Karadeniz Bölgesi'ndeki Bir Üçüncü Basamak Acil Serviste Zehirlenme Vakalarının On Yıllık Klinik-Epidemiyolojik Profili
Öz
Amaç: Bu çalışma, Türkiye'nin Doğu Karadeniz Bölgesi'nde yer alan bir üçüncü basamak acil servisine başvuran akut zehirlenme vakalarının demografik, etiyolojik ve klinik özelliklerini ve 10 yıllık eğilimlerini analiz etmeyi amaçlamıştır.
Gereç ve Yöntemler: Bu retrospektif, kesitsel çalışmada, 20072016 yılları arasında zehirlenme tanısı alan 17 yaş üstü 1811 hasta incelenmiştir. Veriler acil servis veri tabanından toplanmıştır. Demografik veriler, zehirlenme etkenleri, klinik bulgular ve sonuçlar gibi temel değişkenler değerlendirilmiştir. Dekontaminasyon ve eliminasyon teknikleri ile madde kullanımı ve başvuru zamanlarındaki eğilimler incelenmiştir.
Bulgular: 505.525 acil servis başvurusunun %0,4’ü (n=1811) zehirlenmeler nedeniyle olmuş ve vakaların çoğunluğu kadınlar (%63,1) ve 17-24 yaş grubundaki kişilerden (%50,0) oluşmuştur. Vaka sayısının %60,7’si intihar girişimleri ile ilişkili bulunmuş, bu hastaların %44,6’sının psikiyatrik hastalık öyküsü olduğu tespit edilmiştir. En yaygın zehirlenme etkenleri analjezikler (%24,4) ve antidepresanlar (%24,3) olup, parasetamol ve amitriptilin en sık sorumlu tutulan ilaçlar olmuştur. Hastaların %57,3’üne dekontaminasyon uygulanmış, %13,4’üne antidot tedavisi verilmiştir. On yıllık süreçte amitriptilin zehirlenmelerinin azaldığı, parasetamol zehirlenmelerinin ise arttığı görülmüştür. Mortalite oranı %0,2 ile düşük bulunmuş ve hastaların %90,8’i tamamen iyileşmiştir.
Sonuç: Bu çalışma, on yıllık süreçte zehirlenme etkenlerindeki önemli değişikliklere dikkat çekmektedir; parasetamol kullanımındaki artış ve amitriptilin zehirlenmelerindeki azalma bunlara örnek olarak verilebilir. Bulgular, bölgeye özgü epidemiyolojik çalışmaların, koruyucu ve klinik stratejiler geliştirilmesindeki önemini vurgulamaktadır. Bu tür çalışmalar, zehirlenme ile ilişkili morbidite ve mortaliteyi azaltmaya ve halk sağlığı politikalarını iyileştirmeye katkı sağlayabilir.
Anahtar Kelimeler
Akut zehirlenme ilaç doz aşımı retrospektif çalışma toksikoloji
Etik Beyan
Ethical approval was obtained from the local ethical committee (Approval No: 2016/48).
Destekleyen Kurum
This research received no specific grant from any funding agency in the public, commercial, or not for-profit sectors.
Kaynakça
- Andiran N, Sarikayalar F. Acute poisoning cases observed in Hacettepe University Ihsan Dogramaci Children's Hospital over the past 6 years. Katkı Pediatri Derg. 2001;22:396-408.
- Islam MN, Islam N. Retrospective study of 273 deaths due to poisoning at Sir Salimullah Medical College from 1988 to 1997. Leg Med (Tokyo). 2003;5:S129-S31.
- Avsarogullari L, Senol V, Akdur O, Akin A, Durukan P, Özkan S. Characteristics of acute adult poisonings in a university hospital emergency department in central Turkey: a three-year analysis. J Pak Med Assoc. 2012;62(2):129.
- Goksu S, Yildirim C, Kocoglu H, Tutak A, Oner U. Characteristics of acute adult poisoning in Gaziantep, Turkey. J Toxicol Clin Toxicol. 2002;40(7):833-7.
- Kubota Y, Hasegawa K, Taguchi H, Kitamura T, Nishiyama C, Iwami T, et al. Characteristics and trends of emergency patients with drug overdose in Osaka. Acute Med Surg. 2015;2(4):237-43.
- Soslow AR. Acute drug overdose: one hospital's experience. Ann Emerg Med. 1981;10(1):18-21.
