba\u011fl\u0131 zehirlenmeler gelmektedir. Y\u0131lan \u0131s\u0131r\u0131klar\u0131 ve akrep sokmalar\u0131na ba\u011fl\u0131 zehirlenmeler \u00f6l\u00fcme sebebiyet verebilir. Y\u0131lan \u0131s\u0131r\u0131\u011f\u0131na ba\u011fl\u0131, dakikalar i\u00e7erisinde olduk\u00e7a a\u011f\u0131r mortal tablolar ortaya \u00e7\u0131kabilir. Bu hastalara h\u0131zl\u0131ca antivenom verilmesi hayat kurtar\u0131c\u0131 olacakt\u0131r. Son y\u0131llarda deniz canl\u0131lar\u0131 ile olan zehirlenmeler dikkati \u00e7ekmekte, \u00f6zellikle balon bal\u0131\u011f\u0131n\u0131n yanl\u0131\u015fl\u0131kla besin olarak t\u00fcketilmesine ba\u011fl\u0131 \u00f6l\u00fcmc\u00fcl zehirlenme tablolar\u0131yla kar\u015f\u0131la\u015f\u0131lmaktad\u0131r. Ege B\u00f6lgesi ve Akdeniz B\u00f6lgesi\u2019nden bildirimler daha fazlad\u0131r. Balon bal\u0131\u011f\u0131nda bulunan tetradotoksin \u0131s\u0131ya dayan\u0131kl\u0131 bir toksindir. Pi\u015firilmekle denature olmaz. Halk\u0131n balon bal\u0131\u011f\u0131 gibi \u00f6l\u00fcmc\u00fcl zehire sahip deniz canl\u0131lar\u0131 konusunda bilgilendirilmesi, bunlar\u0131n d\u0131\u015f g\u00f6r\u00fcn\u00fc\u015flerinin bilinerek t\u00fcketilmemesi, bu zehirlenmeleri olduk\u00e7a azaltacakt\u0131r.<\/p>\n\n\n\n

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(Balon bal\u0131\u011f\u0131 d\u0131\u015f g\u00f6r\u00fcn\u00fcm\u00fc)<\/figcaption><\/figure>\n\n\n\n

\u00dclkemizde \u00d6r\u00fcmcek sokmas\u0131na ba\u011fl\u0131 da bildirimler mevcuttur (UZEM\u2019e bildirilen \u00f6r\u00fcmcek \u0131s\u0131r\u0131\u011f\u0131 say\u0131s\u0131 128). Asl\u0131nda \u00f6r\u00fcmcek \u0131s\u0131r\u0131\u011f\u0131na ikincil zehirlenmeler nadiren acil servislerde kar\u015f\u0131m\u0131za \u00e7\u0131kmaktad\u0131r. \u00dclkemizde toplumda en s\u0131k g\u00f6r\u00fclen kahverengi ke\u015fi\u015f \u00f6r\u00fcmce\u011fine ba\u011fl\u0131 lokal toksisitedir, olduk\u00e7a a\u011f\u0131r lokal hasara yol a\u00e7abilir. Sistemik toksisitesi olduk\u00e7a nadirdir. Zehirli di\u011fer bir t\u00fcr, ciddi zehirlenme tablolar\u0131na yol a\u00e7an karadul \u00f6r\u00fcmce\u011fidir. Venomuna ba\u011fl\u0131 ciddi lokal a\u011fr\u0131, kas kramplar\u0131, n\u00f6rotoksisite, kardiyotoksisite, otonom bozukluklarla karekterize bu tabloya \u2018Latrodectism\u2019 ad\u0131 verilir. \u00dclkemizden nadiren bildirilen vakalar mevcut olup, baz\u0131 y\u0131llarda ve b\u00f6lgelerde (Akdeniz B\u00f6lgesi) bildirim s\u0131kl\u0131\u011f\u0131 artmaktad\u0131r. T\u00fcm d\u00fcnyada karadul toksisitesine rastlanmakla beraber, d\u00fcnyan\u0131n belli b\u00f6lgelerinde spesifik antivenomu vard\u0131r. Fakat t\u00fcm d\u00fcnyada antivenoma eri\u015fimi k\u0131s\u0131tl\u0131d\u0131r. \u00dclkemizde antivenomu bulunmamaktad\u0131r.<\/p>\n\n\n\n

