Ackee jiriden (Hypoglycine mɔgɔbali Jamayika fɔɔnɔ bana) ani Lychee (MCPG) Sunɔgɔtɔgɔnin sukarodunbana kunsɛmɛnasumaya denmisɛnw na¶

Sɔgɔmadafɛ fɔɔnɔ barikama, sɛgɛnba, kirinni caman, walima kɔma ackee jiriden mɔbali dunni kɔfɛ (Blighia sapida) walima ka lychee (Litchi chinensis) kɔnɔbara lankolon kan ni wulada dumuni tɛ, o ye farikoloɲɛnajɛ kɔrɔtɔlen ye min bɛ waati kɔnɔ, min bɛ sɔrɔ balawu fɛ sukarodunbana min tɛ ketotiki ye (blood glucose often below 20 mg/dL or 1.1 mmol/L). Aw ye aw ka sigida kɔrɔtɔko nimɔrɔ wele (911 Ameriki ani Kanada, 112 Erɔpu tɔnba bɛɛ kɔnɔ, 999 Angletɛri) walima aw ye an ka diɲɛ kɔnɔ kɔrɔtɔko nimɔrɔw ɲɛbilasɛbɛn o yɔrɔnin bɛɛ, ka a fɔ ciden ye ko banabagatɔ ka kan ka joli sukaro sɛgɛsɛgɛli teliya la ani ka Dextrose 10% kɛ joli la. Ni aw bɛ furakɛlikɛlaw makɔnɔ, aw bɛ kirinni baarakɛtaw ɲɛnabɔ ni an ka status epilepticus kuntaalajan kirinni protocole, ka farikoloɲɛnajɛ gɛlɛya ni fura tali danfara bɔ ɲɔgɔn na sulfonylurea sukarodunbana hakɛ caya kojugu, ani ka baara kɛ ni jenerali ye baga jugumanba dɛmɛ fɔlɔ.

ackee (Jamaika jamana jiriden, min bɛ sɛnɛ kosɛbɛ Karayibu, Afiriki Tlebi, Floride ani Cɛma Ameriki) ani lychee (ka fara longan ni rambutan kan, u balimakɛw bɛ jiriw ka denbaya kɔnɔ Sapindaceae) fila bɛɛ la, sikloporopili amino acide protoxine barikamaw bɛ sɔrɔ: Hypoglycin A (L-methylenecyclopropylalanine) ani a duguma homologue alfa-(methylenecyclopropyl)glycine (MCPG). Ni denmisɛn walima baliku ye ackee arils mɔbaliw dun, minnu dabɔra fanga la (walima ni a ye ackee tobi ji min na), walima ni den balodɛsɛ bɛ lychees mɔbaliw/minnu mɔbali caman dun tile fɛ, ka taa a da k’a sɔrɔ a ma sufɛdumuni dun, o baga ninnu bɛ to u makun 4 to 12 hours k’a sɔrɔ farikolo bɛ sugunɛ glycogène mara hali bi. Sɔgɔmada joona fɛ (typically 3:00 AM to 8:00 AM), ni sugunɛ gilikozɛni banna su fɛ, farikolo b’a ɲini ka wuli ka taa asidi fatɔ beta-oxydation ani gluconeogenesis la walasa ka sukaro sɔrɔ hakili la. Sabula MCPA-CoA (ka bɔ Hypoglycin A la) ani MCPF-CoA (ka bɔ MCPG la) bɛ mitokondriyaw cakɛda cɛmancɛ asili-CoA dehydrogenase (MCAD) ani gluconeogenic enzymes, joli sukaro bɛ jigin teliya la ka taa zeru la ka sɔrɔ asidi organique toxic cakɛda surunw bɛ woyo ka kɛ kunsɛmɛ na, ka kɛ sababu ye ka kunsɛmɛ na teliya la, ka status epilepticus, ani saya kɛ a kɔnɔ 12 to 48 hours fo ni teliya la 10% Dextrose (D10W) bololanɛgɛ ni sukaro hakɛ caman pikiri kɛli tuma bɛɛ bɛ kɛ.