- Bakhaidar M, Jan S, Farahat F, Attar A, Alsaywid B, Abuznadah W. Pattern of drug overdose and chemical poisoning among patients attending an emergency department, western Saudi Arabia. J Community Health. 2015;40(1):57-61.
- Koylu R, Dundar ZD, Koylu O, et al. The experiences in a toxicology unit: a review of 623 cases. J Clin Med Res. 2014;6(1):59.
- Gündüz A, Kesen J, Topbaş M, Narcı H, Yandı M. İntihar amaçlı zehirlenme nedeniyle acil servise başvuran hastaların analizi. TSK Koruyucu Hekim Bülteni. 2004;3(10):234-42.
- Tountas C, Sotiropoulos A, Skliros SA, Kotsini V, Peppas TA, Tamvakos E, et al. Voluntary self-poisoning as a cause of admission to a tertiary hospital internal medicine clinic in Piraeus, Greece within a year. BMC Psychiatry. 2001;1(1):4.
- Mort JR, Aparasu RR. Prescribing potentially inappropriate psychotropic medications to the ambulatory elderly. Arch Intern Med. 2000;160(18):2825-31.
- Rhee TG, Schommer JC, Capistrant BD, Hadsall RL, Uden DL. Potentially inappropriate antidepressant prescriptions among older adults in office-based outpatient settings: National trends from 2002 to 2012. Adm Policy Ment Health. 2018;45(2):224-35.
- Curtis LH, Østbye T, Sendersky V, Hutchison S, Dans PE, Wright A, et al. Inappropriate prescribing for elderly Americans in a large outpatient population. Arch Intern Med. 2004;164(15):1621-5.
- Willcox SM, Himmelstein DU, Woolhandler S. Inappropriate drug prescribing for the community-dwelling elderly. JAMA. 1994;272(4):292-6.
- McKenzie MS, McFarland BH. Trends in antidepressant overdoses. Pharmacoepidemiol Drug Saf. 2007;16(5):513-23.
- Ozkose Z, Ayoglu F. Etiological and demographical characteristics of acute adult poisoning in Ankara, Turkey. Hum Exp Toxicol. 1999;18(10):614-8.
- Kavalcı C, Durukan P, Çevik Y, Mehmet Ö. Zehirlenme olgularının analizi: Yeni bir hastanenin bir yıllık deneyimi. Turk J Emerg Med. 2006;6(4):163-6.
- Baydin A, Yardan T, Aygun D, Doganay Z, Nargis C, Incealtin O. Retrospective evaluation of emergency service patients with poisoning: a 3-year study. Adv Ther. 2005;22(6):650-8.
- Karakaya A, Vural N. Acute poisoning admissions in one of the hospitals in Ankara. Hum Toxicol. 1985;4(3):323-6.
- Seydaoglu G, Satar S, Alparslan N. Frequency and mortality risk factors of acute adult poisoning in Adana, Turkey, 1997-2002. Mt Sinai J Med. 2005;72(6):393.
- Cardozo L, Mugerwa R. The pattern of acute poisoning in Uganda. East Afr Med J. 1972;49(12):983.
- Evans JG. Deliberate self-poisoning in the Oxford area. Br J Prev Soc Med. 1967;21(3):97.
- Jamil H. Acute poisoning: A review of 1900 cases. J Pak Med Assoc. 1990;40(6):131-3.
- Rygnestad T. A comparative prospective study of self-poisoned patients in Trondheim, Norway between 1978 and 1987: epidemiology and clinical data. Hum Toxicol. 1989;8(6):475-82.
- Senewiratne B, Thambipillai S. Pattern of poisoning in a developing agricultural country. J Epidemiol Community Health. 1974;28(1):32-6.
- Smith A. Self-poisoning with drugs: a worsening situation. Br Med J. 1972;4(5833):157.
- Akkas M, Coskun F, Ulu N, Sivri B. An epidemiological evaluation of 1098 acute poisoning cases from Turkey. Vet Hum Toxicol. 2004;46(4):213-5.
- Onur D, Kavak H, Serhat A, Ünlüer EE, Aksay E. Acil servise başvuran zehirlenme olgularının geriye dönük incelemesi. Çağdaş Tıp Derg. 2013;3(1).
- Satar S, Seydaoglu G, Akpinar A, Sebe A, Karakoc E, Gumusay U, et al. Trends in acute adult poisoning in a ten-year period in Turkey: factors affecting the hazardous outcome. Bratisl Lek Listy. 2009;110(7):404-11.
