{"id":565,"date":"2017-06-21T13:07:59","date_gmt":"2017-06-21T10:07:59","guid":{"rendered":"https:\/\/tatd.org.tr\/tatdtoks\/2021\/09\/17\/hidrojen-sulfur-zehirlenmeleri\/"},"modified":"2021-11-10T22:35:24","modified_gmt":"2021-11-10T19:35:24","slug":"hidrojen-sulfur-zehirlenmeleri","status":"publish","type":"post","link":"https:\/\/tatd.org.tr\/toksikoloji\/2017\/06\/21\/hidrojen-sulfur-zehirlenmeleri\/","title":{"rendered":"H\u0130DROJEN S\u00dcLF\u00dcR ZEH\u0130RLENMELER\u0130"},"content":{"rendered":"<div class=\"pcrstb-wrap\"><table border=\"0\" cellspacing=\"2\" cellpadding=\"1\">\n<tbody>\n<tr>\n<td style=\"width: 10px\"><\/td>\n<td style=\"width: 734px\">\n<h2><u><strong>H\u0130DROJEN S\u00dcLF\u00dcR NED\u0130R?<\/strong><\/u><\/h2>\n<p>Kimyasal yolla asfiksi olu\u015fturan gazlar, oksijenin doku taraf\u0131ndan al\u0131nmas\u0131n\u0131 engelleyerek etki ederler. Hemoglobin ve h\u00fccresel enzimlerle birle\u015fip h\u00fccresel oksijen kullan\u0131m\u0131n\u0131 do\u011frudan bozarak doku hipoksisi yaparlar. Hidrojen s\u00fclf\u00fcr (H<sub>2<\/sub>S) gaz\u0131 da, kimyasal yolla asfiksi olu\u015fturan zehirli gazlardan biridir.<\/p>\n<h2><strong><u>Maruziyet<\/u><\/strong><\/h2>\n<p>Hidrojen s\u00fclf\u00fcr gaz\u0131 \u00e7o\u011funlukla petrol ve gaz end\u00fcstrisi, kanalizasyon, la\u011f\u0131m \u00e7ukurlar\u0131, k\u00f6m\u00fcr madenleri ve petrol yataklar\u0131nda insan sa\u011fl\u0131\u011f\u0131na y\u00f6nelik tehdit olu\u015fturur.\u00a0 Suda \u00e7\u00f6z\u00fcn\u00fcrl\u00fc\u011f\u00fc d\u00fc\u015f\u00fck biz gazd\u0131r, havadan daha a\u011f\u0131rd\u0131r. Koku e\u015fi\u011fi d\u00fc\u015f\u00fck oldu\u011fu i\u00e7in zehirlenmeleri ciddi seyirlidir. Maruziyetin s\u00fcresinden \u00e7ok, gaz\u0131n yo\u011funlu\u011fu tehlike yarat\u0131r.<\/p>\n<p>Hidrojen s\u00fclf\u00fcr zehirlenmeleri sporadik vakalar \u015feklinde olup, travma maruziyetiyle i\u00e7 i\u00e7e olan durumlard\u0131r. Vaka serileri nadirdir, daha \u00e7ok tek tek vaka d\u00fczeyinde incelenerek toksisite hakk\u0131nda yorum yap\u0131lmaktad\u0131r.<\/td>\n<\/tr>\n<\/tbody>\n<\/table><\/div>\n<p><img decoding=\"async\" style=\"height: 300px;width: 800px\" src=\"https:\/\/tatd.org.tr\/tatdtoks\/wp-content\/uploads\/sites\/36\/2021\/10\/13-2.png\" alt=\"\" \/><\/p>\n<h2><strong><u>Klinik Etkiler<\/u><\/strong><\/h2>\n<p>Literat\u00fcr \u00e7o\u011funlukla vaka d\u00fczeyinde s\u0131n\u0131rl\u0131 kalsa da, H<sub>2<\/sub>S zehirlenmesine ba\u011fl\u0131 geli\u015fen semptomlar asl\u0131nda bir toksidrom olu\u015fturmaktad\u0131r. Bu da vakalar\u0131 tan\u0131ma a\u00e7\u0131s\u0131ndan bize fayda sa\u011flayabilir:<\/p>\n<ul>\n<li><strong>\u2018\u2018Knockdown\u2019\u2019 (akut santral n\u00f6rotoksisite)<\/strong><\/li>\n<li><strong>Pulmoner \u00f6dem<\/strong><\/li>\n<li><strong>\u201cGas eye\u201d irritatif konjonktivit <\/strong><\/li>\n<li><strong>Olfakt\u00f6r paralizi sonras\u0131 geli\u015fen koku persepsiyonu\u00a0\u00a0<\/strong><\/li>\n<\/ul>\n<p><img decoding=\"async\" style=\"height: 350px;width: 