{"id":3724,"date":"2024-04-26T20:17:12","date_gmt":"2024-04-26T17:17:12","guid":{"rendered":"https:\/\/tatd.org.tr\/toksikoloji\/?p=3724"},"modified":"2024-04-26T20:17:13","modified_gmt":"2024-04-26T17:17:13","slug":"metanol-zehirlenmesi-ve-uzun-donem-klinik-sonuclari","status":"publish","type":"post","link":"https:\/\/tatd.org.tr\/toksikoloji\/2024\/04\/26\/metanol-zehirlenmesi-ve-uzun-donem-klinik-sonuclari\/","title":{"rendered":"METANOL ZEH\u0130RLENMES\u0130 VE UZUN D\u00d6NEM KL\u0130N\u0130K SONU\u00c7LARI"},"content":{"rendered":"\n<p><strong>Yazar: <\/strong>Uzm. Dr. Giray Alt\u0131nok, Mersin \u015eehir Hastanesi, Acil T\u0131p Klini\u011fi, Mersin<\/p>\n\n\n\n<p><strong>Moderat\u00f6r<\/strong>: Prof. Dr. Seyran Bozkurt, Mersin \u00dcniversitesi T\u0131p Fak\u00fcltesi Acil T\u0131p Anabilim Dal\u0131<\/p>\n\n\n\n<p>Metanol intoksikasyonlar\u0131 akut y\u00fcksek doz al\u0131m ve kronik d\u00fc\u015f\u00fck doz al\u0131m \u015feklinde kendini g\u00f6sterebilmektedir. Kronik y\u00fcksek doz al\u0131mlara dair literat\u00fcr bilgisi olduk\u00e7a azd\u0131r. \u00c7o\u011funlukla i\u015f yerlerinde ve inhalasyon\/dermal maruziyete ba\u011fl\u0131 g\u00f6r\u00fclmekte ve dermatit, g\u00f6z irritasyonu, ba\u015fa\u011fr\u0131s\u0131, g\u00f6rme bulan\u0131kl\u0131\u011f\u0131 \u015feklinde bulgular ortaya \u00e7\u0131kt\u0131\u011f\u0131 bildirilmi\u015ftir [1,2].<\/p>\n\n\n\n<p><strong>Akut Y\u00fcksek Doz Al\u0131m<\/strong><\/p>\n\n\n\n<p>Metanol g\u00f6rece d\u00fc\u015f\u00fck toksisiteye sahip bir alkol t\u00fcr\u00fcd\u00fcr. Akut metanol intoksikasyonlar\u0131nda temel patogenezden sorumlu olan madde metanol metaboliti olan formik asittir. Metanol oral al\u0131mdan sonra h\u0131zl\u0131ca emilerek karaci\u011ferde alkol dehidrojenaz arac\u0131l\u0131\u011f\u0131yla formaldehite, formaldehit ise aldehitdehidrojenaz aracal\u0131\u011f\u0131yla formik asite d\u00f6n\u00fc\u015f\u00fcr. Ortaya \u00e7\u0131kan formik asit, sitokorom-c inhibisyonu yaparak h\u00fccresel d\u00fczeyde hipoksemiye neden olur. Metanol\u00fcn toksik metabolitlerine d\u00f6n\u00fc\u015f\u00fcm\u00fc genellikle saatler s\u00fcrer bu nedenle klinik bulgular latent periyot sonras\u0131nda ortaya \u00e7\u0131kar (Tablo 1) [3].<\/p>\n\n\n\n<p>Al\u0131nan metanol miktar\u0131, asidoz d\u00fczeyi ve n\u00f6rolojik semptomlar prognozu belirleyen temel parametrelerdir [4]. Tedavide temel hedefler metabolitlerin olu\u015fmas\u0131n\u0131 engellemek (etanol\/fomepizol), asidozu engellemek ve metabolitleri uzakla\u015ft\u0131rmak ( alkalinizasyon ve dializ) \u00fczerine kuruludur.<\/p>\n\n\n\n<p><strong>Tablo-1:<\/strong>&nbsp; Akut metanol intoksikasyonunda klinik bulgular [3].