- Albert M, McCaig L, Uddin S. Emergency department visits for drug poisoning: United States, 2008-2011. NCHS Data Brief. 2015;(196).
- Dorado SP, Martín JF, Sabugal GR, Caballero PV. Epidemiology of acute poisoning: study of 613 cases in the community of Madrid in 1994. Rev Clin Esp. 1996;196(3):150-6.
- Viertel A, Weidmann E, Brodt H. Cases of acute poisoning admitted to a medical intensive care unit. Dtsch Med Wochenschr. 2001;126(42):1159-63.
- Yeşil O, Akoğlu H, Onur Ö, Güneysel Ö. Acil servise başvuran zehirlenme olgularının geriye dönük analizi. Marmara Med J. 2008;21(1):26-32.
- Vallersnes OM, Jacobsen D, Ekeberg Ø, Brekke M. Patients presenting with acute poisoning to an outpatient emergency clinic: a one-year observational study in Oslo, Norway. BMC Emerg Med. 2015;15(1):18.
- World Health Organization. WHO Chemical Safety - Activity Report 2017. World Health Organization; 2017. Available from: http://www.who.int/ipcs/poisons/en/. Accessed December 2024.
- Skegg K, Skegg D, Richards SM. Incidence of self-poisoning in patients prescribed psychotropic drugs. Br Med J (Clin Res Ed). 1983;286(6368):841-3.
- T.C. Sağlık Bakanlığı. Yataklı Sağlık Tesislerinde Acil Servis Hizmetlerinin Uygulama Usul ve Esasları Hakkında Tebliğ. Resmi Gazete; 2009. Available from: http://www.mevzuat.gov.tr/Metin.Aspx?MevzuatKod=9.5.13494&MevzuatIliski=0. Accessed November 2024.
- Shadnia S, Esmaily H, Sasanian G, Pajoumand A, Hassanian-Moghaddam H, Abdollahi M. Pattern of acute poisoning in Tehran-Iran in 2003. Hum Exp Toxicol. 2007;26(9):753-6.
- Hettiarachchi J, Kodithuwakku G. Pattern of poisoning in rural Sri Lanka. Int J Epidemiol. 1989;18(2):418-22.
- Staikowsky F, Theil F, Mercadier P, Candella S, Benais JP. Change in profile of acute self-drug poisonings over a 10-year period. Hum Exp Toxicol. 2004;23(11):507-11.
A Ten-Year Clinico-Epidemiology Profile of Poisoned Patients in a Tertiary Care Emergency Department in the Black Sea Region of Türkiye
Öz
Aim: This study aimed to analyze the demographic, etiological, and clinical characteristics of acute poisoning cases, along with 10year trends, in patients presenting to a tertiary emergency department in the Eastern Black Sea Region of Türkiye.
Material and Methods: This retrospective, cross-sectional study included 1811 patients aged over 17 years who were diagnosed with intoxications between 2007 and 2016. Data were collected from the emergency department database. Key variables included demographics, intoxication agents, clinical presentations, and outcomes. Decontamination and elimination techniques, as well as trends in substance use and presentation times, were evaluated.
Results: Of 505,525 emergency department visits, 0.4% (n=1811) were due to intoxications, predominantly involving females (63.1%) and individuals aged 17–24 years (50.0%). Suicide attempts accounted for 60.7% of cases, with 44.6% of these patients having a psychiatric history. The most common agents were analgesics (24.4%) and antidepressants (24.3%), with paracetamol and amitriptyline being the most frequently implicated drugs. Decontamination was applied to 57.3% of patients, and antidote therapy to 13.4%. Over the decade, a shift from amitriptyline to paracetamol poisonings was observed. Mortality was low, at 0.2%, and 90.8% of patients fully recovered.
Conclusion: This study highlights significant changes in poisoning agents over a decade, with increasing paracetamol use and decreasing amitriptyline-related cases. These findings underscore the importance of region-specific epidemiological studies to guide preventive and clinical strategies, reduce intoxication-related morbidity and mortality, and improve public health policies.
Anahtar Kelimeler
Acute poisoning drug overdose retrospective study toxicology
Etik Beyan
This research was designed as a retrospective, cross-sectional, descriptive, single-center study. Ethical approval was obtained from the local ethical committee (Approval No: 2016/48). The study included all patients who were assigned intoxication-related International Statistical Classification of Diseases and Related Health Problems (ICD-10) codes between January 2007 and December 2016. Patient data were retrospectively retrieved from the hospital’s software system, and records from the archives were examined. All data were anonymized to ensure patient confidentiality.