750px\" src=\"https:\/\/tatd.org.tr\/tatdtoks\/wp-content\/uploads\/sites\/36\/2021\/10\/23-1.png\" alt=\"\" \/><\/p>\n<p><strong><em>Knockdown:<\/em><\/strong><\/p>\n<p>Hidrojen s\u00fclf\u00fcr\u00fcn akut merkezi sinir sistemi toksisitesine ba\u011fl\u0131 geli\u015fen, reversible bilin\u00e7 kayb\u0131. Tablo tam anlam\u0131yla bir d\u00fc\u011fmeyi kapat\u0131r gibi geli\u015fti\u011fi i\u00e7in bu isim verilmi\u015ftir. \u00c7ok yo\u011fun gaz maruziyetinde kurban olay yerinden uzakla\u015ft\u0131r\u0131lmad\u0131\u011f\u0131nda, h\u00fccresel anoksi de duruma eklenip \u00f6l\u00fcmc\u00fcl olabilir.<\/p>\n<p><strong><em>Pulmoner \u00d6dem ve \u0130rritasyona Ba\u011fl\u0131 Toksisite:<\/em><\/strong><\/p>\n<p>\u00c7\u00f6z\u00fcn\u00fcrl\u00fc\u011f\u00fc d\u00fc\u015f\u00fck olan H<sub>2<\/sub>S molek\u00fclleri alveoler d\u00fczeyde doku hasar\u0131 yaparak akci\u011fer \u00f6demine sebep olur. Bu tabloya ba\u011fl\u0131 \u00f6l\u00fcm oran\u0131 %50\u2019ye yak\u0131n d\u00fczeyde bulunmu\u015ftur.<\/p>\n<p><strong><em>Gas Eye:<\/em><\/strong><\/p>\n<p>Hidrojen s\u00fclf\u00fcr\u00fcn irritan etkisine ba\u011fl\u0131 olarak kornea ve konjontivada olu\u015fan y\u00fczeyel inflamasyondur.<\/p>\n<p><strong><em>Olfakt\u00f6r etkiler:<\/em><\/strong><\/p>\n<p>Gaz yo\u011funlu\u011fu d\u00fc\u015f\u00fck d\u00fczeydeyken \u00e7\u00fcr\u00fck yumurta kokusuna benzer bir koku duyulurken yo\u011funluk artt\u0131k\u00e7a n\u00f6rotoksik etkiye ba\u011fl\u0131 olarak koku duyusunda azalma geli\u015fir. Y\u00fcksek yo\u011funlukta kokunun az hissedilmesi de toksisiteye maruziyetten ka\u00e7\u0131lmas\u0131n\u0131 engellemi\u015f olur. Bu koku persepsiyonu tablosunu en iyi ifade eden, gaza maruziyet ya\u015fam\u0131\u015f bir petrol i\u015f\u00e7isinin kendi s\u00f6zleridir: \u2018\u2018you\u2019re not really in trouble until you can\u2019t smell it anymore\u2019\u2019 (kokuyu hissetti\u011finiz s\u00fcrece, ger\u00e7ekten ba\u015f\u0131n\u0131z belaya girmemi\u015ftir).<\/p>\n<h2><strong><u>Tedavi<\/u><\/strong><\/h2>\n<p><img decoding=\"async\" style=\"height: 150px;width: 250px\" src=\"https:\/\/tatd.org.tr\/tatdtoks\/wp-content\/uploads\/sites\/36\/2021\/10\/35-1.png\" alt=\"\" \/><\/p>\n<p>Maruziyet alan\u0131nda uzakla\u015ft\u0131rma ve dekontaminasyon ilk basamak tedavidir. Destek tedavi t\u00fcm zehirlenme tablolar\u0131nda oldu\u011fu gibi esas tedavidir. Vaka d\u00fczeyinde \u00e7al\u0131\u015fmalar\u0131 mevcut olan di\u011fer tedaviler ise:<\/p>\n<ul>\n<li><strong><em>Hiperbarik oksijen tedavisi (HBO): <\/em><\/strong><\/li>\n<\/ul>\n<p>Tedavide ama\u00e7 u\u00e7 dokular\u0131n oksijenlenmesini sa\u011flamak ve aerobik metabolizman\u0131n devaml\u0131l\u0131\u011f\u0131n\u0131 sa\u011flayan sitokrom oksidaz aktivitesini normale d\u00f6nd\u00fcrmektir. Literat\u00fcrde, toksisiteye ba\u011fl\u0131 arrest olup CPR ile hayata d\u00f6nd\u00fcr\u00fclm\u00fc\u015f 24 ya\u015f\u0131nda bir hastan\u0131n, HBO ve hipotermi uyguland\u0131ktan sonra vital bulgular\u0131n\u0131n normal seyretti\u011fi ve 3. g\u00fcnde ext\u00fcbe edildi\u011fini yazar. 