{"id":837,"date":"2018-07-06T01:21:34","date_gmt":"2018-07-05T22:21:34","guid":{"rendered":"https:\/\/tatd.org.tr\/tatdtoks\/2021\/09\/15\/ilaca-bagli-zehirlenmelerin-yonetiminde-renal-replasman-tedavisinin-rolu-bolum-1-genel-bilgiler\/"},"modified":"2021-11-10T22:35:23","modified_gmt":"2021-11-10T19:35:23","slug":"ilaca-bagli-zehirlenmelerin-yonetiminde-renal-replasman-tedavisinin-rolu-bolum-1-genel-bilgiler","status":"publish","type":"post","link":"https:\/\/tatd.org.tr\/toksikoloji\/2018\/07\/06\/ilaca-bagli-zehirlenmelerin-yonetiminde-renal-replasman-tedavisinin-rolu-bolum-1-genel-bilgiler\/","title":{"rendered":"\u0130laca Ba\u011fl\u0131 Zehirlenmelerin Y\u00f6netiminde Renal Replasman Tedavisinin Rol\u00fc B\u00d6L\u00dcM 1 &#8211; Genel Bilgiler"},"content":{"rendered":"<div class=\"pcrstb-wrap\"><table border='0' cellpadding='1' cellspacing='2'>\n<tbody>\n<tr>\n<td style='width:99px'>\n<p><img alt='' src='https:\/\/tatd.org.tr\/tatdtoks\/wp-content\/uploads\/sites\/36\/2021\/10\/Ekran-Resmi-2018-07-06-11_00_58-1.png' style='height:90px;width:90px' \/><br \/>\n\t\t\t<strong>Do\u00e7.\u00a0Dr. Ali Kemal Erenler<\/strong><br \/>\n\t\t\tHitit \u00dcniversitesi T\u0131p Fak\u00fcltesi\u00a0Acil T\u0131p\u00a0Anabilimdal\u0131<\/p>\n<p><img alt='' src='https:\/\/tatd.org.tr\/tatdtoks\/wp-content\/uploads\/sites\/36\/2021\/10\/Ekran-Resmi-2018-07-06-11_00_43-1.png' style='height:90px;width:90px' \/><\/p>\n<p><strong>Prof. Dr. Zeynep Keke\u00e7<\/strong><br \/>\n\t\t\t\u00c7ukurova \u00dcniversitesi T\u0131p\u00a0Fak\u00fcltesi<br \/>\n\t\t\tAcil T\u0131p Anabilimdal\u0131<\/p>\n<\/td>\n<td>\n<h1 style='text-align:center'>\u00a0<\/h1>\n<h1 style='text-align:center'><strong>\u0130laca Ba\u011fl\u0131 Zehirlenmelerin Y\u00f6netiminde Renal Replasman Tedavisinin Rol\u00fc<\/strong><\/h1>\n<p style='text-align:center'><strong>B\u00d6L\u00dcM 1 &#8211; Genel Bilgiler<\/strong><\/p>\n<p style='text-align:center'>\u00a0<\/p>\n<p>De\u011ferli arkada\u015flar<\/p>\n<p>\u00a0<\/p>\n<p><strong>\u201c\u0130laca Ba\u011fl\u0131 Zehirlenmelerin Y\u00f6netiminde Renal Replasman Tedavisinin Rol\u00fc\u201d\u00a0<\/strong>hakk\u0131nda pek \u00e7ok \u00f6nemli yaz\u0131 ve katk\u0131 veren makale mevcut. Bug\u00fcn sizlerle\u00a0<strong>Mirrakhimov<\/strong><strong>\u00a0ve arkada\u015flar\u0131<\/strong>\u00a0taraf\u0131ndan bu konuda yay\u0131nlanm\u0131\u015f olan\u00a0<strong>International Journal of Nephrology\u2019<\/strong>\u00a0de 2016\u2019 da yay\u0131nlanm\u0131\u015f bir makale ve bu konudaki iz d\u00fc\u015f\u00fcmlerini payla\u015fmaya ba\u015flayaca\u011f\u0131z.\u00a0 Bu konuda yaz\u0131y\u0131 okuyarak g\u00fcncellemeleri yapan yazar ve edit\u00f6r hocalar\u0131m\u0131za te\u015fekk\u00fcr ederiz<\/p>\n<p>Sekiz b\u00f6l\u00fcmden\u00a0olu\u015facak olan bu yaz\u0131 dizisinin ilk b\u00f6l\u00fcm\u00fc olan &#039;<em><strong>Genel Bilgiler<\/strong><\/em>&#039;i\u00a0a\u015fa\u011f\u0131da sizlere sunuyoruz.\u00a0<\/p>\n<p>\u0130yi okumalar dileriz.