Abstract
Giriş: Yaşla birlikte değişen fizyoloji, özgeçmişte
bulunan komorbit hastalıklar ve bu nedenle kullanılan ilaçlar geriatrik yaş
grubunda akut zehirlenmeler de çoklu komplikasyonların ortaya çıkmasına neden
olur. Bu nüfusta temelde mevcut olan kronik hastalıklar istemli toksik madde
alımlarının en sık nedenidir.
Materyal-Metod: Bu retrospektif çalışma, üçüncü basamak Eğitim ve
Araştırma Hastanesinin Acil Tıp Kliniğine 2009 ve 2019 yılları arasında zehirlenme
şüphesi nedeniyle başvuran 60 yaş ve üzeri geriatrik hastaların verileri,
hastane bilgi yönetim sistemi üzerinden değerlendirildi.
Bulgular: 10 yıllık süre içerisinde zehirlenme nedeniyle acil
servise 600 hasta başvurmuş, bunlardan 16’sı (%2.66) geriatrik yaş grubuna
aitti. Hastaların yaş aralığı 60 ve 85 yaş arasında değişmekteydi. Yaşa göre
dağılıma bakıldığında 80 yaş ve üzerinde 3 hastanın (%18.75) olduğu ve 2
hastanın (%12.5) istemli olarak toksik madde alımı olduğu tespit edildi. İstemeden toksine maruz kalan hastalarda
erkek cinsiyet (n=5, %31.5) daha fazlayken isteyerek kasıtlı olarak maruz kalan
hastalarda kadın cinsiyet (n=7, %43.75) sayıca fazlaydı. İstemeden toksine maruz kalan hastalarda en fazla
koroziv maddeye (n=7, %43.75) maruziyet varken isteyerek kasıtlı olarak
maruziyette ise hastaların psikiyatrik hastalıkları nedeniyle aldıkları
antipsikotik ilaçların (n=3, %18.75) tedavi dozundan daha yüksek miktarlarda
alımı vardı. İsteyerek kasıtlı olarak
toksik maddeye maruz kalan 3 hasta, aldıkları toksik maddelerin özellikleri ve
ek komorbit hastalıkları olması nedeniyle yatırılarak takip ve tedavileri yapılmış.
Tartışma: İstemli olarak toksik maddeye maruziyet tüm yaş
gruplarında akut zehirlenmenin baskın nedeniyken geriatrik yaş gruplarında
istemsiz maruziyet öyküsü ön plandadır. Ancak 60 yaş ve üzeri nüfusta fiziksel
hareket kısıtlılığına neden olan durumlar, depresyon, sosyal izolasyon ya da
tedavisi mümkün olmayan hastalıkların varlığı kendi kendine zarar verme
duygusunu ortaya çıkartarak intihar girişimine neden olabilmektedir.
Keywords
References
- 1. Camidge DR, Wood RJ, Bateman DN. The epidemiology of self-poisoning in the UK. Br J Clin Pharmacol 2003; 56: 613-619.
- 2. Gür STA, Aköz A. Demographic and clinical features of applications to The Emergency Service for suicide attempts. Eurasian J Tox 2019; 1:29-32.
- 3. Kaeley N, Bhushan B, Subramanyam V, Kumar S, Kabi A. Clinical and demographic of geriatric patients with acute poisoning inthe state of Uttarakhand. J Family Med Prim Care 2019; 8: 443-448.
- 4. Seydaoğlu G, Satar S, Alpaslan N. Frequency and mortality risk factors of acute adult poisoning in Adana, Turkey, 1997-2002. Mt Sinai J Med 2005; 72: 393-401.
- 5. Gunnel D, Middleton N, Whitley E, Dorling D, Frankel S. Influence of cohort effects on patterns of suicide in England and Wales, 1950-1999. Br J Psychiatry 2003; 182: 164-170.Chan J, Draper B, Banerjee S. Deliberate self-harm in older adults: a review of the literatüre from 1995 to 2004. Int J Geriatr Psychiatry 2007; 22: 720-732.
- 6. World Health Organization. Social Development and Ageing Crisis or opportunity. Special panel at Geneva 2000. http://www.who.int/ageing /publications/development/alc_social_development.pdf. Erişim tarihi: 24.05.2019.