Destekleyen Kurum
This study did not receive any financial support or funding from any institution, organization, or agency.
Teşekkür
We thank all the healthcare professionals and administrative staff who contributed to the completion of this study.
Kaynakça
- Andiran N, Sarikayalar F. Acute poisoning cases observed in Hacettepe University Ihsan Dogramaci Children's Hospital over the past 6 years. Katkı Pediatri Derg. 2001;22:396-408.
- Islam MN, Islam N. Retrospective study of 273 deaths due to poisoning at Sir Salimullah Medical College from 1988 to 1997. Leg Med (Tokyo). 2003;5:S129-S31.
- Avsarogullari L, Senol V, Akdur O, Akin A, Durukan P, Özkan S. Characteristics of acute adult poisonings in a university hospital emergency department in central Turkey: a three-year analysis. J Pak Med Assoc. 2012;62(2):129.
- Goksu S, Yildirim C, Kocoglu H, Tutak A, Oner U. Characteristics of acute adult poisoning in Gaziantep, Turkey. J Toxicol Clin Toxicol. 2002;40(7):833-7.
- Kubota Y, Hasegawa K, Taguchi H, Kitamura T, Nishiyama C, Iwami T, et al. Characteristics and trends of emergency patients with drug overdose in Osaka. Acute Med Surg. 2015;2(4):237-43.
- Soslow AR. Acute drug overdose: one hospital's experience. Ann Emerg Med. 1981;10(1):18-21.
- Bakhaidar M, Jan S, Farahat F, Attar A, Alsaywid B, Abuznadah W. Pattern of drug overdose and chemical poisoning among patients attending an emergency department, western Saudi Arabia. J Community Health. 2015;40(1):57-61.
- Koylu R, Dundar ZD, Koylu O, et al. The experiences in a toxicology unit: a review of 623 cases. J Clin Med Res. 2014;6(1):59.
- Gündüz A, Kesen J, Topbaş M, Narcı H, Yandı M. İntihar amaçlı zehirlenme nedeniyle acil servise başvuran hastaların analizi. TSK Koruyucu Hekim Bülteni. 2004;3(10):234-42.
- Tountas C, Sotiropoulos A, Skliros SA, Kotsini V, Peppas TA, Tamvakos E, et al. Voluntary self-poisoning as a cause of admission to a tertiary hospital internal medicine clinic in Piraeus, Greece within a year. BMC Psychiatry. 2001;1(1):4.
- Mort JR, Aparasu RR. Prescribing potentially inappropriate psychotropic medications to the ambulatory elderly. Arch Intern Med. 2000;160(18):2825-31.
- Rhee TG, Schommer JC, Capistrant BD, Hadsall RL, Uden DL. Potentially inappropriate antidepressant prescriptions among older adults in office-based outpatient settings: National trends from 2002 to 2012. Adm Policy Ment Health. 2018;45(2):224-35.
- Curtis LH, Østbye T, Sendersky V, Hutchison S, Dans PE, Wright A, et al. Inappropriate prescribing for elderly Americans in a large outpatient population. Arch Intern Med. 2004;164(15):1621-5.
- Willcox SM, Himmelstein DU, Woolhandler S. Inappropriate drug prescribing for the community-dwelling elderly. JAMA. 1994;272(4):292-6.
- McKenzie MS, McFarland BH. Trends in antidepressant overdoses. Pharmacoepidemiol Drug Saf. 2007;16(5):513-23.
- Ozkose Z, Ayoglu F. Etiological and demographical characteristics of acute adult poisoning in Ankara, Turkey. Hum Exp Toxicol. 1999;18(10):614-8.
- Kavalcı C, Durukan P, Çevik Y, Mehmet Ö. Zehirlenme olgularının analizi: Yeni bir hastanenin bir yıllık deneyimi. Turk J Emerg Med. 2006;6(4):163-6.
- Baydin A, Yardan T, Aygun D, Doganay Z, Nargis C, Incealtin O. Retrospective evaluation of emergency service patients with poisoning: a 3-year study. Adv Ther. 2005;22(6):650-8.
- Karakaya A, Vural N. Acute poisoning admissions in one of the hospitals in Ankara. Hum Toxicol. 1985;4(3):323-6.
