{"id":482,"date":"2017-04-10T10:03:06","date_gmt":"2017-04-10T07:03:06","guid":{"rendered":"https:\/\/tatd.org.tr\/tatdtoks\/2021\/09\/15\/intravenoz-lipid-tedavisi-icin-oneriler\/"},"modified":"2021-11-10T22:35:24","modified_gmt":"2021-11-10T19:35:24","slug":"intravenoz-lipid-tedavisi-icin-oneriler","status":"publish","type":"post","link":"https:\/\/tatd.org.tr\/toksikoloji\/2017\/04\/10\/intravenoz-lipid-tedavisi-icin-oneriler\/","title":{"rendered":"\u0130ntraven\u00f6z Lipid Tedavisi \u0130\u00e7in \u00d6neriler"},"content":{"rendered":"<p>\u00c7al\u0131\u015fmay\u0131 bir tablo \u015feklinde \u00f6zetlemeye \u00e7al\u0131\u015ft\u0131m, bu tablonun biz klinisyenlere hangi durumlarda ILE uygulamay\u0131 d\u00fc\u015f\u00fcnmeliyiz konusunda yard\u0131mc\u0131 olaca\u011f\u0131 kanaatindeyim.<\/p>\n<p>Derlemeyi \u00a0genel olarak de\u011ferlendirdi\u011fimiz de ilk g\u00f6ze \u00e7arpan bulgu bir\u00e7ok toksin i\u00e7in literat\u00fcrde tavsiyede bulunmaya yetecek miktarda kan\u0131t bulunamam\u0131\u015f olmas\u0131. Yine de klinikte i\u015fimize yarayaca\u011f\u0131n\u0131 d\u00fc\u015f\u00fcnd\u00fc\u011f\u00fcm \u00f6nerileri maddeler halinde \u00f6zetlemeye \u00e7al\u0131\u015ft\u0131m.<\/p>\n<ul>\n<li>ILE tedavisi i\u00e7in \u00f6nerilen endikasyonlar \u00f6zellikle \u015fu iki durum;\n<ol>\n<li>Bupivakain\u2019e ba\u011fl\u0131 kardiyak arrest<\/li>\n<li>Bupivakain, LA, Amitriptilin ve Bupropion zehirlenmelerinde di\u011fer tedavi se\u00e7eneklerinin ba\u015far\u0131z olmas\u0131<\/li>\n<\/ol>\n<\/li>\n<li>ILE tedavisi hi\u00e7bir toksin i\u00e7in hi\u00e7bir klinik durumda \u0130lk basamak tedavi de\u011fil!!! E\u011fer \u00f6nce ABC tedavisi ile ba\u015flamaz isek ba\u015far\u0131 beklememeliyiz.<\/li>\n<li>Hayat\u0131 tehdit etmeyen zehirlenme vakalar\u0131nda ILE kullan\u0131m\u0131 hakk\u0131nda \u00e7o\u011funlukla \u00f6neride bulunulmam\u0131\u015f fakat pek \u00e7ok uzman\u0131n uygulanmas\u0131na kar\u015f\u0131 \u00f6nyarg\u0131l\u0131 oldu\u011fu belirtilmi\u015f.<\/li>\n<li>ILE tedavisi hayat\u0131 tehdit etmeyen Amitriptilin d\u0131\u015f\u0131 TCA, Dihidropridin t\u00fcrevi KKB ve Difenhidramin zehirlenmelerinde di\u011fer tedavi se\u00e7enekleri ba\u015far\u0131s\u0131z olsa bile \u00f6nerilmiyor.<\/li>\n<\/ul>\n<ul>\n<li>En s\u0131k uygulama \u015fekli %20\u2019lik sol\u00fcsyondan 1,5 ml\/kg \u0130V bolus takiben 0,25-0,5 ml\/kg\/dak oldu\u011fu ve bu uygulaman\u0131n standardize edilmesinin, ILE olas\u0131 yan etkilerini saptamada fayda sa\u011flayaca\u011f\u0131 belirtilmi\u015f. Ancak uyama \u015fekli i\u00e7in resmi bir \u00f6neride bulunulmam\u0131\u015f.<\/li>\n<li>T\u00fcm LA zehirlenmelerin ILE endike ise %20\u2019lik sol\u00fcsyonun kullan\u0131lmas\u0131 \u00f6nerilmi\u015f. Ancak non-LA zehirlenmeler i\u00e7in \u00f6neri yok.