- 7. Wananukul W, Sriapha C, Tongpoo A, Sadabthammarak U, Wongvisawakorn S, et al. Human poisoning in Thailand: the Ramathibodi Poison Center’s experience (2001-2004). Clin Toxicol (Phila) 2007; 45: 582-588.
- 8. Mühlberg W, Becher K, Heppner HJ, Wicklein S, Sieber C. Acute poisoning in old and very old patients: a longitudinal retrospective study of 5883 patients in a toxicological intensive care unit. Z Gerontol Geriatr 2005; 38: 182-189.
- 9. Afshari R, Majdzadeh R, Balai-Mood M. Pattern of acute poisning in Mashhad, Iran, 1993-2000. J Toxicol Clin Toxicol 2004; 42: 965-975.
- 10. Srivastava A, Peshin SS, Kaleekal T, Gupta SK. An epidemio-logical study of poisoning cases reported to the National Poisons Information Centre, All India Institute of Medical Sciences, New Delhi. Hum Exp Toxicol 2005; 24: 279-285.
- 11. Mrazova K, NAvratil T, Pelclova D. Consequences of ingestions of potentially corrosive cleaning products, one years follow-up. Int J Electrochem Sci. 2012; 7: 1734-1748.
- 12. Caganova B, Foltanova T, Puchon E, Ondriasova E, Plackova S, Fazekas T, Kuzelova M. Caustic ingestion in the elderly: influence of age on clinical outcome. Molecules 2017; 22: 1726.
- 13. Gambert SR. Alcohol abuse: medical effects of heavy drinking in late life. Geriatrics 1997; 52: 30-37.
- 14. Hu YH, Chou HL, Lu WH, Huang HH, Yang CC, et al. Features and prognostic factors for elderly with acute poisoning in the emergency department. J Chin Med Assoc 2010; 73: 78-87.
- 15. Hawton K, Harris L. Deliberate self-harm in people aged 60 years and over: characteristics and outcome of a 20-year cohort. Int J Geriatr Psychiatry 2006; 21: 275-281.
- 16. Gokbulut C. Türkiye’de pestisit zehirlenmeleri. Erişim: 23 Mayıs 2019, https://www.researchgate.net/publication/283479192.
- 17. Karbakhsh M, Zandi NS. Pattern of poisoning in the elderly: an experience from Tehran. Clin Toxicol (Phila) 2008; 46: 211-217.
Abstract
Background: Physiology changing with
age, comorbid diseases in the history of the patient and medication used for
this reason cause the emergence of multiple complications in acute poisoning in
geriatric age group. Chronic diseases basically present in this population are
the most important cause of intentional toxic substance intake.
Materials
and Methods: In this retrospective study, the data of patients aged 60 and older who
referred to the Emergency Medicine Clinic of a tertiary Training and Research
Hospital between 2009 and 2019 with a suspicion of intoxication were assessed
through hospital information management system.
Result: 600 patients referred to
emergency service for intoxication within a period of 10 years and 16 (2.66%)
of these were in geriatric age group. The patients’ age range differed between
60 and 85 years of age. In terms of age distribution, it was found that there
were 3 (18.75%) patients aged 80 and older and 2 patients (12.5%) were found to
ingest toxic substance intentionally. While male patients who were exposed to
toxins unintentionally were higher in number (n=5, 31.5%), the number of
patients who were exposed to toxins intentionally were higher among female
patients (n=7, 43.75%). While the highest number of unintentional toxic substance
exposure occurred with corrosive substance (n=7, 43.75%), the highest number of
intentional exposure occurred by taking higher amounts of antipsychotic drugs
(n=3, 18.75%) than the therapy dose prescribed for psychiatric diseases. 3
patients who were exposed to toxic substance intentionally were hospitalized
and monitored and treated due to the characteristics of the toxic substances
they were exposed to and since they had comorbid diseases.
Conclusion: Although intentional
exposure to toxic substance is the dominant reason for acute intoxication in
all age groups, unintentional exposure history is in the foreground in
geriatric age groups. However, in 60 years of age and older population,
situations which cause limitations in physical movement, depression, social
isolation or the presence of diseases which are impossible to treat can cause
the emergence of the feeling of self-destruction and result in suicidal
attempt.