- Seydaoglu G, Satar S, Alparslan N. Frequency and mortality risk factors of acute adult poisoning in Adana, Turkey, 1997-2002. Mt Sinai J Med. 2005;72(6):393.
- Cardozo L, Mugerwa R. The pattern of acute poisoning in Uganda. East Afr Med J. 1972;49(12):983.
- Evans JG. Deliberate self-poisoning in the Oxford area. Br J Prev Soc Med. 1967;21(3):97.
- Jamil H. Acute poisoning: A review of 1900 cases. J Pak Med Assoc. 1990;40(6):131-3.
- Rygnestad T. A comparative prospective study of self-poisoned patients in Trondheim, Norway between 1978 and 1987: epidemiology and clinical data. Hum Toxicol. 1989;8(6):475-82.
- Senewiratne B, Thambipillai S. Pattern of poisoning in a developing agricultural country. J Epidemiol Community Health. 1974;28(1):32-6.
- Smith A. Self-poisoning with drugs: a worsening situation. Br Med J. 1972;4(5833):157.
- Akkas M, Coskun F, Ulu N, Sivri B. An epidemiological evaluation of 1098 acute poisoning cases from Turkey. Vet Hum Toxicol. 2004;46(4):213-5.
- Onur D, Kavak H, Serhat A, Ünlüer EE, Aksay E. Acil servise başvuran zehirlenme olgularının geriye dönük incelemesi. Çağdaş Tıp Derg. 2013;3(1).
- Satar S, Seydaoglu G, Akpinar A, Sebe A, Karakoc E, Gumusay U, et al. Trends in acute adult poisoning in a ten-year period in Turkey: factors affecting the hazardous outcome. Bratisl Lek Listy. 2009;110(7):404-11.
- Albert M, McCaig L, Uddin S. Emergency department visits for drug poisoning: United States, 2008-2011. NCHS Data Brief. 2015;(196).
- Dorado SP, Martín JF, Sabugal GR, Caballero PV. Epidemiology of acute poisoning: study of 613 cases in the community of Madrid in 1994. Rev Clin Esp. 1996;196(3):150-6.
- Viertel A, Weidmann E, Brodt H. Cases of acute poisoning admitted to a medical intensive care unit. Dtsch Med Wochenschr. 2001;126(42):1159-63.
- Yeşil O, Akoğlu H, Onur Ö, Güneysel Ö. Acil servise başvuran zehirlenme olgularının geriye dönük analizi. Marmara Med J. 2008;21(1):26-32.
- Vallersnes OM, Jacobsen D, Ekeberg Ø, Brekke M. Patients presenting with acute poisoning to an outpatient emergency clinic: a one-year observational study in Oslo, Norway. BMC Emerg Med. 2015;15(1):18.
- World Health Organization. WHO Chemical Safety - Activity Report 2017. World Health Organization; 2017. Available from: http://www.who.int/ipcs/poisons/en/. Accessed December 2024.
- Skegg K, Skegg D, Richards SM. Incidence of self-poisoning in patients prescribed psychotropic drugs. Br Med J (Clin Res Ed). 1983;286(6368):841-3.
- T.C. Sağlık Bakanlığı. Yataklı Sağlık Tesislerinde Acil Servis Hizmetlerinin Uygulama Usul ve Esasları Hakkında Tebliğ. Resmi Gazete; 2009. Available from: http://www.mevzuat.gov.tr/Metin.Aspx?MevzuatKod=9.5.13494&MevzuatIliski=0. Accessed November 2024.
- Shadnia S, Esmaily H, Sasanian G, Pajoumand A, Hassanian-Moghaddam H, Abdollahi M. Pattern of acute poisoning in Tehran-Iran in 2003. Hum Exp Toxicol. 2007;26(9):753-6.
- Hettiarachchi J, Kodithuwakku G. Pattern of poisoning in rural Sri Lanka. Int J Epidemiol. 1989;18(2):418-22.
- Staikowsky F, Theil F, Mercadier P, Candella S, Benais JP. Change in profile of acute self-drug poisonings over a 10-year period. Hum Exp Toxicol. 2004;23(11):507-11.
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Acil Tıp |
| Bölüm | Orijinal Çalışma |
| Yazarlar | |
| Yayımlanma Tarihi | 26 Haziran 2025 |
| Gönderilme Tarihi | 23 Ocak 2025 |
| Kabul Tarihi | 20 Mayıs 2025 |
| Yayımlandığı Sayı | Yıl 2025 Cilt: 8 Sayı: 2 |