<\/li>\n<li>ILE tedavisinin s\u00fcresi ve maksimum dozu i\u00e7in de bir \u00f6neride bulunulmam\u0131\u015f. Ancak toplam doz hastan\u0131n kan vol\u00fcm\u00fcn\u00fcn %10\u2019unu ge\u00e7meyecek \u015fekilde uygulanmas\u0131n\u0131n en mant\u0131kl\u0131 se\u00e7enek oldu\u011fundan bahsedilmi\u015f.<\/li>\n<\/ul>\n<div class=\"pcrstb-wrap\"><table class=\"table table-striped\">\n<tbody>\n<tr>\n<th>&nbsp;<\/th>\n<th>&nbsp;<\/th>\n<th><strong>KARD\u0130YAK ARREST<\/strong><\/th>\n<th colspan=\"3\"><strong>HAYATI TEHD\u0130T EDEN ZEH\u0130RLENME<\/strong><\/th>\n<th colspan=\"3\"><strong>HAYATI TEHD\u0130T ETMEYEN ZEH\u0130RLENME<\/strong><\/th>\n<\/tr>\n<tr>\n<td>&nbsp;<\/td>\n<td>TOKS\u0130N<\/td>\n<td>&nbsp;<\/td>\n<td>\u0130LK TERC\u0130H<\/td>\n<td>TEDAV\u0130 SE\u00c7ENE\u011e\u0130<\/td>\n<td>SON TERC\u0130H<\/td>\n<td>\u0130LK TERC\u0130H<\/td>\n<td>TEDAV\u0130 SE\u00c7ENE\u011e\u0130<\/td>\n<td>SON TERC\u0130H<\/td>\n<\/tr>\n<tr>\n<td rowspan=\"2\"><strong>LA<\/strong><\/td>\n<td>Bupivakain<\/td>\n<td>++<\/td>\n<td>0<\/td>\n<td>+<\/td>\n<td>++<\/td>\n<td>0<\/td>\n<td>0<\/td>\n<td>0<\/td>\n<\/tr>\n<tr>\n<td>Di\u011fer LA<\/td>\n<td>0<\/td>\n<td>0<\/td>\n<td>0<\/td>\n<td>+<\/td>\n<td>0<\/td>\n<td>0<\/td>\n<td>0<\/td>\n<\/tr>\n<tr>\n<td>&nbsp;<\/td>\n<td>&nbsp;<\/td>\n<td>&nbsp;<\/td>\n<td>&nbsp;<\/td>\n<td>&nbsp;<\/td>\n<td>&nbsp;<\/td>\n<td>&nbsp;<\/td>\n<td>&nbsp;<\/td>\n<td>&nbsp;<\/td>\n<\/tr>\n<tr>\n<td rowspan=\"20\"><strong>NON-LA<\/strong><\/td>\n<td>S\u0131n\u0131f 1 Antiaritmikler<\/td>\n<td>0<\/td>\n<td>0<\/td>\n<td>0<\/td>\n<td>0<\/td>\n<td>&#8211;<\/td>\n<td>0<\/td>\n<td>0<\/td>\n<\/tr>\n<tr>\n<td>Amitriptilin<\/td>\n<td>0<\/td>\n<td>&#8211;<\/td>\n<td>0<\/td>\n<td>+<\/td>\n<td>&#8212;<\/td>\n<td>&#8211;<\/td>\n<td>0<\/td>\n<\/tr>\n<tr>\n<td>Di\u011fer TCA<\/td>\n<td>0<\/td>\n<td>&#8211;<\/td>\n<td>0<\/td>\n<td>0<\/td>\n<td>&#8211;<\/td>\n<td>&#8211;<\/td>\n<td>&#8211;<\/td>\n<\/tr>\n<tr>\n<td>Baklofen<\/td>\n<td>0<\/td>\n<td>0<\/td>\n<td>0<\/td>\n<td>0<\/td>\n<td>&#8211;<\/td>\n<td>0<\/td>\n<td>0<\/td>\n<\/tr>\n<tr>\n<td>Beta Blok\u00f6r<\/p>\n<p>(lipofilik)<\/td>\n<td>0<\/td>\n<td>0<\/td>\n<td>0<\/td>\n<td>0<\/td>\n<td>&#8211;<\/td>\n<td>0<\/td>\n<td>0<\/td>\n<\/tr>\n<tr>\n<td>Beta Blok\u00f6r<\/p>\n<p>(lipofobik)<\/td>\n<td>0<\/td>\n<td>&#8211;<\/td>\n<td>0<\/td>\n<td>0<\/td>\n<td>&#8211;<\/td>\n<td>&#8211;<\/td>\n<td>0<\/td>\n<\/tr>\n<tr>\n<td>Bupropion<\/td>\n<td>0<\/td>\n<td>&#8211;<\/td>\n<td>0<\/td>\n<td>+<\/td>\n<td>&#8211;<\/td>\n<td>0<\/td>\n<td>0<\/td>\n<\/tr>\n<tr>\n<td>KKB (Diltiazem-Verapamil)<\/td>\n<td>0<\/td>\n<td>&#8211;<\/td>\n<td>0<\/td>\n<td>0<\/td>\n<td>&#8211;<\/td>\n<td>0<\/td>\n<td>0<\/td>\n<\/tr>\n<tr>\n<td>KKB (Dihidropridin)<\/td>\n<td>0<\/td>\n<td>&#8211;<\/td>\n<td>0<\/td>\n<td>0<\/td>\n<td>&#8211;<\/td>\n<td>&#8211;<\/td>\n<td>&#8211;<\/td>\n<\/tr>\n<tr>\n<td>Kokain<\/td>\n<td>0<\/td>\n<td>&#8211;<\/td>\n<td>0<\/td>\n<td>0<\/td>\n<td>&#8211;<\/td>\n<td>&#8211;<\/td>\n<td>0<\/td>\n<\/tr>\n<tr>\n<td>Difenhidramin<\/td>\n<td>0<\/td>\n<td>&#8211;<\/td>\n<td>0<\/td>\n<td>0<\/td>\n<td>&#8211;<\/td>\n<td>&#8211;<\/td>\n<td>&#8211;<\/td>\n<\/tr>\n<tr>\n<td>\u0130vermectin<\/td>\n<td>0<\/td>\n<td>0<\/td>\n<td>0<\/td>\n<td>0<\/td>\n<td>&#8211;<\/td>\n<td>0<\/td>\n<td>0<\/td>\n<\/tr>\n<tr>\n<td>Di\u011fer \u0130nsektisitler<\/td>\n<td>0<\/td>\n<td>&#8211;<\/td>\n<td>0<\/td>\n<td>0<\/td>\n<td>&#8211;<\/td>\n<td>0<\/td>\n<td>0<\/td>\n<\/tr>\n<tr>\n<td>Lamotrijin<\/td>\n<td>0<\/td>\n<td>&#8211;<\/td>\n<td>0<\/td>\n<td>0<\/td>\n<td>&#8211;<\/td>\n<td>&#8211;<\/td>\n<td>0<\/td>\n<\/tr>\n<tr>\n<td>Malathion<\/td>\n<td>0<\/td>\n<td>&#8211;<\/td>\n<td>0<\/td>\n<td>0<\/td>\n<td>&#8211;<\/td>\n<td>0<\/td>\n<td>0<\/td>\n<\/tr>\n<tr>\n<td>&nbsp;<\/td>\n<td>&nbsp;<\/td>\n<td>&nbsp;<\/td>\n<td>&nbsp;<\/td>\n<td>&nbsp;<\/td>\n<td>&nbsp;<\/td>\n<td>&nbsp;<\/td>\n<td>&nbsp;<\/td>\n<\/tr>\n<tr>\n<td>Di\u011fer Pestisitler<\/td>\n<td>0<\/td>\n<td>&#8211;<\/td>\n<td>0<\/td>\n<td>0<\/td>\n<td>&#8211;<\/td>\n<td>0<\/td>\n<td>0<\/td>\n<\/tr>\n<tr>\n<td>Olanzapin<\/td>\n<td>0<\/td>\n<td>0<\/td>\n<td>0<\/td>\n<td>0<\/td>\n<td>&#8211;<\/td>\n<td>0<\/td>\n<td>0<\/td>\n<\/tr>\n<tr>\n<td>Di\u011fer Antipsikotikler<\/td>\n<td>0<\/td>\n<td>&#8211;<\/td>\n<td>0<\/td>\n<td>&nbsp;<\/td>\n<td>&#8211;<\/td>\n<td>0<\/td>\n<td>0<\/td>\n<\/tr>\n<tr>\n<td>SSRI<\/td>\n<td>0<\/td>\n<td>0<\/td>\n<td>0<\/td>\n<td>&nbsp;<\/td>\n<td>&#8211;<\/td>\n<td>0<\/td>\n<td>0<\/td>\n<\/tr>\n<\/tbody>\n<\/table><\/div>\n<p><strong>Tablo 1.\u00a0 <\/strong><\/p>\n<p>LA: Lokal Anestezik, NON-LA: Lokal Anestezik olmayan, TCA: Trisiklik Antidepresan, KKB: Kalsiyum Kanal Blok\u00f6r\u00fc, SSRI: Selektif Serotonin Geri Al\u0131m \u0130nhibit\u00f6r\u00fc.<\/p>\n<p><strong>++<\/strong> Recommended (\u00d6nerilen)<\/p>\n<p><strong>+<\/strong>\u00a0 Suggested (Tavsiye edilen)<\/p>\n<p><strong>0<\/strong>\u00a0 Neutral (N\u00f6tr)<\/p>\n<p><strong>&#8211; <\/strong>\u00a0Not Suggested (Tavsiye edilmeyen)<\/p>\n<p><strong>&#8212;<\/strong> Not Recommended (Kesinlikle \u00f6nerilmeyen)<\/p>\n<p><strong>SONU\u00c7<\/strong><\/p>\n<p>Akut zehirlenme vakalar\u0131nda ILE uygulamas\u0131 bir heyecan yaratm\u0131\u015f olsa da \u00e7al\u0131\u015fma grubu bir\u00e7ok zehirlenme veya klinik senaryoda ILE uygulamas\u0131n\u0131 destekleyen kan\u0131tlar\u0131n yetersiz oldu\u011fu g\u00f6r\u00fc\u015f\u00fcnde birle\u015fmi\u015f.