<\/p>\n\n\n\n<figure class=\"wp-block-table\"><div class=\"pcrstb-wrap\"><table><tbody><tr><td>Klinik<\/td><td>Yorum<\/td><\/tr><tr><td>Akut SSS depresyonu<\/td><td>Metanol\u00fcn kendi etkisi, etanole g\u00f6re daha az belirgin olup ilk saatlerde ortaya \u00e7\u0131kar. G\u0130S irritasyonu e\u015flik eder<\/td><\/tr><tr><td>Asemptomatik latent periyot<\/td><td>Al\u0131mdan sonraki 12-24 saat, nadiren 48 saat s\u00fcrer. Hasta belirgin semptom veya bulgu tariflemez<\/td><\/tr><tr><td>Metabolik Asidoz<\/td><td>Bulant\u0131, kusma ve ba\u015f a\u011fr\u0131s\u0131 asidozla beraber g\u00f6r\u00fclebilir<\/td><\/tr><tr><td>Okuler Toksisite<\/td><td>Hafif fotofobi ve &#8220;kar alan\u0131&#8221; g\u00f6r\u00fc\u015f\u00fcnden belirgin derecede azalm\u0131\u015f g\u00f6rme keskinli\u011fine ve k\u00f6rl\u00fc\u011fe kadar de\u011fi\u015fen g\u00f6rme bozukluklar\u0131, al\u0131mdan 12-48 saat sonra geli\u015febilir. G\u00f6rme bozuklu\u011fu genellikle merkezi skotom veya optik atrofiye sekonder tam k\u00f6rl\u00fck \u015feklinde olur.<\/td><\/tr><tr><td>Major SSS toksisitesi<\/td><td>Semptomlar maruziyetten 12-24 saat sonra ortaya \u00e7\u0131kar ve metabolik asidozun bir sonucu olarak geli\u015febilecek n\u00f6betleri, komay\u0131 veya beyin \u00f6demini i\u00e7erir. Tremor, demans, rijidite ve bradikinezide g\u00f6zlemlenmi\u015ftir.<\/td><\/tr><\/tbody><\/table><\/div><\/figure>\n\n\n\n<p><strong>METANOL \u0130NTOKS\u0130KASYONUNUN UZUN D\u00d6NEM ETK\u0130LER\u0130<\/strong><\/p>\n\n\n\n<p>Akut metanol intoksikasyonunun uzun d\u00f6nem etkilerine dair yap\u0131lan \u00e7al\u0131\u015fmalar hasta takibinin zor olmas\u0131 sebebiyle olduk\u00e7a k\u0131s\u0131tl\u0131d\u0131r [5,6]. \u00c7al\u0131\u015fmalarda uzun d\u00f6nem etkiler daha \u00e7ok g\u00f6z ve n\u00f6rolojik sekeller \u00fczerine odaklanmaktad\u0131r. Hastalarda geli\u015fen b\u00f6brek yetmezli\u011fi sekeli a\u00e7\u0131s\u0131ndan Wang ve arkada\u015flar\u0131n\u0131n yapt\u0131\u011f\u0131 metanaliz \u00e7al\u0131\u015fmas\u0131; \u00e7al\u0131\u015fma standartlar\u0131n\u0131n uygun olmad\u0131\u011f\u0131, t\u00fcm toksik alkol t\u00fcrlerinin uzun vadeli sonu\u00e7lar\u0131na ili\u015fkin raporlar\u0131n yetersizli\u011fini vurgulamaktad\u0131r [7].<\/p>\n\n\n\n<p>Metanol intoksikasyonun uzun d\u00f6nem etkileri; optik n\u00f6ropatiye ba\u011fl\u0131 g\u00f6rme bozukluklar\u0131, parkinsonizm, ensefalopati ve periferik n\u00f6ropatidir [8].<\/p>\n\n\n\n<ol class=\"wp-block-list\">\n<li><strong>Optik N\u00f6ropati<\/strong><\/li>\n<\/ol>\n\n\n\n<p>Metanol intoksikasyonuna ba\u011fl\u0131 optik n\u00f6ropati (M\u0130BON) uzun d\u00f6nem sekeller aras\u0131nda en s\u0131k g\u00f6r\u00fclenidir. Tedavi yakla\u015f\u0131mlar\u0131 geli\u015fmesine ra\u011fmen hayatta kalanlar\u0131n %30-40&#8217;\u0131nda kal\u0131c\u0131 g\u00f6rsel hasar ortaya \u00e7\u0131kmaktad\u0131r. Uzun d\u00f6nem sonu\u00e7lara bak\u0131ld\u0131\u011f\u0131nda tam k\u00f6rl\u00fck, g\u00f6rme alan\u0131 defektleri, renk k\u00f6rl\u00fc\u011f\u00fc olarak kar\u015f\u0131m\u0131za \u00e7\u0131kabilmektedir [9]. G\u00f6rme sorunlar\u0131 \u00e7o\u011funlukla ba\u015fvuruda ortaya \u00e7\u0131kmakla beraber Zakharov ve arkada\u015flar\u0131 taraf\u0131ndan yap\u0131lan \u00e7al\u0131\u015fmada hastalar\u0131n takiplerinde de ortaya \u00e7\u0131kabilece\u011fi bildirilmi\u015ftir [10]. Subakut d\u00f6nemde g\u00f6rme bozuklu\u011funun ortaya \u00e7\u0131kmas\u0131n\u0131n alt\u0131nda yatan temel sebep akut d\u00f6nemde hastan\u0131n mevcut bulgular\u0131 ay\u0131rt etmekte zorlanmas\u0131d\u0131r. Ayr\u0131ca akut d\u00f6nemde geli\u015fen optik hasar\u0131n tespiti i\u00e7in ileri testler (oculer coherence tomography\/OCT, VEP \/visual evoked potential) \u00e7o\u011fu zaman akut d\u00f6nemde yap\u0131lmad\u0131\u011f\u0131 i\u00e7in bulgular ancak subakut d\u00f6nemde tan\u0131 almaktad\u0131r.