5. g\u00fcnde hasta taburcu edilmi\u015f, sonras\u0131nda k\u0131sa s\u00fcreli haf\u0131za kayb\u0131 ve g\u00f6rme ile ilgili \u015fikayetler d\u0131\u015f\u0131nda ek semptomu geli\u015fmemi\u015ftir.<\/p>\n<ul>\n<li><strong><em>Nitrit tedavisi:<\/em><\/strong><\/li>\n<\/ul>\n<p>Siyan\u00fcr zehirlenmesindeki mekanizmayla ayn\u0131 etkilidir. Siyan\u00fcr\u00fcn methemoglobine afinitesi, hemoglobine afinitesinden daha fazlad\u0131r bu sebeple nitrit i\u00e7erikli ajanlarla\u00a0methemoglobinemi ind\u00fcklenir. Bunun sonucunda olu\u015fan siyanomethemoglobinin karaci\u011ferde elimine edilerek idrarla at\u0131lmas\u0131 sa\u011flanm\u0131\u015f olur. Ancak nitrit tedavisinin ciddi eksikleri mevcuttur. Literat\u00fcr, nitrit tedavisinin ideal olarak ilk 5-10 dk\u2019l\u0131k s\u00fcre\u00e7te ve 0,33 ml\/kg dozunda (%3\u2019l\u00fck sodyum nitrit) uygulanmas\u0131n\u0131n efektif oldu\u011funu ifade etmektedir. Ayr\u0131ca ciddi<\/p>\n<p>hipotansiyon ve hipoksi gibi yan etkiler a\u00e7\u0131s\u0131ndan da hastan\u0131n yak\u0131n takipte olmas\u0131 gerekti\u011fi unutulmamal\u0131d\u0131r.<\/p>\n<p style=\"text-align: center\"><img decoding=\"async\" style=\"height: 300px;width: 450px\" src=\"https:\/\/tatd.org.tr\/tatdtoks\/wp-content\/uploads\/sites\/36\/2021\/10\/43-1.png\" alt=\"\" \/><\/p>\n<ul>\n<li><strong><em>Kobalamin tedavisi: <\/em><\/strong><\/li>\n<\/ul>\n<p>Ama\u00e7 siyan\u00fcr\u00fc ba\u011flay\u0131p \u015felat olu\u015fturarak do\u011frudan v\u00fccuttan at\u0131l\u0131m\u0131n\u0131 sa\u011flamakt\u0131r. Literat\u00fcrde kobalamin i\u00e7eren formlar\u0131n H<sub>2<\/sub>S maruziyeti sonras\u0131 antidot olarak kullan\u0131ld\u0131\u011f\u0131nda etkilerini ara\u015ft\u0131ran \u00e7al\u0131\u015fmalar mevcuttur. Bu \u00e7al\u0131\u015fmalar daha \u00e7ok hayvan \u00e7al\u0131\u015fmas\u0131 olup, kitlesel bir maruziyet durumunda farkl\u0131 formlardaki kobalamin molek\u00fcllerinin ve farkl\u0131 uygulama y\u00f6ntemlerinin (IV, IM) etkinli\u011fini ara\u015ft\u0131rmaya y\u00f6neliktir. Bu \u00e7al\u0131\u015fmalara bak\u0131ld\u0131\u011f\u0131nda \u2018Aquohydroxocobinamide\u2019 formunun \u00f6l\u00fcmc\u00fcl H<sub>2<\/sub>S maruziyetinde en etkili form oldu\u011fu ifade edilmi\u015f ancak etkin dozun kesinle\u015ftirilmesi konusunda yeni \u00e7al\u0131\u015fmalar da yap\u0131lmas\u0131 gerekti\u011fi ifade edilmi\u015ftir. Daha a\u015fina oldu\u011fumuz \u2018Hydroxocobalamin\u2019 formunun etkinli\u011fi ise olduk\u00e7a d\u00fc\u015f\u00fck bulunmu\u015ftur.<\/p>\n<ul>\n<li><strong><em>Bikarbonat ve glikoz:<\/em><\/strong><\/li>\n<\/ul>\n<p>Literat\u00fcrde H<sub>2<\/sub>S gaz\u0131n\u0131n h\u00fccresel hipoglisemi ve karbonik anhidraz aktivitesi ile ilgili etkileri olabilece\u011fi teorisinden yola \u00e7\u0131karak yap\u0131lm\u0131\u015f bir hayvan \u00e7al\u0131\u015fmas\u0131nda tedavide bikarbonat ve glikoz kullan\u0131m\u0131 hedeflenmi\u015ftir. Bu \u00e7al\u0131\u015fma neticesinde erken d\u00f6nemde bikarbonat ve glikozun birlikte kullan\u0131ld\u0131\u011f\u0131nda koma tablosunu ve mortaliteyi azaltt\u0131\u011f\u0131 izlenmi\u015ftir. Bundan yola \u00e7\u0131karak, yine kitlesel maruziyet durumlar\u0131nda olay yerinde ikili tedavi ba\u015flaman\u0131n faydal\u0131 olabilece\u011fi \u00f6ne s\u00fcr\u00fclm\u00fc\u015ft\u00fcr.