+-------------------------------------------------------------------------+
|       SAPINDACEAE FRUIT HYPOGLYCEMIC ENCEPHALOPATHY ACTION MATRIX       |
+-------------------------------------------------------------------------+
|  THE OVERNIGHT GLYCOGEN TRAP (WHY CHILDREN CRASH AT 4:00 TO 7:00 AM):   |
|  * Afternoon/Evening: Child eats unripe Ackee OR eats Lychees & skips   |
|    dinner -> Liver glycogen stores run completely dry by 3:00-6:00 AM   |
|  * Hypoglycin A (MCPA-CoA) & MCPG (MCPF-CoA) block fatty acid beta-     |
|    oxidation (MCAD/SCAD) and Pyruvate Carboxylase gluconeogenesis       |
|  * Result: Blood glucose drops < 20 mg/dL (< 1.1 mmol/L) + Toxic        |
|    organic acidemia -> Sudden vomiting, seizures, cerebral edema, coma  |
+-------------------------------------------------------------------------+
|  IMMEDIATE PRE-HOSPITAL & EMERGENCY DEPARTMENT RESCUE:                  |
|  1. Awake & Able to Swallow: Give 15-30 g fast oral sugar (sugar water, |
|     honey, fruit juice, glucose gel) immediately + complex carbs        |
|  2. Drowsy, Vomiting, or Seizuring: NEVER pour liquid in mouth; apply   |
|     buccal sugar/glucose gel inside cheek while awaiting EMS            |
|  3. Hospital IV Bolus: 2 to 5 mL/kg of 10% Dextrose (D10W) IV push      |
|  4. Continuous IV Infusion: 10% Dextrose at 6 to 8 mg/kg/minute (avoid  |
|     hypotonic fluids that worsen cerebral edema) + L-Carnitine/Glycine  |
+-------------------------------------------------------------------------+

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Aw bɛ o kɛ sisan¶

1. Aw bɛ kɛnɛyaso wele joona ani ka dɔgɔtɔrɔso ɲini ni Dextrose ye joli la. Aw bɛ telefɔni 911 (Amerika ni Kanada), 112 (Erɔpu jamana), 999 (Royaume-Uni), 119 / 911 (Jamaika ni Karayibu), walima 108 / 112 (Endi) wele. Aw bɛ a fɔ ciden ye ko banabagatɔ ye ackee walima lychee jiridenw dun ani ko a bɛ sukarodunbana jugumanba toxic ani metabolic encephalopathy fɛ.
2. Ni a tigi kununna ka ɲɛ ani ni a bɛ se ka munumunu ka ɲɛ, aw bɛ sukaro da la min bɛ baara kɛ joona joona. Aw bɛ a wuli 2 to 3 tablespoons (30 to 45 grams) ka tabali sukaro, mɔni, ɲɔ siro, walima sukaro mugu kɛ ji walima jiridenji galasi kelen kɔnɔ ka sɔrɔ ka a tigi bila ka a min o yɔrɔnin bɛɛ. Hali ni mɔgɔ dɔ y’a ye k’u ye ackee mɔbali dun dɔrɔn walima denmisɛn dɔ ye lychees dun kɔnɔbara lankolon na, k’a sɔrɔ a bɛ a yɛrɛ jate hali bi a cogo la pewu, ka dumuni kɛ min na witaminiw ka ca ni sukaro ye joona o bɛ sugunɛbilenni glycogène marayɔrɔw fa ani ka farikolo bali ka tulumafɛnw oksidan sira datugulen baara k’a sɔrɔ i bɛ bolifɛn ta ka taa dɔgɔtɔrɔso la.
3. Ni sunɔgɔ bɛ a tigi la, ni a hakili ɲagamina, ni fɔɔnɔ bɛ a la, walima ni kirinni bɛ a la, aw kana ji bɔn a da la abada. Aw bɛ banabagatɔ lamaga a kininbolo fan fɛ (a kɛnɛyali yɔrɔ) walasa fɔɔnɔ kana don fogonfogon la. Aw bɛ se ka glucose gel, mɔni, walima tabali sukaro dɔɔni dɔɔni kɛ ka a ɲɛsin ɲɛda duguma ni ɲinw kɔnɔna na (buccal mucosa), nka kisi dafalen bɛ Dextrose 10% (D10W) min bɛ kɛ dɔgɔtɔrɔso baarakɛlaw fɛ walima kɔrɔtɔko ɲɛmɔgɔso baarakɛlaw fɛ.
4. Aw ye a faamu mun na Glucagon pikiri TƐ baara kɛ Ackee walima Lychee baga la. Denbaya walima dɔgɔtɔrɔso baarakɛlaw minnu bɛ kɔrɔtɔko glucagon pikirikɛminɛnw ta, olu ka kan k’a dɔn ko glucagon bɛ baara kɛ dɔrɔn ni a bɛ sugunɛ bila ka glycogen maralen tiɲɛ (glycogenolysis) ani ka sukaro kura sɔrɔ ( .gluconeogenesis). Ackee ni lychee kunsɛmɛnasumaya la, sugunɛbilenni bɛ sɔrɔ kaban 100% a bɛ dɔgɔya ani gluconeogenesis bɛ bali biyokimiki fɛ Hypoglycin A ni MCPG fɛ, o kɔrɔ ye ko glucagon tɛ nafa sɔrɔ pewu. dextrose (glucose) min bɛ bɔ kɛnɛma, o tali tilennen dɔrɔn de bɛ hakili kisi.
5. Ackee pods, tobilikɛji, walima lychee jiriden minnu tora walima minnu tobilen, aw bɛ olu mara. Aw kana a to du kɔnɔ mɔgɔ wɛrɛ ka dumuni kɛ o daga kelen na, kɛrɛnkɛrɛnnenya la tobilikɛji (pot water) walima shɔ min kɔnɔ ackee arils tun bɛ tobi, i n’a fɔ Hypoglycin A min bɛ se ka ji la, o bɛ wuli ka taa ji la.

