Düzce Üniversitesi Tıp fakültesi acil servisine başvuran acı bal (GRAYANOTOKSİN) olgularının analizi
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Tarih
2016
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Düzce Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Acı bal, Rhododendron (Rh.) familyası bitkilerden beslenen arıların ürettiği ve grayanotoksin (GTX) içeren bala verilen addır. Aynı zamanda deli bal olarak da anılmaktadır. Türkiye'de yaygın görülen Rh familyasının İspanya, Portekiz, Japonya, Brezilya gibi dünyanın çeşitli bölgelerinde 750'den fazla türü bulunmaktadır. Rh familyasının GTX içeren türlerinin en önemlileri Türkiye'de Karadeniz kıyısı boyunca uzanan dağların denize bakan kesimlerinde bulunan Rh. ponticum ve Rh. Flavum'dur. Günümüzde deli bal, alternatif tıp ilacı olarak kullanılmaktadır. Bu balın bir çay kaşığından fazla alınması zehirlenme bulgularına neden olabilmektedir. Bu zehirlenme, şuur kayıplarına, kaslarda gevşemelere neden olabilmekte; belirgin kan basıncı ve nabız düşüşlerine bağlı ölüme kadar varabilen sonuçlar doğurabilmektedir. Bu amaçla acı bal yedikten sonra rahatsızlanan ve acil servisimize başvuran hastalar değerlendirilmiştir. Bu çalışmayla GTX zehirlenmesi sonucu acil servise başvuran olguların ayrıntılı bir analizi yapılarak; günlük acil tıp pratiğinde hekime tanı, tedavi, takip ve prognoz tahmininde yardımcı olabilmek amaçlanmıştır. Düzce Üniversitesi Araştırma ve Uygulama Hastanesi Acil Servisi'ne 01.03.2015 ile 01.03.2016 tarihleri arasında deli bal yeme sonucu semptom ve bulgu gelişen toplam 36 olgu çalışmaya dâhil edilmiştir. Kontrol grubuna da 10 olgu dâhil edilmiştir. Çalışmamız prospektif bir olgu kontrol çalışması olarak tasarlanmıştır. Hastalardan alınan venöz kan örneklerinde GTX ile temel biyokimyasal değerler incelenmiştir. Veriler kontrol grubu ile kıyaslanarak çeşitli istatistiksel testler ile anlamlılığı değerlendirilmiştir. Deli bal yiyen hastaların (çalışma grubu) ortalama GTX düzeyi 7.88 ng/ml (min: 0,00; mak: 30.47 ng/ml) olarak saptanmıştır. Kontrol grubu hastalarında GTX düzeyi 0 ng/ml olarak saptanmıştır. Çalışma grubu GTX düzeyi kontrol grubuna göre istatistiksel olarak anlamlı şekilde yüksek saptanmıştır. Baş dönmesi, bulantı, kusma, halsizlik, fenalaşma ve boğazda yanma semptomları ile GTX düzeyleri arasında istatistiksel olarak anlamlı bir ilişki görülmemiştir. Çalışmamızda, çalışma grubu böbrek fonksiyon testlerinin (üre, BUN, kreatinin), troponin ve kontrol troponin değerleri ile ilişkili olduğu görülmüştür. Belirgin kan basıncı ve nabız düşüşleri ile acil servise başvuran hastalarda, acil hekimleri tarafından mutlaka deli bal hatta genel anlamda bal yeme öyküsü sorgulanmalıdır, çünkü bazı durumlarda hastalar yedikleri balın deli bal olmadığını iddia ettikleri halde GTX zehirlenmesi bulguları ortaya çıkabilmektedir. Sadece alınan balın miktarı ile semptomlar ilişkilendirilmemeli, arının beslendiği bitki ve mevsim özellikleri de göz önünde bulundurularak, çok az miktarda alınan balın ciddi zehirlenme bulgularına neden olabileceği unutulmamalıdır. Sepmtomlar ile GTX ilişkisini daha doğru ortaya koymak üzere çalışmamızdaki sınırlılıkların da giderildiği daha ileri araştırmalara ihtiyaç vardır. Böylece daha anlamlı sonuçlara ulaşılabilecektir.