<\/p>\n\n\n\n<p>&nbsp;Optik n\u00f6ropatinin molek\u00fcler temelinin alt\u0131nda yatan ana mekanizma, metanol\u00fcn toksik metaboliti olan formik asidin bu s\u00fcrecin anahtar enzimi olan sitokrom c oksidaz ile ba\u011flanmas\u0131 yoluyla mitokondriyal oksidatif fosforilasyon s\u00fcrecinin inhibisyonudur. G\u00f6z dokular\u0131ndaki histopatolojik de\u011fi\u015fiklikler, esas olarak optik sinirin aksonlar\u0131n\u0131n ve glial h\u00fccrelerinin dejenerasyonu ile kendini g\u00f6sterir ve s\u0131kl\u0131kla retinan\u0131n t\u00fcm katmanlar\u0131n\u0131 tutabilen hasara e\u015flik eder [9].<\/p>\n\n\n\n<p>M\u0130BON genellikle iki tarafl\u0131, simetriktir ve \u00e7o\u011fu durumda \u015fiddetli, h\u0131zl\u0131 ilerleyen bir seyir g\u00f6sterir. Ba\u015fvuru s\u0131ras\u0131nda hastalar; g\u00f6z k\u00fcresinin arkas\u0131nda yer alan g\u00f6z a\u011fr\u0131s\u0131, g\u00f6rme keskinli\u011finde hafif bir azalmadan, tamamen g\u00f6rme kayb\u0131na kadar varan g\u00f6rme bozukluklar\u0131 bildirebilirler. Hastalarda bozulmu\u015f kontrast duyarl\u0131l\u0131\u011f\u0131, diskromatopsi, bulan\u0131k g\u00f6rme, diplopi, periferik g\u00f6rme alan\u0131 defekti olan veya olmayan santral veya seosantral skotom ve daha nadir olarak sakkadik g\u00f6z hareketleri ve g\u00f6rsel hal\u00fcsinasyonlar gibi di\u011fer semptomlar da mevcut olabilir [11-13].<\/p>\n\n\n\n<p>Fizik muayenede g\u00f6zde k\u0131zar\u0131kl\u0131k, g\u00f6zbebeklerinin \u0131\u015f\u0131\u011fa tepkisizli\u011fi tespit edilebilir. Karakteristik g\u00f6z muayenesinde pupiller dilatasyon, pupiller refleks kayb\u0131 optik disk hiperemisi, disk soluklu\u011fu veya optik disk \u00f6demi g\u00f6r\u00fclebilir [11-13].<\/p>\n\n\n\n<p>M\u0130BON tan\u0131s\u0131nda fundus muayenesi, okuler tomografi ve okuler ultrasonografi kullan\u0131labilir. Fundus muayenesinde genellikle iki tarafl\u0131 hiperemi ve optik disk \u00f6demi ortaya \u00e7\u0131kar; metanol intoksikasyonundan 6-24 saat sonra ortaya \u00e7\u0131kar. Retinal \u00f6dem 6-10 g\u00fcn kadar s\u00fcrd\u00fckten sonra yerini \u00e7o\u011funlukla retinal atrofiye b\u0131rak\u0131r [14]. Kemal \u015eener ve arkada\u015flar\u0131 taraf\u0131ndan yap\u0131lan \u00e7al\u0131\u015fmada, akut d\u00f6nemde ok\u00fcler ultrasonografi de optik sinir k\u0131l\u0131f\u0131 \u00e7ap\u0131n\u0131n metanol zehirlenmesi vakalar\u0131nda artt\u0131\u011f\u0131n\u0131, etanol zehirlenmesi vakalar\u0131nda art\u0131\u015f olmad\u0131\u011f\u0131n\u0131 tespit etmi\u015flerdir. \u00c7al\u0131\u015fmada optik sinir k\u0131l\u0131f\u0131 \u00e7ap\u0131n\u0131n, alkol al\u0131m\u0131yla ba\u015fvuran ve metanol toksisitesinden \u015f\u00fcphelenilen hastalar\u0131n ay\u0131r\u0131c\u0131 tan\u0131s\u0131nda kullan\u0131labilece\u011fi bildirilmi\u015ftir [15].