<\/p>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table><\/div>\n<p>Farmakolojik ajanlarla zehirlenmeler s\u0131k g\u00f6r\u00fclmekle birlikte hafif seyredendenler ile \u00a0ya\u015fam\u0131 tehdit eden aras\u0131nda \u00e7e\u015fitlilik g\u00f6sterir. Farmakolojik ajanlarla zehirlenmelerin y\u00f6netiminde Renal Replasman\u00a0Tedavi\u2019nin (RRT) rol\u00fc hakk\u0131nda yaz\u0131lanlar\u0131n taranmas\u0131 yap\u0131lm\u0131\u015f ve \u00f6zetlenmi\u015f olarak size sunuyoruz. Konuyla ilgili yay\u0131nlar; farmakolojik toksisite, hemodiyaliz, hemofiltrasyon, renal replasman tedavisi, toksikoloji, zehirlenmeler, kritik hastal\u0131k ve yo\u011fun bak\u0131m terimlerinin MEDLINE\u2019a girilmesi ile aranm\u0131\u015f ve yay\u0131nlardan toplanm\u0131\u015f olan verilerin derlemesidir. Acil T\u0131p alan\u0131nda s\u0131k g\u00f6rd\u011f\u00fcm\u00fcz hastalara Nefroloji ve Farmakoloji ortak platformunda yakla\u015f\u0131m prensiplerinin derlenmesi faydal\u0131 olacakt\u0131r.<\/p>\n<p>Farmakolojik maddenin diyaliz yap\u0131labilir say\u0131lmas\u0131 i\u00e7in bir tak\u0131m \u00f6n ko\u015fullar gerekmektedir. Bunlar aras\u0131nda k\u00fc\u00e7\u00fck molek\u00fcl a\u011f\u0131rl\u0131kl\u0131 olma (&lt;500 Da), d\u00fc\u015f\u00fck proteine ba\u011flanma derecesi (&lt;%80), suda \u00e7\u00f6z\u00fclebilir olma ve da\u011f\u0131l\u0131m hacminin az olmas\u0131 (&lt;1 L\/kg) say\u0131labilir. Toksik alkol al\u0131m\u0131, salisilat a\u015f\u0131r\u0131 al\u0131m\u0131, ciddi valproik asid zehirlenmesi, metformin a\u015f\u0131r\u0131 al\u0131m\u0131 ve lityum zehirlenmesi olan kritik hastalarda RRT ciddi \u015fekilde g\u00f6z \u00f6n\u00fcnde bulundurulmal\u0131d\u0131r. Di\u011fer farmakolojik zehirlenmelerde RRT\u2019nin rol\u00fc daha az kesin olmakla birlikte vaka baz\u0131nda de\u011ferlendirme yap\u0131larak dikkate al\u0131nmal\u0131d\u0131r.<\/p>\n<p>Farmakolojik maddeler yap\u0131lar\u0131 gere\u011fi veya a\u015f\u0131r\u0131 doza ba\u011fl\u0131 olarak do\u011fal bir zehirleme riski ta\u015f\u0131rlar. \u00d6rne\u011fin, 2013\u2019te de\u011fi\u015fik maddelere 2188013 insan maruziyeti sonucu 20749 olumsuz reaksiyon ya\u015fanm\u0131\u015f ve bunlar\u0131n da 1552 tanesi \u00f6l\u00fcmle sonu\u00e7lanm\u0131\u015ft\u0131r.\u00a02014 y\u0131l\u0131nda olgular\u0131n %61.4\u2019\u00fcnden ila\u00e7 toksisiteleri sorumlu iken, ila\u00e7 d\u0131\u015f\u0131 maruziyetler kay\u0131tl\u0131 olgular\u0131n %14.1\u2019i olarak tespit edilmi\u015ftir. Bu makalenin amac\u0131 belirli ila\u00e7 a\u015f\u0131r\u0131 al\u0131mlar\u0131n\u0131n y\u00f6netiminde RRT kullan\u0131m\u0131 hakk\u0131ndaki bilgi ve kan\u0131tlar\u0131 g\u00f6zden ge\u00e7irmektir. Makalede ilk olarak, ila\u00e7 ve toksinlerin diyaliz yap\u0131labilirli\u011fini etkileyen farkl\u0131 fakt\u00f6rler g\u00f6zden ge\u00e7irilmi\u015f. \u0130kinci olarak, hemodiyaliz ve hemofiltrasyon odakl\u0131 olmak \u00fczere farkl\u0131 ekstrakorporeal tedavi y\u00f6ntemlerini tart\u0131\u015f\u0131lm\u0131\u015f. \u00dc\u00e7\u00fcnc\u00fc olarak, toksik alkol, salisilat, lityum, metformin, valproik asid ve dabigatran gibi spesifik ila\u00e7lar\u0131n y\u00f6netiminde RRT\u2019nin rol\u00fcn\u00fc vurgulanm\u0131\u015f. Daha sonra nadir g\u00f6r\u00fclen \u00e7e\u015fitli zehirlenmelerin y\u00f6netiminde RRT\u2019nin rol\u00fc tart\u0131\u015f\u0131lm\u0131\u015ft\u0131r.