<\/p>\n<h2><u><strong>Kaynaklar:<\/strong><\/u><\/h2>\n<ol>\n<li>Guidotti TL. Hydrogen sulfide. Occup Med. 1996;46(5):367-371.<\/li>\n<li>Woodall GM, Smith RL, Granville GC. Proceedings of the hydrogen sulfide health research and risk assessment symposium October 31-November 2, 2000. Inhal Toxicol. 2005;17(11): 593-639.<\/li>\n<li><a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/?term=Asif%20MJ%5BAuthor%5D&amp;cauthor=true&amp;cauthor_uid=22004989\">Asif MJ<\/a>,\u00a0<a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/?term=Exline%20MC%5BAuthor%5D&amp;cauthor=true&amp;cauthor_uid=22004989\">Exline MC<\/a>. Utilization of hyperbaric oxygen therapy and induced hypothermia after\u00a0hydrogen sulfide\u00a0exposure. Respiratory care, 2012;57(2): 307-310.<\/li>\n<li>Hall A. H. &amp; Rumack B. H.\u00a0Hydrogen sulfide poisoning: an antidotal role for sodium nitrite?\u00a0Vet. Hum. Toxicol. 1997;39:152\u2013154.<\/li>\n<li>Brenner, M., Benavides, S., Mahon, S. B., Lee, J., Yoon, D., Mukai, D. <em>et al.<\/em>\u00a0The vitamin B12 analog cobinamide is an effective hydrogen sulfide antidote in a lethal rabbit model.\u00a0Clin. Toxicol. 2014;52:490\u2013497.<\/li>\n<li>Almeida A, Nation P, Guidotti TL. Mechanism and treatment of sulfide-induced coma: a rat model. Int J Toxicol. 2008;27(3): 287-293.<\/li>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"<p>H\u0130DROJEN S\u00dcLF\u00dcR NED\u0130R? Kimyasal yolla asfiksi olu\u015fturan gazlar, oksijenin doku taraf\u0131ndan al\u0131nmas\u0131n\u0131 engelleyerek etki ederler. Hemoglobin ve h\u00fccresel enzimlerle birle\u015fip h\u00fccresel oksijen&hellip;<\/p>\n","protected":false},"author":1380,"featured_media":1446,"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":[176,177,178],"class_list":["post-565","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-akademik-blog-yazisi","tag-hidrojen-sulfur","tag-hidrojen-sulfur-intoksikasyonu","tag-hidrojen-sulfur-zehirlenmesi"],"acf":[],"_links":{"self":[{"href":"https:\/\/tatd.org.tr\/toksikoloji\/wp-json\/wp\/v2\/posts\/565","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\/1380"}],"replies":[{"embeddable":true,"href":"https:\/\/tatd.org.tr\/toksikoloji\/wp-json\/wp\/v2\/comments?post=565"}],"version-history":[{"count":0,"href":"https:\/\/tatd.org.tr\/toksikoloji\/wp-json\/wp\/v2\/posts\/565\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/tatd.org.tr\/toksikoloji\/wp-json\/wp\/v2\/media\/1446"}],"wp:attachment":[{"href":"https:\/\/tatd.org.tr\/toksikoloji\/wp-json\/wp\/v2\/media?parent=565"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/tatd.org.tr\/toksikoloji\/wp-json\/wp\/v2\/categories?post=565"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/tatd.org.tr\/toksikoloji\/wp-json\/wp\/v2\/tags?post=565"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}