&nbsp; OCT ile tespit edilebilen, peripapiller retinal sinir fiber tabakas\u0131 (RSFT) \u00f6demi bulunmas\u0131 g\u00f6rme bozuklu\u011funun \u00f6nc\u00fcl\u00fcd\u00fcr. Ayr\u0131ca VEP ile uyar\u0131 iletimi bozuklu\u011fu tespit edilmesi uzun d\u00f6nem hasar bulgular\u0131ndand\u0131r [16].<\/p>\n\n\n\n<p>M\u0130BON tedavisinin en \u00f6nemli basama\u011f\u0131 genel metanol intosikasyon tedavisidir. Genel tedavi d\u0131\u015f\u0131nda glukokortikoidlerin erken (ilk 6 g\u00fcn) ba\u015flanmas\u0131n\u0131n g\u00f6rme aktivitesinde %80 d\u00fczelme sa\u011flad\u0131\u011f\u0131 g\u00f6r\u00fclm\u00fc\u015ft\u00fcr [9]. Uygulama protokol\u00fc konusunda net uzla\u015f\u0131 bulunmamaktad\u0131r. Ge\u00e7 ba\u015flanan glukokortikoidlerin etkilerine dair \u00e7al\u0131\u015fmalar ise birbirleriyle uyu\u015fmamaktad\u0131r. &nbsp;Tedavide denenmekte olan eritropoetin-EPO, antioksidan vb tedavilere dair kan\u0131t d\u00fczeyi y\u00fcksek \u00e7al\u0131\u015fma bulunmamaktad\u0131r.<\/p>\n\n\n\n<p>Prognozda kal\u0131c\u0131 g\u00f6rme hasar\u0131n\u0131 g\u00f6sterebilecek bulgular; derin metabolik asidoz (pH&lt;7.2), pupil reaktivitesinde azalma, ileri ya\u015f, RSFT\u2019de kal\u0131nla\u015fma, VEP\u2019te ileti bozuklu\u011fu, santral sinir sistemi manyetik rezonans g\u00f6r\u00fcnt\u00fclemede bulgu olmas\u0131d\u0131r [10,16-19].<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Uzun D\u00f6nem N\u00f6rolojik Etkiler<\/strong><\/li>\n<\/ul>\n\n\n\n<p>Metil alkol zehirlenmesinde toksik beyin hasar\u0131n\u0131n patogenezi karma\u015f\u0131kt\u0131r ve hala tam olarak anla\u015f\u0131lamam\u0131\u015ft\u0131r. Metanol\u00fcn di\u011fer molek\u00fcl a\u011f\u0131rl\u0131\u011f\u0131 y\u00fcksek olan alkollere g\u00f6re santral sinir sisteminde (SSS) daha az toksiktir. SSS toksitesinde sorumlu olan metaboliti formik asittir. Formik asit mitokondrial enzim inhibasyonu ve do\u011frudan sitotoksik etkisi ile n\u00f6ronal hasar yapmaktad\u0131r. N\u00f6ronal hasar\u0131n patofizyolojisine dair \u00f6ne s\u00fcr\u00fclen di\u011fer teori ise inflamasyondur ancak Zakharov ve arkada\u015flar\u0131 taraf\u0131ndan yap\u0131lan \u00e7al\u0131\u015fmada bunu net olarak ispat edebilecek veri bulunmamaktad\u0131r [20].<\/p>\n\n\n\n<p>Akut d\u00f6nemde n\u00f6ro-klinik semptomlar daha \u00e7ok metanol\u00fcn SSS depresan etkisine ba\u011fl\u0131 olarak konf\u00fczyon, koma, n\u00f6bet \u015feklinde ortaya \u00e7\u0131kmaktad\u0131r latent periyot sonras\u0131nda subakut ve kronik d\u00f6nemde ise parkinsonizm, ps\u00f6dobulbar palsi, kognitif bozukluklar, ensefalopati, serebellar disfonksiyon, polin\u00f6ropati \u015feklinde ortaya \u00e7\u0131kabilmektedir. Kronik d\u00f6nemde g\u00f6r\u00fclen bu bulgular\u0131n temelinde g\u00f6r\u00fcnt\u00fcleme serilerinde ve postmortem patoloji vaka serilerinde g\u00f6sterilen bazal ganglion nekrozu (hemorajik, non hemorajik), subkortikal&nbsp; beyaz cevher lezyonlar\u0131, serebellar nekroz ve beyin \u00f6demi bulgular\u0131 g\u00f6r\u00fclebilmektedir [21-23].