<\/p>\n<p>\u00a0\u00a0<\/p>\n<h2><strong>\u00a0\u0130la\u00e7 ve Toksinlerin Ekstrakorporeal Tedaviler ile Uzakla\u015ft\u0131r\u0131lmas\u0131<\/strong><\/h2>\n<p>\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 E\u011fer ciddi bir zehirlenme g\u00f6stergesi varsa toksinleri uzakla\u015ft\u0131rmak i\u00e7in ekstrakorporeal y\u00f6ntemlerin kullan\u0131m\u0131 onaylanmaktad\u0131r. Bir ilac\u0131n ekstrakorporeal tedavilerden ne \u00f6l\u00e7\u00fcde etkilenece\u011fi Tablo 1\u2019de \u00f6zetlendi\u011fi \u00fczere ilac\u0131n baz\u0131 fizyokimyasal \u00f6zellikleri ile belirlenebilir. Bunlar aras\u0131nda molek\u00fcl b\u00fcy\u00fckl\u00fc\u011f\u00fc, proteine ba\u011flanma, da\u011f\u0131l\u0131m hacmi, suda \u00e7\u00f6z\u00fclebilirlik ve endojen klirens bulunmaktad\u0131r. \u0130lac\u0131n bu \u00f6zelliklerine ek olarak, ilac\u0131n uzakla\u015ft\u0131r\u0131labilir olmas\u0131 i\u015flemin teknik durumuna da ba\u011fl\u0131d\u0131r.<\/p>\n<p style='text-align:center'><img alt='' src='https:\/\/tatd.org.tr\/tatdtoks\/wp-content\/uploads\/sites\/36\/2021\/10\/Ekran-Resmi-2018-07-05-15_12_09-1.png' style='height:200px;width:700px' \/><\/p>\n<p style='text-align:center'><strong>Tablo 1.<\/strong>\u00a0\u0130la\u00e7lar\u0131 ekstrakorporeal olarak uzakla\u015ft\u0131r\u0131lmalar\u0131 a\u00e7\u0131s\u0131ndan optimal fizikokimyasal \u00f6zellikleri<\/p>\n<p>\u00a0<\/p>\n<h3><strong><em>Molek\u00fcl A\u011f\u0131rl\u0131\u011f\u0131<\/em><\/strong><\/h3>\n<p>\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Diyaliz, sabit delik boyutlu bir sentetik diyaliz zar\u0131n\u0131n kullan\u0131m\u0131na dayan\u0131r. \u0130la\u00e7 ve di\u011fer \u00e7\u00f6zeltilerin hareketi b\u00fcy\u00fck \u00f6l\u00e7\u00fcde bu molek\u00fcllerin b\u00fcy\u00fckl\u00fc\u011f\u00fc ile zar\u0131n delik b\u00fcy\u00fckl\u00fc\u011f\u00fc aras\u0131ndaki ili\u015fkiyle belirlenir. Genel bir kural olarak, b\u00fcy\u00fck molek\u00fcl a\u011f\u0131rl\u0131kl\u0131 maddelerle k\u0131yasland\u0131\u011f\u0131nda daha k\u00fc\u00e7\u00fck molek\u00fcl a\u011f\u0131rl\u0131kl\u0131 maddeler zardan daha kolay ge\u00e7ecektir.<\/p>\n<h3>\u00a0<\/h3>\n<h3><strong><em>Proteine Ba\u011flanma<\/em><\/strong><\/h3>\n<p>\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Diyaliz esnas\u0131nda ilac\u0131n uzakla\u015ft\u0131r\u0131lmas\u0131n\u0131 etkileyen bir di\u011fer \u00f6nemli fakt\u00f6r de diyaliz zar\u0131ndan ge\u00e7en ba\u011fl\u0131 olmayan (serbest) ila\u00e7 konsantrasyon gradyenidir. Pek \u00e7ok ila\u00e7 i\u00e7in birincil ba\u011flanma proteinleri (esas olarak albumin) b\u00fcy\u00fck molek\u00fcl boyutlar\u0131na sahip olduklar\u0131ndan ila\u00e7 protein kompleksleri diyaliz zar\u0131ndan genellikle ge\u00e7emez. Protein ba\u011flanma derecesi y\u00fcksek olan ila\u00e7lar\u0131n diyalize uygun plazma serbest ila\u00e7 konsantrasyonlar\u0131 az olaca\u011f\u0131ndan klirensleri de d\u00fc\u015f\u00fck olacakt\u0131r.