\n
\"\"<\/figure>\n\n\n\n
\"\"<\/figure>\n
Karadul \u00d6r\u00fcmce\u011fi<\/figcaption><\/figure>\n\n\n\n

5)<\/strong> \u00dclkemizde Mantar zehirlenmeleri<\/p>\n\n\n\n

T\u00fcm d\u00fcnyada ve \u00fclkemizde zehirlenmeye ba\u011fl\u0131 mortalitenin \u00f6nemli nedenlerinden biri mantar zehirlenmeleridir. \u00dclkemizde mantar zehirlenmeleri ile ilgili \u00e7al\u0131\u015fmalar incelendi\u011finde, genellikle t\u00fcr bildirimlerinin olmad\u0131\u011f\u0131 g\u00f6r\u00fclmektedir. Y\u0131ll\u0131k UZEM\u2019e bildirilen yakla\u015f\u0131k 3500 civar\u0131 vaka mevcuttur. Karadeniz, Marmara, Akdeniz, Ege B\u00f6lgesi ba\u015fta olmak \u00fczere T\u00fcrkiye\u2019nin her b\u00f6lgesi\u2019nde g\u00f6r\u00fclmektedir. Mantar zehirlenmelerine ba\u011fl\u0131 akut karaci\u011fer toksisitesinin g\u00f6r\u00fcld\u00fc\u011f\u00fc vakalarda silibilin \u00f6nerilmektedir. Literat\u00fcr incelendi\u011finde mantar zehirlenmesine ba\u011fl\u0131 antidot kullan\u0131m\u0131 ile ilgili g\u00fc\u00e7l\u00fc kan\u0131t d\u00fczeyinde veri maalesef yoktur. N_asetil sistein ve Silibilin klasik kaynaklarda \u00f6nerilmektedir. Zehirlenme hastalar\u0131nda tedavi \u00e7o\u011funlukla vaka serisi bildirimlerine dayan\u0131r. Bu nedenle akut karaci\u011fer toksisitesi geli\u015fen bir hastada genel \u00f6neriler klasik toksikoloji kitaplar\u0131nda silibilin kullan\u0131lmas\u0131 y\u00f6n\u00fcndedir. Yap\u0131lm\u0131\u015f geni\u015f vaka serili literatur analizlerine bak\u0131ld\u0131\u011f\u0131nda, amatoxin zehirlenmlerinde silibiline kullan\u0131lan ve kullan\u0131lmayan hastalarda anlaml\u0131 bir mortalite fark\u0131 olmad\u0131\u011f\u0131n\u0131 bildirilsede, bu \u00e7al\u0131\u015fmalar\u0131n hi\u00e7biri randomize kontroll\u00fc \u00e7al\u0131\u015fmalar de\u011fildir. Daha a\u011f\u0131r toksisitelerde silibilline kullan\u0131m\u0131 tercih edildi\u011fi i\u00e7in, mortalite fark\u0131n\u0131n olmamas\u0131 bile anlaml\u0131 olabilir mi? sorusunu akla getirmektedir. \u00dclkemizde \u00f6zellikle b\u00f6lgesel mantar t\u00fcrlerinin bildirildi\u011fi yay\u0131nlara ihtiya\u00e7 vard\u0131r.<\/p>\n\n\n\n