<\/p>\n\n\n\n<ol class=\"wp-block-list\" style=\"list-style-type:lower-alpha\">\n<li><strong>Bazal Ganglia Etkilenmesi Ve Parkinsonizm<\/strong><\/li>\n<\/ol>\n\n\n\n<p>&nbsp;SSS\u2019de en s\u0131k g\u00f6r\u00fclen bulgu her ne kadar patognomik olmasa da olduk\u00e7a spesifik olan bilateral putamen nekrozudur [24]. Bazal ganlionlar\u0131n s\u0131k etkilenmesinin alt\u0131nda yatan temel sebebe dair net kan\u0131t bulunmamaktad\u0131r. Hipotetik olarak ATP t\u00fcketiminin fazla olmas\u0131yla ili\u015fkilendirilmektedir. Putamen nekrozu ayn\u0131 zamanda k\u00f6t\u00fc prognozla ili\u015fkilidir ve \u00e7o\u011funlukla kal\u0131c\u0131 olarak parkinsonizm bulgular\u0131yla seyretmektedir [25]. &nbsp;&nbsp;<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Kognitif Disfonksiyon<\/strong><\/li>\n<\/ul>\n\n\n\n<p>Ciddi methanol zehirlenmesine ba\u011fl\u0131 ensefalopati ve kognitif disfonksiyon g\u00f6r\u00fclebilmektedir; yap\u0131lan bir \u00e7al\u0131\u015fmada akut d\u00f6nemde kognitif bozuklu\u011fu olan hastalar\u0131n 2 y\u0131ll\u0131k takiplerinin sonunda kognitif disfonksiyonlar\u0131n devam etti\u011fi g\u00f6r\u00fclm\u00fc\u015ft\u00fcr [26]. Bu \u00e7al\u0131\u015fmaya gore \u00f6zellikle beyin g\u00f6r\u00fcnt\u00fclemelerinde birden fazla b\u00f6lgede bulgusu olan hastalarda ilk de\u011ferlendirme ve iki y\u0131l sonraki de\u011ferlendirmede kognitif disfonksiyon ve haf\u0131za problemleri g\u00f6r\u00fclm\u00fc\u015ft\u00fcr [26].<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Polin\u00f6ropati<\/strong><\/li>\n<\/ul>\n\n\n\n<p>Metanol intoksikasyonu ile polin\u00f6ropati geli\u015fme riski aras\u0131ndaki ili\u015fki kesin olarak ispatlanamam\u0131\u015ft\u0131r. \u00c7o\u011fu methanol intoksiasyon hastas\u0131n\u0131n kronik alkolizm \u00f6yk\u00fcs\u00fc bulunmas\u0131ndan dolay\u0131 sebep-sonu\u00e7 ili\u015fkisi net de\u011fildir. Nitekim Katerina Kotikova ve arkada\u015flar\u0131 taraf\u0131ndan yap\u0131lan, hastalar\u0131n 6 y\u0131l boyunca takip edildi\u011fi \u00e7al\u0131\u015fmada polin\u00f6ropati oran\u0131n\u0131n alkolizm olan hastalarda daha s\u0131k g\u00f6r\u00fclmesi, methanol intoksikasyonun derecesi ile polin\u00f6ropati aras\u0131nda ba\u011f\u0131ms\u0131z ili\u015fki olmas\u0131, polin\u00f6ropati geli\u015fen hastalar\u0131n alkol\u00fc brakt\u0131ktan sonra polin\u00f6ropati bugular\u0131n\u0131n gerilemesi bu d\u00fc\u015f\u00fcnceyi desteklemektedir [27].<\/p>\n\n\n\n<p>N\u00f6rolojik sekel geli\u015fmesini \u00f6nlemeye y\u00f6nelik yap\u0131lan literatur taramas\u0131nda akut metanol zehirlenmesinin standart tedavisidir. Steroid ve EPO tedavileri denenmi\u015f olsa da kan\u0131t d\u00fczeyi d\u00fc\u015f\u00fckt\u00fcr [20-24].<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Di\u011fer Sistemelerde Etkiler<\/strong><\/li>\n<\/ul>\n\n\n\n<p>Metanol intoksikasyonun di\u011fer sistemler \u00fczerindeki uzun d\u00f6nem etkilerine dair literat\u00fcrde istatistiksel anlaml\u0131 kesin sonu\u00e7lar bulunmamaktad\u0131r.