<\/p>\n<p>Kan\u0131t azl\u0131\u011f\u0131na ra\u011fmen \u00e7al\u0131\u015fma grubu, s\u0131kl\u0131kla tercih edilen %20 ILE sol\u00fcsyonunun 1,5 ml\/kg \u0130V bolus takiben 0,25 ml\/kg inf\u00fczyon dozunda uygulanmas\u0131n\u0131n standardize edilmesinin ILE tedavisi hakk\u0131nda daha g\u00fc\u00e7l\u00fc \u00f6neriler olu\u015fturulmas\u0131nda fayda sa\u011flayaca\u011f\u0131n\u0131 belirtmi\u015f.<\/p>\n<p>Ayr\u0131ca \u00e7al\u0131\u015fma grubu maksimum doz konusunda \u00f6neride bulunmasa da toplam verilecek ILE miktar\u0131n\u0131n hastan\u0131n toplam kan hacminin %10\u2019unu a\u015fmamas\u0131 g\u00f6r\u00fc\u015f\u00fc a\u011f\u0131rl\u0131k kazanm\u0131\u015f. Bu sayede ILE tedavisinin risk ve yararlar\u0131 konusunda daha nitelikli verilere ula\u015f\u0131labilece\u011fi \u00f6ng\u00f6r\u00fclm\u00fc\u015f.<\/p>\n<p>Sonu\u00e7 olarak yarar\/zarar dengesini daha net hesaplayabilece\u011fimiz kardiyak arrest veya ciddi sistemik toksisite gibi endikasyonlarda ILE tedavisi biz klinisyenler i\u00e7in iyi bir tercih olabilece\u011fi belirtilmi\u015f. Buna kar\u015f\u0131l\u0131k organ yetmezli\u011fi veya \u00f6l\u00fcm riskinin d\u00fc\u015f\u00fck oldu\u011fu zehirlenmelerde etkisi kan\u0131tlanm\u0131\u015f tedavi se\u00e7enekleri denenmeden ILE uygulamas\u0131ndan ka\u00e7\u0131n\u0131lmas\u0131 gerekti\u011finin alt\u0131 \u00e7izilmi\u015f.<\/p>\n<p>\u0130yi okumalar dilerim.<\/p>\n<p><img decoding=\"async\" style=\"float: left;height: 26px;margin-left: 5px;margin-right: 5px;width: 25px\" src=\"https:\/\/tatd.org.tr\/tatdtoks\/wp-content\/uploads\/sites\/36\/2021\/10\/unnamed-file.pdf-2.png\" alt=\"\" \/>Makalenin tamam\u0131na\u00a0ula\u015fmak i\u00e7in l\u00fctfen <a href=\"http:\/\/tatdtoksikoloji.org\/files\/files\/Evidence_based_recommendations_on_the_use_of_intravenous_lipid_emulsion_therapy_in_poisoning.pdf\" target=\"_blank\" rel=\"noopener\">t\u0131klay\u0131n\u0131z<\/a>.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>\u0130ntraven\u00f6z Lipid Em\u00fclsiyon(ILE) tedavisi son y\u0131llarda toksikoloji alan\u0131nda \u00fczerinde en \u00e7ok \u00e7al\u0131\u015fma yap\u0131lan ve klinik kullan\u0131mda etkinli\u011fi en \u00e7ok merak edilen konular\u0131n ba\u015f\u0131nda gelmekte. Ancak endikasyonlar\u0131, dozu, uygulama \u015fekli, yan etkileri konusunda yeterli bilgi ve standardizasyon sa\u011flanabilmi\u015f de\u011fil. Bu ba\u011flamda Lipid Emulsion Workgroup taraf\u0131ndan Clinical Toxicology\u2019de 2016 y\u0131l\u0131n\u0131n Eyl\u00fcl ay\u0131nda yay\u0131nlanan review biz klinisyenlere yararl\u0131 \u00f6nerilerde bulunuyor. Konuyla ilgilenenler i\u00e7in bu \u00e7al\u0131\u015fmay\u0131 \u00f6zetlemeye \u00e7al\u0131\u015ft\u0131m. \u00c7al\u0131\u015fman\u0131n orjinalinehttp:\/\/www.tandfonline.com\/doi\/full\/10.1080\/15563650.2016.1214275 adresinden ula\u015f\u0131labilir. \u00c7al\u0131\u015fmaya kat\u0131lan kurulu\u015flar ise konuda otorite olan AACT, EAPCCT, ACMT, APAMT, AAPCC, CAPCC.