<\/p>\n<h3>\u00a0<\/h3>\n<h3><strong><em>Da\u011f\u0131l\u0131m Hacmi\u00a0<\/em><\/strong><\/h3>\n<p>\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Toksinin uzakla\u015fmas\u0131 da\u011fl\u0131m hacmi (DH)\u2019den de teorik olarak etkilenir. DH\u2019si b\u00fcy\u00fck olan ila\u00e7 dokulara da\u011f\u0131l\u0131r ve kanda nispeten k\u00fc\u00e7\u00fck bir miktar\u0131 kal\u0131r. DH\u2019nin b\u00fcy\u00fck olmas\u0131na etki eden fakt\u00f6rlery\u00fcksek ya\u011f \u00e7\u00f6z\u00fcn\u00fcrl\u00fc\u011f\u00fc ve d\u00fc\u015f\u00fck plazma proteinlerine ba\u011flanmad\u0131r. Y\u00fcksek DH\u2019li ila\u00e7lar (&gt;1 L\/kg) diyalizden daha az etkilenirler.<\/p>\n<h3>\u00a0<\/h3>\n<h3><strong><em>Suda \u00c7\u00f6z\u00fcn\u00fcrl\u00fck<\/em><\/strong><\/h3>\n<p>\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Hemodiyalizde kullan\u0131lan diyalizat ak\u00f6z bir \u00e7\u00f6zeltidir. Genelde, suda \u00e7\u00f6z\u00fcn\u00fcrl\u00fc\u011f\u00fc fazla olan ila\u00e7lar y\u00fcksek ya\u011f \u00e7\u00f6z\u00fcn\u00fcrl\u00fckl\u00fc ila\u00e7lardan daha iyi diyaliz olurlar. Y\u00fcksek ya\u011f \u00e7\u00f6z\u00fcn\u00fcrl\u00fckl\u00fc ila\u00e7lar dokulara daha fazla da\u011f\u0131lma e\u011filimi g\u00f6sterirler ve b\u00f6ylece diyalizden ge\u00e7ebilecek plazma miktarlar\u0131 az olur.<\/p>\n<h3>\u00a0<\/h3>\n<h3><strong><em>Endojen Klirens<\/em><\/strong><\/h3>\n<p>\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Bu terim ilac\u0131n renal ve renal olmayan (\u00f6zellikle hepatik) klirensini tan\u0131mlar. Endojen yollardan h\u0131zl\u0131ca at\u0131lan ila\u00e7lar (&gt;4 mL\/Kg\/min)i\u00e7in diyalizin s\u0131n\u0131rl\u0131 bir etkisi olacakt\u0131r. E\u011fer v\u00fccut klirensine en az %30 ek fayda sa\u011flayacaksa ekstrakorporeal tedavilerin kullan\u0131m\u0131 onaylanmaktad\u0131r.\u00a0<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Do\u00e7.\u00a0Dr. Ali Kemal Erenler Hitit \u00dcniversitesi T\u0131p Fak\u00fcltesi\u00a0Acil T\u0131p\u00a0Anabilimdal\u0131 Prof. Dr. Zeynep Keke\u00e7 \u00c7ukurova \u00dcniversitesi T\u0131p\u00a0Fak\u00fcltesi Acil T\u0131p Anabilimdal\u0131 \u00a0 \u0130laca Ba\u011fl\u0131&hellip;<\/p>\n","protected":false},"author":1380,"featured_media":1770,"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":[143,193,350,412,450],"class_list":["post-837","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-akademik-blog-yazisi","tag-ekstrakorporeal-tedaviler","tag-ilaca-bagli-zehirlenmeler","tag-renal-replasman-tedavisi","tag-toksinler","tag-zehirlenmeler"],"acf":[],"_links":{"self":[{"href":"https:\/\/tatd.org.tr\/toksikoloji\/wp-json\/wp\/v2\/posts\/837","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=837"}],"version-history":[{"count":0,"href":"https:\/\/tatd.org.tr\/toksikoloji\/wp-json\/wp\/v2\/posts\/837\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/tatd.org.tr\/toksikoloji\/wp-json\/wp\/v2\/media\/1770"}],"wp:attachment":[{"href":"https:\/\/tatd.org.tr\/toksikoloji\/wp-json\/wp\/v2\/media?parent=837"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/tatd.org.tr\/toksikoloji\/wp-json\/wp\/v2\/categories?post=837"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/tatd.org.tr\/toksikoloji\/wp-json\/wp\/v2\/tags?post=837"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}