<\/p>\n\n\n\n<ol class=\"wp-block-list\" style=\"list-style-type:lower-alpha\">\n<li><strong>Kardiyovask\u00fcler<\/strong><\/li>\n<\/ol>\n\n\n\n<p>Akut metanol intoksikasyonunda kardiyovask\u00fcler etkiler daha \u00e7ok geli\u015fen metabolik asidoza ba\u011fl\u0131d\u0131r ve \u00e7o\u011funlukla asidoz d\u00fczelince etkilerde d\u00fczelmektedir. Zardasht Jaff ve arkada\u015flar\u0131 taraf\u0131ndan yap\u0131lan \u00e7al\u0131\u015fmada; akut metanol intoksikasyonu ile ba\u015fvuran hastalarda en s\u0131k g\u00f6r\u00fclen EKG bulgular\u0131n\u0131n sin\u00fcs ta\u015fikardisi ve non-spesifik T dalga de\u011fi\u015fikleri oldu\u011fu, b\u00fct\u00fcn olgular\u0131n EKG bulgular\u0131n\u0131n hastane takiplerinde d\u00fczeldi\u011fi bildirlmi\u015ftir [28]. &nbsp;<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Renal<\/strong><\/li>\n<\/ul>\n\n\n\n<p>Toksik alkol zehirlenmelerinin b\u00f6brek etkilerine dair yap\u0131lan bir meta-analize g\u00f6re vaka raporlar\u0131 ve vaka serileri \u015feklinde zengin bir literat\u00fcr bulunmas\u0131na ra\u011fmen, kan\u0131t d\u00fczeyi y\u00fcksek \u00e7al\u0131\u015fma bulunmamaktad\u0131r [29].&nbsp; Bu metaanalize g\u00f6re methanol ve etilen glikol zehirlenmesi olan hastalara dair yap\u0131lan b\u00fct\u00fcn \u00e7al\u0131\u015fmalar incelendi\u011finde vakalar\u0131n %2-3.6\u2019s\u0131 dializ ba\u011f\u0131ml\u0131 hale gelmi\u015ftir.<\/p>\n\n\n\n<p><strong>KAYNAK\u00c7A<\/strong><\/p>\n\n\n\n<ol class=\"wp-block-list\">\n<li>International Programme on Chemical Safety (IPCS). Methanol. Environmental Health Criteria 196, 1997. World Health Organization: Geneva.<\/li>\n\n\n\n<li>International Programme on Chemical Safety (IPCS). Methanol. International Chemical Safety Card (ICSC): 0057, 2004. World Health Organization: Geneva.<\/li>\n\n\n\n<li>https:\/\/assets.publishing.service.gov.uk\/media\/5a7f16d6e5274a2e8ab4a0be\/Methanol_TO_PHE_260815.pdf<\/li>\n\n\n\n<li><a href=\"https:\/\/emedicine.medscape.com\/article\/1174890-overview\">https:\/\/emedicine.medscape.com\/article\/1174890-overview<\/a><\/li>\n\n\n\n<li>Paasma R, Hovda KE, Jacobsen D. Methanol poisoning and long term sequelae &#8211; a six years follow-up after a large methanol outbreak. BMC Clin Pharmacol. 2009 Mar 27;9:5. doi: 10.1186\/1472-6904-9-5. PMID: 19327138; PMCID: PMC2667428.<\/li>\n\n\n\n<li>Bart\u00e1k, M., Rogalewicz, V., Doubek, J., \u0160ejvl, J., Petru\u017eelka, B., Zakharov, S., &amp; Miovsk\u00fd, M. (2021). Estimation of long-term costs of postacute care in survivors of the methanol poisoning outbreak.\u00a0BMJ open,\u00a011(5), e043037. <a href=\"https:\/\/doi.org\/10.1136\/bmjopen-2020-043037\">https:\/\/doi.org\/10.1136\/bmjopen-2020-043037<\/a><\/li>\n\n\n\n<li>Wang, C., Hiremath, S., Sikora, L., Kanji, S., Bugeja, A., Samaha, D., Sood, M. M., Kong, J. W. Y., &amp; Clark, E. G. (2023). Kidney outcomes after methanol and ethylene glycol poisoning: a systematic review and meta-analysis.\u00a0Clinical toxicology (Philadelphia, Pa.),\u00a061(5), 326\u2013335. https:\/\/doi.org\/10.1080\/15563650.2023.2200547<\/li>\n\n\n\n<li><a href=\"https:\/\/www.cdc.gov\/niosh\/ershdb\/EmergencyResponseCard_29750029.html\">https:\/\/www.cdc.gov\/niosh\/ershdb\/EmergencyResponseCard_29750029.html<\/a><\/li>\n\n\n\n<li>Liberski S, Kaluzny BJ, Koci\u0119cki J. Methanol-induced optic neuropathy: a still-present problem. Arch Toxicol. 2022 Feb;96(2):431-451. doi: 10.1007\/s00204-021-03202-0. Epub 2022 Jan 6. PMID: 34988610; PMCID: PMC8731680.