Mad honey is the type of honey made by bees that are nourished from the plants of Rhododendron (Rh.) family, and it contains grayanotoksin (GTX). It is also named as bitter honey. The honey is commonly seen in Turkey and Rh family has more than 750 types in various regions of the world including Spain, Portuguese, Japan and Brazil. The most significant types of Rh family, which contain GTX, are Rh. Ponticum and Rh. Flavum and found in the parts of mountains towards the sea along the Black Sea coast in Turkey. Today, mad honey is used as an alternative medicine cure. Having more than one tea spoon of the honey may cause intoxication symptoms. This type of intoxication may cause blackout, muscle relaxation; and even death because of significant blood pressure and pulse drops is also a possible outcome. In order to analyze the results of a possible overdose, we evaluated the patients taken to the emergency deparment after eating mad honey and falling sick. In this study, cases who came to the emergency room because of GTX intoxication are analyzed in detail in order to help diagnosis, treatment, follow-up and prognosis in daily emergency medicine practice. A total of 36 patients, who came to Düzce University Research and Education Hospital Emergency Deparment between 03.01.2015 and 03.01.2016 with the symptoms and diagnosis of intoxication after consuming mad honey, were included in the study. Ten healthy induviduals who did not have a history of taking mad honey were included in the control group. The study is designed as a prospective case control study. GTX and standard biochemical parameters were examined in patients' venous blood samples. All data were compared with control group and the significance of these data was evaluated by various statistical tests. The average GTX level of the group who ate mad honey (study group) was 7, 88 ng/ml (min: 0,00 / max: 30,47). At control group, GTX level was 0 ng/ml. The difference of GTX level between the study group and the control group was statistically significant. There was no statistically significant relationship between the symptoms like dizziness, nausea, vomiting, weakness, deterioration, angina and blood GTX level. According to our study there was a relationship between kidney function tests (urea, creatinin and BUN) and troponin and control troponin levels. The patients who have absolute decrease in blood pressure and pulse should be questioned by emergency medicine doctors about consuming mad honey; because even though the patients claim that they did not eat mad honey, in some situations, we may care acress the result and symptoms of GTX poisoning. The amount of mad honey should not only be illustrated with symptoms, but olso considered that the plants that the bees feed on and seasonel conditions and even the smallest amount of mad honey may cause a serious poisoning findings. Further studies are needed to demonstrate the relationship between symptoms and GTX poisoning. By this way we can reach more meaningful results.
Mad honey is the type of honey made by bees that are nourished from the plants of Rhododendron (Rh.) family, and it contains grayanotoksin (GTX). It is also named as bitter honey. The honey is commonly seen in Turkey and Rh family has more than 750 types in various regions of the world including Spain, Portuguese, Japan and Brazil. The most significant types of Rh family, which contain GTX, are Rh. Ponticum and Rh. Flavum and found in the parts of mountains towards the sea along the Black Sea coast in Turkey. Today, mad honey is used as an alternative medicine cure. Having more than one tea spoon of the honey may cause intoxication symptoms. This type of intoxication may cause blackout, muscle relaxation; and even death because of significant blood pressure and pulse drops is also a possible outcome. In order to analyze the results of a possible overdose, we evaluated the patients taken to the emergency deparment after eating mad honey and falling sick. In this study, cases who came to the emergency room because of GTX intoxication are analyzed in detail in order to help diagnosis, treatment, follow-up and prognosis in daily emergency medicine practice. A total of 36 patients, who came to Düzce University Research and Education Hospital Emergency Deparment between 03.01.2015 and 03.01.2016 with the symptoms and diagnosis of intoxication after consuming mad honey, were included in the study. Ten healthy induviduals who did not have a history of taking mad honey were included in the control group. The study is designed as a prospective case control study. GTX and standard biochemical parameters were examined in patients' venous blood samples. All data were compared with control group and the significance of these data was evaluated by various statistical tests. The average GTX level of the group who ate mad honey (study group) was 7, 88 ng/ml (min: 0,00 / max: 30,47). At control group, GTX level was 0 ng/ml. The difference of GTX level between the study group and the control group was statistically significant. There was no statistically significant relationship between the symptoms like dizziness, nausea, vomiting, weakness, deterioration, angina and blood GTX level. According to our study there was a relationship between kidney function tests (urea, creatinin and BUN) and troponin and control troponin levels. The patients who have absolute decrease in blood pressure and pulse should be questioned by emergency medicine doctors about consuming mad honey; because even though the patients claim that they did not eat mad honey, in some situations, we may care acress the result and symptoms of GTX poisoning. The amount of mad honey should not only be illustrated with symptoms, but olso considered that the plants that the bees feed on and seasonel conditions and even the smallest amount of mad honey may cause a serious poisoning findings. Further studies are needed to demonstrate the relationship between symptoms and GTX poisoning. By this way we can reach more meaningful results.
Açıklama
YÖK Tez No: 447367
Anahtar Kelimeler
İlk ve Acil Yardım, Emergency and First Aid, Acil servis-hastane, Emergency service-hospital, Bal, Honey, Düzce, Düzce, Orman gülü, Rhododendron, Rhododendron, Rhododendron, Toksisite, Toxicity, Zehirlenmeler, Poisonings