Sonu\u00e7 olarak, zehirlenmeler gen\u00e7 eri\u015fkinlerde \u00f6nemli bir \u00f6l\u00fcm nedenidir. \u00dclkemizde mortal sonu\u00e7lara neden olabilen zehirlenme etiyolojik ajanlar\u0131n riskli alanlar\u0131 belirlenerek, tedavi i\u00e7in hastane, il, b\u00f6lge bazl\u0131 kaynaklara erken eri\u015fim de\u011ferlendirilmelidir. Ayn\u0131 zamanda halk\u0131 bilgilendirecek e\u011fitici faaliyetler (\u00f6zellikle \u00e7ok fazla ki\u015fiye ula\u015f\u0131m\u0131n sa\u011fland\u0131\u011f\u0131 medya arac\u0131l\u0131 bildirimler) kazara zehirlenmeleri azaltabilir.<\/p>\n\n\n\n

KAYNAKLAR<\/strong><\/p>\n\n\n\n

T\u00fcrkiye\u2019nin Toksikolojik Haritas\u0131, TATD, 1-5 Aral\u0131k, 8. Avrasya Acil T\u0131p, 18. T\u00fcrkiye Acil T\u0131p ve 17. WINFOCUS D\u00fcnya Kongresinde,<\/strong> Toksikoloji Paneli, Sunu \u00d6zeti.<\/p>\n\n\n\n

D\u00fcnya uyu\u015furucu madde raporu 2022, https:\/\/www.unodc.org\/unodc\/en\/data-and-analysis\/world-drug-report-2022.html<\/a><\/p>\n\n\n\n

D\u00fcnya uyu\u015fturucu madde raporu 2021, https:\/\/www.unodc.org\/unodc\/en\/data-and-analysis\/wdr2021.html<\/a><\/p>\n\n\n\n

D\u00fcnya uyu\u015fturucu madde raporu 2020, https:\/\/wdr.unodc.org\/wdr2020\/en\/index2020.html<\/a><\/p>\n\n\n\n

D\u00fcnya uyu\u015fturucu madde raporu 2019,<\/p>\n\n\n\n

T\u00fcrkiye uyu\u015fturucu raporu 2022 https:\/\/www.narkotik.pol.tr\/kurumlar\/narkotik.pol.tr\/TUB%C4%B0M\/Ulusal%20Yay%C4%B1nlar\/Turkiye-Uyusturucu-Raporu-2022.pdf<\/p>\n\n\n\n

Narkolog 2022, Madde kullan\u0131c\u0131lar\u0131 profil analizi, http:\/\/www.narkotik.pol.tr\/kurumlar\/narkotik.pol.tr\/TUB%C4%B0M\/Ulusal%20Yay%C4%B1nlar\/NARKOLOG-2022-MADDE-KULLANICILARI-PROFIL-ANALIZI.pdf<\/p>\n\n\n\n

TURBAHAR, T\u00fcrkiye Ba\u011f\u0131ml\u0131l\u0131k Risk Profili ve Ruh Sa\u011fl\u0131\u011f\u0131 Haritas\u0131 Proje Sonu\u00e7 Raporu 2019, Hseyin \u00dcn\u00fcbol, G\u00f6kben H\u0131zl\u0131 Sayar. https:\/\/uuyayinlari.com\/turbahar-turkiye-bagimlilik-risk-profili-ve-ruh-sagligi-haritasi-proje-sonuc-raporu-2019<\/p>\n\n\n\n

F Asicioglu , M Kuloglu Genc , T Tekin Bulbul , M Yayla , SZ Simsek, C Adioren, S Mercan, \u2217 Investigation of temporal illicit drugs, alcohol and tobacco trends in Istanbul city: Wastewater analysis of 14 treatment plants. Water Research 190 (2021), 116729<\/p>\n\n\n\n

Ulusal Zehir Dan\u0131\u015fma Merkezi (UZEM) Raporlar\u0131 2014-2020, https:\/\/hsgm.saglik.gov.tr\/depo\/kurumsal\/yayinlarimiz\/Raporlar\/Uzem\/uzem_raporlari_2014-2020.pdf<\/p>\n\n\n\n

