{"id":790,"date":"2018-04-10T17:57:41","date_gmt":"2018-04-10T14:57:41","guid":{"rendered":"https:\/\/tatd.org.tr\/tatdtoks\/2021\/09\/17\/kratom\/"},"modified":"2021-11-10T22:35:23","modified_gmt":"2021-11-10T19:35:23","slug":"kratom","status":"publish","type":"post","link":"https:\/\/tatd.org.tr\/toksikoloji\/2018\/04\/10\/kratom\/","title":{"rendered":"KRATOM"},"content":{"rendered":"

\"\"<\/p>\n

Kratom di\u011fer ad\u0131yla Mitragynaspeciosa \u00fclkemizde do\u011fal olarak yeti\u015fmez. G\u00fcneydo\u011fu Asya\u2019da hem do\u011fal olarak bulunur hem de yasaklanmam\u0131\u015f b\u00f6lgelerde tar\u0131m\u0131 yap\u0131lmaktad\u0131r. Bunun d\u0131\u015f\u0131nda ABD\u2019de de tar\u0131m\u0131 yap\u0131lmaktad\u0131r. Ayr\u0131ca ABD\u2019nin belli eyaletlerinde \u2018KRATOM BAR\u2019 ismi verilen yerlerde hem kullan\u0131ma uygun hem de toz ya da yaprak halinde sat\u0131\u015f\u0131 mevcuttur.<\/p>\n

\"\"<\/p>\n

\"\"<\/p>\n

Kratomun kullan\u0131m\u0131; b\u00f6lgeden b\u00f6lgeye farkl\u0131l\u0131k g\u00f6sterse de sigara \u015feklinde inhalasyon yoluyla kullan\u0131m\u0131ndan daha ziyade oral al\u0131m\u0131 tercih edilir. Yo\u011furt ile, protein tozlar\u0131n\u0131n i\u00e7inde ya da kaps\u00fcl olarak t\u00fcketildi\u011fi bilinmektedir. 2-3 gram ile al\u0131nmas\u0131 ile etkisini g\u00f6stermedi\u011fi bilinen Kratom\u2019uny\u00fcksek kalitelileri 4-5 grama kadar k\u00fc\u00e7\u00fck al\u0131mlarda bile etkisini g\u00f6sterdi\u011fi bilinmektedir. Ayr\u0131ca yerli halk taraf\u0131ndan de\u011fi\u015fik kokteyller bulunmaktad\u0131r ve i\u00e7eri\u011finde ne kadar kratom ya da etken madde oldu\u011fu bilinmemektedir.<\/p>\n

Kratomun etkisi;7-hydroxymitragynine ve mitragynine Kratomunesas etkilerinden sorumlu kimyasallard\u0131r. Fakat bunun d\u0131\u015f\u0131nda 25\u2019ten fazla alkaloid i\u00e7erdi\u011fi de bilinmektedir. 7-hydroxymitragynine ve mitragyninesupraspinal mu- ve delta- opioid resept\u00f6rleri uyararak etki g\u00f6sterir. Opioid benzeri etkileri nedeniyle suiistimal edilen Kratom bir d\u00f6nem ABD\u2019de kronik a\u011fr\u0131s\u0131 olanlarda kullan\u0131lm\u0131\u015ft\u0131r.<\/p>\n

\"\"<\/p>\n

Doza ba\u011fl\u0131 etki g\u00f6r\u00fclmektedir.<\/p>\n

10 gram civar\u0131 al\u0131mlar hafif al\u0131m olarak nitelendirilir ve konu\u015fmada artma, \u00f6fori ve sosyal davran\u0131\u015flarda rahatl\u0131k g\u00f6zlenir. (Koka ve khat\u2019a ne kadar da \u00e7ok benziyor de\u011fil mi? Bir sonraki konumuz Khat olsun o zaman)<\/p>\n