<\/li>\n\n\n\n<li>Zakharov, S., Pelclova, D., Diblik, P., Urban, P., Kuthan, P., Nurieva, O., \u2026 Hovda, K. E. (2015). Long-term visual damage after acute methanol poisonings: Longitudinal cross-sectional study in 50 patients. Clinical Toxicology, 53(9), 884\u2013892. doi:10.3109\/15563650.2015.1086488\u00a0<\/li>\n\n\n\n<li>Sharma R, Marasini S, Sharma AK, Shrestha JK, Nepal BP. Methanol poisoning: ocular and neurological manifestations.\u00a0Optom vis Sci.\u00a02012;89:178\u2013182.\u00a0<\/li>\n\n\n\n<li>Kraut JA. Approach to the treatment of methanol intoxication.\u00a0Am J Kidney Dis.\u00a02016;68:161\u2013167.\u00a0<\/li>\n\n\n\n<li>Seme MT, Summerfelt P, Neitz J, Eells JT, Henry MM. Differential recovery of retinal function after mitochondrial inhibition by methanol intoxication.\u00a0Investig Ophthalmol vis Sci.\u00a02001;42:834\u2013841.<\/li>\n\n\n\n<li>Ingemansson SO. Clinical observations on ten cases of methanol poisoning with particular reference to ocular manifestations.\u00a0Acta Ophthalmol (copenh)\u00a01984;62:15\u201324.<\/li>\n\n\n\n<li>Sener, K., Cak\u0131r, A., Altug, E., Korkut, S., G\u00fcven, R., &amp; Kapci, M. (2023). Is optic nerve sheath diameter diagnostic in methanol intoxication?.\u00a0Alcohol,\u00a0113, 27-31.<\/li>\n\n\n\n<li>Desai T, Sudhalkar A, Vyas U, Khamar B. Methanol poisoning: predictors of visual outcomes.\u00a0JAMA Ophthalmol.\u00a02013;131:358\u2013364<\/li>\n\n\n\n<li>Sullivan-Mee M, Solis K. Methanol-induced vision loss.\u00a0J Am Optom Assoc.\u00a01998;69:57\u201365<\/li>\n\n\n\n<li>Nurieva O, Diblik P, Kuthan P, Sklenka P, Meliska M, Bydzovsky J, Heissigerova J, Urban P, Kotikova K, Navratil T, Komarc M, Seidl Z, Vaneckova M, Pelclova D, Zakharov S. Progressive chronic retinal axonal loss following acute methanol-induced optic neuropathy: four-year prospective cohort study.\u00a0Am J Ophthalmol.\u00a02018;191:100\u2013115.<\/li>\n\n\n\n<li>Nurieva O, Kotikova K, Urban P, Pelclova D, Petrik V, Navratil T, Zakharov S. Prevalence, dynamics, and biochemical predictors of optic nerve remyelination after methanol-induced acute optic neuropathy: a 2-year prospective study in 54 patients.\u00a0Monatsh Chem.<\/li>\n\n\n\n<li>Sergey Zakharov, Jiri Hlusicka, Olga Nurieva, et al. Neuroinflammation markers and methyl alcohol induced toxic brain damage, Toxicology Letters, Volume 298, 2018, Pages 60-69, ISSN 0378-4274, <a href=\"https:\/\/doi.org\/10.1016\/j.toxlet.2018.05.001\">https:\/\/doi.org\/10.1016\/j.toxlet.2018.05.001<\/a>.<\/li>\n\n\n\n<li>Anderson TJ, Shuaib A, Becker WJ. Methanol Poisoning: Factors Associated with Neurologic Complications.\u00a0Canadian Journal of Neurological Sciences \/ Journal Canadien des Sciences Neurologiques. 1989;16(4):432-435. doi:10.1017\/S0317167100029528<\/li>\n\n\n\n<li>Karayel, F., Turan, A. A., Sav, A., Pakis, I., Akyildiz, E. U., &amp; Ersoy, G. (2010). Methanol Intoxication. The American Journal of Forensic Medicine and Pathology, 31(1), 34\u201336. doi:10.1097\/paf.0b013e3181c160d9\u00a0<\/li>\n\n\n\n<li>Zakharov S, Kotikova K, Vaneckova M, Seidl Z, Nurieva O, Navratil T, Caganova B, Pelclova D. Acute Methanol Poisoning: Prevalence and Predisposing Factors of Haemorrhagic and Non-Haemorrhagic Brain Lesions. Basic Clin Pharmacol Toxicol. 