Faysal Tekin, Ay\u00e7a A\u00e7\u0131kal\u0131n Akp\u0131nar, \u00d6mer Ta\u015fk\u0131n, Ufuk Akday, N. Rana Di\u015fel and Emre Karako\u00e7. (2022) “Prospective analysis of intoxicated patients developing shock and\/or organ failure,” Turkish Journal of Medical Sciences: Vol. 52: No. 5, Article 28. https:\/\/doi.org\/10.55730\/1300-0144.5508Availableat: https:\/\/journals.tubitak.gov.tr\/medical\/vol52\/iss5\/28<\/p>\n\n\n\n

Valerie Romann<\/a>,Monika Illgen<\/a>, Adrian Derungs<\/a>, Jolanta Klukowska-R\u00f6tzler<\/a>, Meret E Ricklin<\/a>,Aristomenis Exadaktylos<\/a> ,Evangelia Liakoni<\/a>.Presentations with reported methamphetamine use to an urban emergency department in Switzerland Swiss Med Wkly. 2021 Dec 28;151:w30099.  doi: 10.4414\/smw.2021.w30099. eCollection 2021 Dec 20.<\/p>\n\n\n\n

Karadeniz H, Birincioglu I, Turna O, Ketenci HC, Beyhun NE. Fatal poisoning of chilhood in the Eastern Black Sea region of Turkey (2009-2013).<\/a> .J Forensic Leg Med. 2015 Aug;34:109-12. doi: 10.1016\/j.jflm.2015.06.001. Epub 2015 Jun 10.PMID: 26165668<\/p>\n\n\n\n

Tugba Atmaca Temrel, Mortality rate associated with carbon monoxide poisoning in Turkey: A national database study (JPMA 71: 262; 2021), DOI: https:\/\/doi.org\/10.47391\/JPMA.637<\/a><\/p>\n\n\n\n

Zengin S, Y\u0131lmaz M, Al B, Yildirim C, Yavuz E, Akcali A. Therapeutic red cell exchange for severe carbon monoxide poisoning.<\/a> .J Clin Apher. 2013 Oct;28(5):337-40. doi: 10.1002\/jca.21282. Epub 2013 Jun 8.PMID: 23749385<\/p>\n\n\n\n

Demet Altun, Dilek Altun, Bet\u00fcl Ayaz. Y\u0131lan sokmalar\u0131nda Klinik deneyimimiz. J Turk Soc Intensive Care 2016;14:100-4 DOI: 10.4274\/tybdd.74046<\/p>\n\n\n\n

Fatma \u00dc\u00c7E\u015e, Mehmet Z\u00fclf\u00fc YILDIZ. Snakes of \u015eanl\u0131urfa  Province. Commagene journal of biology 4(1): 36-61. DOI: 10.31594\/commagene.725036<\/p>\n\n\n\n

Abstract Book EACEM 2022, https:\/\/www.eacem.org\/<\/a>, Sevcan Se\u00e7inti, \u00d6mer Ta\u015fk\u0131n, Ay\u00e7a A\u00e7\u0131kal\u0131n Akp\u0131nar, N. Rana Di\u015fel, Zeynep Keke\u00e7, Ahmet Sebe. Black widow spider toxicity in Turkey. A report of three cases.<\/p>\n\n\n\n

Coexistence of Rhabdomyolysis, Myocarditis and Arrhythmia after Spider Bite: A Case Report.<\/a> Y\u0131lmaz M, Ak\u00e7ay G, G\u00fcrses D.J Trop Pediatr. 2022 Apr 5;68(3):fmac027. doi: 10.1093\/tropej\/fmac027.<\/p>\n\n\n\n

Erdur B, Turkcuer I, Bukiran A, Kuru O, Varol I.Uncommon cardiovascular manifestations after a Latrodectus bite.<\/a>Am J Emerg Med. 2007 Feb;25(2):232-5. doi: 10.1016\/j.ajem.2006.11.005<\/p>\n\n\n\n