20-50 gram aras\u0131 al\u0131mlarda ise sedasyon ve a\u011fr\u0131da azalma g\u00f6r\u00fcl\u00fcr. Dozdan ba\u011f\u0131ms\u0131z olarak (\u00f6zellikle alkol ile birlikte t\u00fcketimde) n\u00f6bet, koma, solunum depresyonu ve \u00f6l\u00fcm g\u00f6r\u00fclebilir. Fakat bu istenmeyen etkiler doz artt\u0131k\u00e7a daha s\u0131k g\u00f6r\u00fcl\u00fcr. \u0130lk al\u0131mlara \u00f6zellikle dikkat edilmelidir.<\/p>\n

Bunun d\u0131\u015f\u0131nda en s\u0131k g\u00f6r\u00fclen yan etkiler opioid resept\u00f6rleri nedeniyle g\u00f6r\u00fcl\u00fcr. Bunlar aras\u0131nda bulant\u0131, kusma, ka\u015f\u0131nt\u0131, a\u011f\u0131z kurulu\u011fu, kab\u0131zl\u0131k, kilo kayb\u0131 ve anksiyete bulunmaktad\u0131r.<\/p>\n

Kronik kullan\u0131mda ise karaci\u011fer yetmezli\u011fi s\u0131k g\u00f6r\u00fclmektedir. Karaci\u011fer yetmezli\u011fi g\u00f6r\u00fclen ki\u015filerde b\u00f6brek yetmezli\u011fi ile s\u0131kl\u0131kla kar\u015f\u0131la\u015f\u0131l\u0131r.<\/p>\n

Acil tedavi<\/strong><\/u><\/h2>\n

Akut Kratom toksisitesinde ilk yakla\u015f\u0131m temel\/ileri ya\u015fam deste\u011fidir. Hastan\u0131n vital ve genel durumu \u00f6nemlidir. Solunum sistemi bulgular\u0131na \u00f6zellikle dikkat edilmelidir. GI dekontaminasyon n\u00f6bet ihtimali fazla oldu\u011fu ve hastalar\u0131n \u00e7o\u011funda kusma g\u00f6r\u00fcld\u00fc\u011f\u00fc i\u00e7in genellikle \u00f6nerilmemektedir. Hastalarda a\u015f\u0131r\u0131 dozda al\u0131m ya da e\u015flik eden ba\u015fka toksik madde al\u0131m\u0131 durumunda aktif k\u00f6m\u00fcr \u00f6nerilmektedir.<\/p>\n

Hafif ve orta d\u00fczeyde toksisitede; tedavi destek tedavisidir. Hastan\u0131n bilin\u00e7 durumu s\u0131k\u00e7a de\u011ferlendirilmeli ve ajitasyonlar\/n\u00f6betler benzodiazepinler ile tedavi edilmelidir. Solunum g\u00fc\u00e7l\u00fc\u011f\u00fc olan hastalarda RSI ile ent\u00fcbasyon \u00f6nerilmektedir.<\/p>\n

\u0130leri d\u00fczeyde toksisitede; hastan\u0131n genel vital bulgular\u0131 ve solunumu daha da fazla \u00f6nem arz eder. Bu hastalar\u0131n \u00e7o\u011funda ent\u00fcbasyonendikasyonu bulunmaktad\u0131r.<\/p>\n

Baz\u0131 deneysel \u00e7al\u0131\u015fmalarda Nalokson7-hydroxymitragynine ve mitragynine\u2019in etkisini geri d\u00f6nd\u00fcrd\u00fc\u011f\u00fc g\u00f6stermi\u015ftir.<\/p>\n