2016 Aug;119(2):228-38. doi: 10.1111\/bcpt.12559. Epub 2016 Feb 10.<\/li>\n\n\n\n<li>Blanco M, Casado R, V\u00e1zquez F, Pumar JM. CT and MR imaging findings in methanol intoxication. AJNR Am J Neuroradiol. 2006 Feb;27(2):452-4.<\/li>\n\n\n\n<li>Hsu HH, Chen CY, Chen FH, et al.\u00a0Optic atrophy and cerebral infarcts caused by methanol intoxication: MRI.\u00a0Neuroradiology\u00a01997;39:192\u201394<\/li>\n\n\n\n<li>Methanol poisoning as a new world challenge: A review, Nekoukar Z, Zakariaei Z, Taghizadeh F, Musavi F, Banimostafavi ES, Sharifpour A, Ebrahim Ghuchi N, Fakhar M, Tabaripour R, Safanavaei S. Ann Med Surg (Lond). 2021 Jun 2;66:102445. doi: 10.1016\/j.amsu.2021.102445. eCollection 2021 Jun.<\/li>\n\n\n\n<li>Katerina Kotikova, Petr Klepis, Petr Ridzon, Jiri Hlusicka, Tomas Navratil, Jan Rulisek, Ivan Zak, Sergey Zakharov, Peripheral polyneuropathy after acute methanol poisoning: Six-year prospective cohort study, NeuroToxicology, Volume 79, 2020, Pages 67-74, ISSN 0161-813X, <a href=\"https:\/\/doi.org\/10.1016\/j.neuro.2020.04.010\">https:\/\/doi.org\/10.1016\/j.neuro.2020.04.010<\/a>.<\/li>\n\n\n\n<li>Impact of methanol intoxication on the human electrocardiogram Zardasht Jaff et al Cardiology Journal 2014, Vol. 21, No. 2, pp. 170\u2013175 DOI: 10.5603\/CJ.a2013.0053<\/li>\n\n\n\n<li>Wang C, Hiremath S, Sikora L, et al. Kidney outcomes after methanol and ethylene glycol poisoning: a systematic review and meta-analysis.\u00a0<em>Clin Toxicol (Phila)<\/em>. 2023;61(5):326-335. doi:10.1080\/15563650.2023.2200547<\/li>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"<p>Yazar: Uzm. Dr. Giray Alt\u0131nok, Mersin \u015eehir Hastanesi, Acil T\u0131p Klini\u011fi, Mersin Moderat\u00f6r: Prof. Dr. Seyran Bozkurt, Mersin \u00dcniversitesi T\u0131p Fak\u00fcltesi Acil&hellip;<\/p>\n","protected":false},"author":4274,"featured_media":3725,"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":[1,10014,10019],"tags":[27,202,10022,406,449],"class_list":["post-3724","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-genel","category-akademik-blog-yazisi","category-tft","tag-acil-tip","tag-intoksikasyon","tag-tft","tag-toksikoloji","tag-zehirlenme"],"acf":[],"_links":{"self":[{"href":"https:\/\/tatd.org.tr\/toksikoloji\/wp-json\/wp\/v2\/posts\/3724","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\/4274"}],"replies":[{"embeddable":true,"href":"https:\/\/tatd.org.tr\/toksikoloji\/wp-json\/wp\/v2\/comments?post=3724"}],"version-history":[{"count":0,"href":"https:\/\/tatd.org.tr\/toksikoloji\/wp-json\/wp\/v2\/posts\/3724\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/tatd.org.tr\/toksikoloji\/wp-json\/wp\/v2\/media\/3725"}],"wp:attachment":[{"href":"https:\/\/tatd.org.tr\/toksikoloji\/wp-json\/wp\/v2\/media?parent=3724"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/tatd.org.tr\/toksikoloji\/wp-json\/wp\/v2\/categories?post=3724"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/tatd.org.tr\/toksikoloji\/wp-json\/wp\/v2\/tags?post=3724"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}