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Desizɔn jiri : Ackee ni Lychee ka sukarodunbana kunsɛmɛnasumaya sɛgɛsɛgɛli¶

flowchart TD
    A["Siga bɛ a la ko Acee mɔbali walima Sunɔgɔ Lychee Minɛ"] --> B{"Aw bɛ kɛnɛyaso cogoya & hakili jateminɛ"}
    B -->|"Taamaʃyɛn tɛ a la (A dunni kɔsa in na, a kununna pewu) ."| C["Aw bɛ dumuni kɛ teliya la min falen don witamini caman na + Glucose minfɛn da la walasa ka sugunɛbilenni sabati"]
    C --> D["Aw bɛ don dɔgɔtɔrɔso la sanga 24-48 kɔnɔ, a bɛ to ka 10% Dextrose pikiri kɛ & Lɛrɛ o lɛrɛ bolokɔnincininw ka sukaro sɛgɛsɛgɛli"]
    B -->|"Fɔɔnɔ barikama, sumaya, sɛgɛn, kirinni walima Kɔma"| E["Aw bɛ a lajɛ Stat Point-of-Care Joli sukaro (A ka ca a la < miligaramu 20-30/dL / 1,1-1,7 mmol/L) + Joli gazi/Lactate"]
    E --> F["Bolus IV teliya la : Dextrose 10% (D10W) mililitiri 2 fo mililitiri 5/kg IV Push (Balikuw: D50W mililitiri 50 walima D10W mililitiri 250)"]
    F --> G["Aw bɛ Dextrose 10% (D10W in 0,9% NaCl) tali daminɛ ka taa a fɛ ni Glucose Infusion Rate (GIR) ye miligaramu 6 fo 8 ye kilogaramu kelen o kilogaramu kelen o miniti kelen kɔnɔ"]
    G --> H{"Active Status Epilepticus walima Cerebral Edema taamasiɲɛw?"}
    H -->|"Ɔwɔ"| I["IV Lorazepam/Midazolam + Aw bɛ kun kɔrɔta degere 30 + Saline hypertonique 3% (Aw bɛ aw yɛrɛ tanga jilamaw ma) ."]
    H -->|"Ayi"| J["Aw bɛ joli sukaro hakɛ mara miligaramu 100-150/dL (5,5-8,3 mmol/L); Aw bɛ L-Carnitine + Glycine + Riboflavine (Witamine B2) fara a kan IV/Oral ."]
    I --> J

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Banakisɛfagalanw : Hypoglycin A ni MCPG bɛ hadamaden fanga sɛnɛcogo datugu cogo min na¶

Walasa k’a faamu mun na den kɛnɛman bɛ se ka taa a da ni nisɔndiya ye lichi walima ackee dunni kɔfɛ ka kunun 5:00 AM ni kɔma min bɛ mɔgɔ faga, dɔgɔtɔrɔw ka kan ka mitokondriyaw ka anzimu balili tigitigi sɛgɛsɛgɛ min bɛ sɔrɔ Hypoglycin A ni MCPG fɛ (a ka ca a la a bɛ fɔ o ma ko acide glutaric acidemia type II walima acquired multiple acyl-CoA dehydrogenase deficienceMADD]).