Ratsameekhae Jongthun<\/a>, Pasin Hemachudha<\/a> <\/sup>, Supaporn Wacharapluesadee<\/a> <\/sup>, Thiravat Hemachudha<\/a> <\/sup>Trop Doct Low-cost management of mushroom poisoning in a limited-resource area: a 12-year retrospective study 2020 Apr;50(2):135-138. doi: 10.1177\/0049475519897704. Epub 2020 Jan 21.<\/p>\n\n\n\n

Nurdan Acar, Mustafa Emin \u00c7anak\u00e7\u0131. Acil servise erken ve ge. D\u00f6nemde ba\u015fvuran mantar zehirlenmesi olgular\u0131n\u0131n de\u011ferlendirilmesi, 10 y\u0131ll\u0131k g\u00f6zlemsel \u00e7al\u0131\u015fma. Ankara Med J.  2020;(3):531-540<\/p>\n\n\n\n

Serdar \u00d6zdemir1 \u0130brahim Altunok1 Abuzer \u00d6zkan1 Abdullah Alg\u0131n1 Hatice \u015eeyma Ak\u00e7a1 G\u00f6khan Aksel1 Serkan Emre Ero\u011flu. 1Effect of the COVID-19 Pandemic on Emergency Department Presentations with Mushroom Poisoning: A Report from Turkey. Avicenna J Med 2022;12:105\u2013110<\/p>\n\n\n\n

Lacombe G, St-Onge M. Towards evidence-based emergency medicine: best BETs from the Manchester Royal Infirmary. BET 1: Silibinin in suspected amatoxin-containing mushroom poisoning.<\/a> Emerg Med J. 2016 Jan;33(1):76-7. doi: 10.1136\/emermed-2015-205558.1.<\/p>\n\n\n\n

. <\/p>\n","protected":false},"excerpt":{"rendered":"

Zehirlenmeler \u00fclkemizde \u00e7o\u011fu merkezde, acil servis ba\u015fvurular\u0131n\u0131n ortalama y\u00fczde %1-4\u2019\u00fcn\u00fc olu\u015fturmaktad\u0131r. 40 ya\u015f alt\u0131 \u00f6l\u00fcmlerin %5-6\u2019s\u0131 direkt zehirlenme nedeniyle olurken, yakla\u015f\u0131k %21\u2019i \u00f6zk\u0131y\u0131m nedeniyle ger\u00e7ekle\u015fmektedir.<\/p>\n","protected":false},"author":1592,"featured_media":3593,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"inline_featured_image":false,"_lmt_disableupdate":"","_lmt_disable":"","footnotes":""},"categories":[10014],"tags":[406],"class_list":["post-3582","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-akademik-blog-yazisi","tag-toksikoloji"],"acf":[],"_links":{"self":[{"href":"https:\/\/tatd.org.tr\/toksikoloji\/wp-json\/wp\/v2\/posts\/3582","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/tatd.org.tr\/toksikoloji\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/tatd.org.tr\/toksikoloji\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/tatd.org.tr\/toksikoloji\/wp-json\/wp\/v2\/users\/1592"}],"replies":[{"embeddable":true,"href":"https:\/\/tatd.org.tr\/toksikoloji\/wp-json\/wp\/v2\/comments?post=3582"}],"version-history":[{"count":0,"href":"https:\/\/tatd.org.tr\/toksikoloji\/wp-json\/wp\/v2\/posts\/3582\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/tatd.org.tr\/toksikoloji\/wp-json\/wp\/v2\/media\/3593"}],"wp:attachment":[{"href":"https:\/\/tatd.org.tr\/toksikoloji\/wp-json\/wp\/v2\/media?parent=3582"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/tatd.org.tr\/toksikoloji\/wp-json\/wp\/v2\/categories?post=3582"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/tatd.org.tr\/toksikoloji\/wp-json\/wp\/v2\/tags?post=3582"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}