<\/p>\n<p>Lipid em\u00fclsiyon \u00e7al\u0131\u015fma grubunu olu\u015fturan uzmanlar\u0131n kurumlar\u0131 ve taranan veri tabanlar\u0131 yaz\u0131n\u0131n sonunda liste halinde eklenmi\u015ftir. Literat\u00fcr taramas\u0131 sonucunda Aral\u0131k 2014 y\u0131l\u0131na kadar yay\u0131nlanm\u0131\u015f 4 sistematik Review incelemeye al\u0131nm\u0131\u015f. Aral\u0131k 2015 y\u0131l\u0131nda ise literat\u00fcr taramas\u0131 yeniden g\u00f6zden ge\u00e7irilerek 56 yay\u0131n daha \u00e7al\u0131\u015fmaya dahil edilmi\u015f. \u00c7al\u0131\u015fman\u0131n metodolojisi de yine Clinical Toxicology\u2019de 2015 y\u0131l\u0131nda yay\u0131nlanm\u0131\u015f. Orijinal makale ile ilgilenenler i\u00e7in linkini payla\u015fmak istedim. (http:\/\/www.tandfonline.com\/doi\/full\/10.3109\/15563650.2015.1052498)<\/p>\n<p>Literat\u00fcr incelemesinin sonucunda yazarlar Lokal anestezik (LA) ve LA d\u0131\u015f\u0131 (Non-LA) toplam 22 toksin veya toksin grubu i\u00e7in ILE etkinli\u011fi a\u00e7\u0131s\u0131ndan de\u011ferlendirmede bulunmaya karar verilmi\u015f. \u00c7al\u0131\u015fma grubu toksinler ile olu\u015fabilecek 3 klinik durum i\u00e7in ILE etkinli\u011fi ve uygulanabilirli\u011fi hakk\u0131nda \u00f6nerilerde bulunmu\u015flar. Bu klinik durumlar; kardiyak arrest, hayat\u0131 tehdit edici zehirlenme ve hayat\u0131 tehdit edici olmayan zehirlenme durumlar\u0131 olarak belirlenmi\u015f<\/p>\n","protected":false},"author":1464,"featured_media":0,"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":[265,266,439],"class_list":["post-482","post","type-post","status-publish","format-standard","hentry","category-akademik-blog-yazisi","tag-lipid-karisimi","tag-lipid-resusitasyonu","tag-yag-emulsiyonu"],"acf":[],"_links":{"self":[{"href":"https:\/\/tatd.org.tr\/toksikoloji\/wp-json\/wp\/v2\/posts\/482","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\/1464"}],"replies":[{"embeddable":true,"href":"https:\/\/tatd.org.tr\/toksikoloji\/wp-json\/wp\/v2\/comments?post=482"}],"version-history":[{"count":0,"href":"https:\/\/tatd.org.tr\/toksikoloji\/wp-json\/wp\/v2\/posts\/482\/revisions"}],"wp:attachment":[{"href":"https:\/\/tatd.org.tr\/toksikoloji\/wp-json\/wp\/v2\/media?parent=482"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/tatd.org.tr\/toksikoloji\/wp-json\/wp\/v2\/categories?post=482"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/tatd.org.tr\/toksikoloji\/wp-json\/wp\/v2\/tags?post=482"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}