Keywords
References
- 1. Camidge DR, Wood RJ, Bateman DN. The epidemiology of self-poisoning in the UK. Br J Clin Pharmacol 2003; 56: 613-619.
- 2. Gür STA, Aköz A. Demographic and clinical features of applications to The Emergency Service for suicide attempts. Eurasian J Tox 2019; 1:29-32.
- 3. Kaeley N, Bhushan B, Subramanyam V, Kumar S, Kabi A. Clinical and demographic of geriatric patients with acute poisoning inthe state of Uttarakhand. J Family Med Prim Care 2019; 8: 443-448.
- 4. Seydaoğlu G, Satar S, Alpaslan N. Frequency and mortality risk factors of acute adult poisoning in Adana, Turkey, 1997-2002. Mt Sinai J Med 2005; 72: 393-401.
- 5. Gunnel D, Middleton N, Whitley E, Dorling D, Frankel S. Influence of cohort effects on patterns of suicide in England and Wales, 1950-1999. Br J Psychiatry 2003; 182: 164-170.Chan J, Draper B, Banerjee S. Deliberate self-harm in older adults: a review of the literatüre from 1995 to 2004. Int J Geriatr Psychiatry 2007; 22: 720-732.
- 6. World Health Organization. Social Development and Ageing Crisis or opportunity. Special panel at Geneva 2000. http://www.who.int/ageing /publications/development/alc_social_development.pdf. Erişim tarihi: 24.05.2019.
- 7. Wananukul W, Sriapha C, Tongpoo A, Sadabthammarak U, Wongvisawakorn S, et al. Human poisoning in Thailand: the Ramathibodi Poison Center’s experience (2001-2004). Clin Toxicol (Phila) 2007; 45: 582-588.
- 8. Mühlberg W, Becher K, Heppner HJ, Wicklein S, Sieber C. Acute poisoning in old and very old patients: a longitudinal retrospective study of 5883 patients in a toxicological intensive care unit. Z Gerontol Geriatr 2005; 38: 182-189.
- 9. Afshari R, Majdzadeh R, Balai-Mood M. Pattern of acute poisning in Mashhad, Iran, 1993-2000. J Toxicol Clin Toxicol 2004; 42: 965-975.
- 10. Srivastava A, Peshin SS, Kaleekal T, Gupta SK. An epidemio-logical study of poisoning cases reported to the National Poisons Information Centre, All India Institute of Medical Sciences, New Delhi. Hum Exp Toxicol 2005; 24: 279-285.
- 11. Mrazova K, NAvratil T, Pelclova D. Consequences of ingestions of potentially corrosive cleaning products, one years follow-up. Int J Electrochem Sci. 2012; 7: 1734-1748.
- 12. Caganova B, Foltanova T, Puchon E, Ondriasova E, Plackova S, Fazekas T, Kuzelova M. Caustic ingestion in the elderly: influence of age on clinical outcome. Molecules 2017; 22: 1726.
- 13. Gambert SR. Alcohol abuse: medical effects of heavy drinking in late life. Geriatrics 1997; 52: 30-37.
- 14. Hu YH, Chou HL, Lu WH, Huang HH, Yang CC, et al. Features and prognostic factors for elderly with acute poisoning in the emergency department. J Chin Med Assoc 2010; 73: 78-87.
- 15. Hawton K, Harris L. Deliberate self-harm in people aged 60 years and over: characteristics and outcome of a 20-year cohort. Int J Geriatr Psychiatry 2006; 21: 275-281.
- 16. Gokbulut C. Türkiye’de pestisit zehirlenmeleri. Erişim: 23 Mayıs 2019, https://www.researchgate.net/publication/283479192.
- 17. Karbakhsh M, Zandi NS. Pattern of poisoning in the elderly: an experience from Tehran. Clin Toxicol (Phila) 2008; 46: 211-217.
Details
| Primary Language | English |
|---|---|
| Subjects | Emergency Medicine |
| Journal Section | Original Articles |
| Authors | |
| Publication Date | November 28, 2019 |
| Submission Date | November 2, 2019 |
| Published in Issue | Year 2019 Volume: 1 Issue: 3 |
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