Kaynaklar<\/strong><\/u><\/h2>\n
    \n
  1. Hassan, Zurina, et al. “FromKratomtomitragynineanditsderivatives: physiologicalandbehaviouraleffectsrelatedtouse, abuse, andaddiction.” Neuroscience&BiobehavioralReviews 37.2 (2013): 138-151.<\/li>\n
  2. Prozialeck, Walter C., Jateen K. Jivan, andShridhar V. Andurkar. “Pharmacology of kratom: an emergingbotanicalagentwithstimulant, analgesicandopioid-likeeffects.” TheJournal of theAmericanOsteopathicAssociation 112.12 (2012): 792-799.<\/li>\n
  3. Nelsen, Jamie L., et al. “SeizureandcomafollowingKratom (MitragyninaspeciosaKorth) exposure.” Journal of medicaltoxicology 6.4 (2010): 424-426.<\/li>\n
  4. Janchawee, B., Keawpradub, N., Chittrakarn, S., Prasettho, S., Wararatananurak, P., &Sawangjareon, K. (2007). A high\u2010performanceliquidchromatographicmethodfordetermination of mitragynine in serum anditsapplicationto a pharmacokineticstudy in rats. BiomedicalChromatography, 21(2), 176-183.<\/li>\n
  5. Fluyau, Dimy, andNeelambikaRevadigar. “Biochemicalbenefits, diagnosis, andclinicalrisksevaluation of kratom.” Frontiers in psychiatry 8 (2017): 62.<\/li>\n
  6. FoodandDrug Administration. (2017). Statement from FDA CommissionerScottGottlieb, MD, on theFDA\u2019snewpolicystepsandenforcementeffortstoensureproperoversight of stemcelltherapiesandregenerativemedicine. August 28, 2017.<\/li>\n
  7. Idid, S. Z., Saad, L. B., Yaacob, H., &Shahimi, M. M. (1998). Evaluation of analgesiainducedbymitragynine, morphineandparacetamol on mice. ASEAN Review of BiodiversityandEnvironmentalConservation (ARBEC), Article IV.<\/li>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"

    Kratom hakk\u0131nda ne biliyoruz?<\/p>\n

    Son d\u00f6nem Google aramalar\u0131nda kar\u015f\u0131ma \u00e7\u0131kan di\u011fer bir madde ise Kratom. Kratom \u00fclkemizde vaka olarak bildirilmemi\u015f olmas\u0131na ra\u011fmen ucuz olmas\u0131 ve yeni yasaklanm\u0131\u015f (2014 y\u0131l\u0131) oldu\u011fu i\u00e7in piyasada kullan\u0131l\u0131yor olmas\u0131 muhtemeldir. Ayr\u0131ca Amerika Birle\u015fik Devletleri\u2019nde \u00e7o\u011fu eyalette yasald\u0131r ve internetten sat\u0131\u015f\u0131 yap\u0131lmaktad\u0131r.\u00a0D\u00fcnya\u2019da bu kadar yayg\u0131n olan bitkinin tan\u0131n\u0131rl\u0131\u011f\u0131n\u0131n hem halk hem de hekimlerce az oldu\u011funu fark etmi\u015f olmak bu yaz\u0131n\u0131n kaleme al\u0131nmas\u0131n\u0131 sa\u011flad\u0131. Vakalar\u0131n\u0131z olduk\u00e7a payla\u015fman\u0131z\u0131 ve bilgilerimizi-deneyimimizi artt\u0131rman\u0131z\u0131 rica ederiz.<\/p>\n

    \u0130yi okumalar.<\/p>\n","protected":false},"author":884,"featured_media":1710,"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":[213,239,256,257,449],"class_list":["post-790","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-akademik-blog-yazisi","tag-kakuam","tag-ketum","tag-kratom","tag-kratom-zehirlemesi-yonetimi","tag-zehirlenme"],"acf":[],"_links":{"self":[{"href":"https:\/\/tatd.org.tr\/toksikoloji\/wp-json\/wp\/v2\/posts\/790","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\/884"}],"replies":[{"embeddable":true,"href":"https:\/\/tatd.org.tr\/toksikoloji\/wp-json\/wp\/v2\/comments?post=790"}],"version-history":[{"count":0,"href":"https:\/\/tatd.org.tr\/toksikoloji\/wp-json\/wp\/v2\/posts\/790\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/tatd.org.tr\/toksikoloji\/wp-json\/wp\/v2\/media\/1710"}],"wp:attachment":[{"href":"https:\/\/tatd.org.tr\/toksikoloji\/wp-json\/wp\/v2\/media?parent=790"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/tatd.org.tr\/toksikoloji\/wp-json\/wp\/v2\/categories?post=790"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/tatd.org.tr\/toksikoloji\/wp-json\/wp\/v2\/tags?post=790"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}