1. Protoxine (porotosini) jiginni ka kɛ CoA tiyoɛsitɛri fagalenw ye¶

Hypoglycine A fana tɛ (L-alpha-amino-beta-[methylenecyclopropyl]propionic acid) fana MCPG (alpha-[methylenecyclopropyl]glycine) ye baga ye k’a ɲɛsin a ka asidi aminiki kɛnɛ ma. Ni u minɛna banakɔtaa fitini na, u bɛ don mitokondriyaw bolofara-cakɛda amino asidi kataboliki sira la: * Sitosoliki ni mitokondriyaw transaminases bɛ Hypoglycin A bɛrɛbɛn ka kɛ methylencyclopropylpyruvic acid ye (MCPP), ani bolofara-cakɛda alfa-kɛto asidi dehidrojɛnazi oksidan bɛ a dekarbokisili kɛ ka kɛ baga fagalen baarakɛta ye: metilɛnisikloporopilasɛtili-CoA (MCPA-CoA). * O cogo kelen na, MCPG (a ka ca lichi kisɛw ni arilw la minnu ma mɔ/minnu tilalen don, ani akɛkisɛw fana) bɛ fɛnɲɛnamafagalanw falen ka kɛ methylenecyclopropylformyl-CoA ye (MCPF-CoA).

+-------------------------------------------------------------------------+
|       MITOCHONDRIAL BLOCKADE BY HYPOGLYCIN A (MCPA-CoA) & MCPG          |
+-------------------------------------------------------------------------+
|                                                                         |
|   Unripe Ackee / Lychee  --->  Hypoglycin A & MCPG                      |
|                                       |                                 |
|                                       v  (Transamination & CoA binding) |
|                            MCPA-CoA  and  MCPF-CoA                      |
|                                       |                                 |
|         +-----------------------------+-----------------------------+   |
|         |                             |                             |   |
|         v                             v                             v   |
|  1. BLOCKS FATTY ACID          2. BLOCKS GLUCONEOGENESIS     3. TOXIC   |
|     BETA-OXIDATION:               * Depletes Free CoA-SH        ACIDS:  |
|     * Irreversibly inactivates      and Carnitine               * Accum.|
|       FAD cofactor of MCAD,       * Depletes Acetyl-CoA &         of C4 |
|       SCAD, IVD, and GCDH           NADH needed to activate       to C10|
|     * Zero ketones produced         Pyruvate Carboxylase          acids |
|                                                                         |
+-------------------------------------------------------------------------+
|   RESULT ONCE OVERNIGHT LIVER GLYCOGEN RUNS OUT (3:00 TO 7:00 AM):      |
|   * Profound Non-Ketotic Hypoglycemia (< 20 mg/dL / 1.1 mmol/L)         |
|   * Volatile short-chain fatty acids (isovaleric, butyric, glutaric,    |
|     hexanoic) cross blood-brain barrier -> Vomiting, Coma, Brain Edema  |
+-------------------------------------------------------------------------+

2. Mun na asidi fatɔ beta-oxydation ni gluconeogenesis fila bɛɛ tɛ se ka kɛ¶

1. Yɛrɛfaga balili Flavin (FAD) Asili-KoA Dehidrojɛnaziw : MCPA-CoA ni MCPF-CoA bɛ kɛ flavin adenini dinukiliyɔtidi (FAD) prothèse kulu min bɛ mitokondriyaw kan cakɛda surun asiil-CoA dehydrogenase ( .SCAD), asili-CoA dehidrojɛnazi cakɛda cɛmancɛ (MCAD), isovalerili-CoA dehidrojɛnazi (IVD), ani glutaril-CoA dehydrogenase (GCDH). Ikomi farikolo tɛ se ka asidi fatɔw oksidan kɛ tugun sunɔgɔ waati, farikolo yɔrɔw bɛ wajibiya ka sukaro jeni ni teliya ye ka sɔrɔ ketone farikolo labɛnni (acetoacetate ani beta-hydroxybutyrate) bɛ bali pewu.
2. Sugunɛbilenni (Gluconeogenesis) dabila: Ni sugunɛbaralabana (4 to 10 hours dumuni laban kɔfɛ, a teliyalen don kosɛbɛ denmisɛnni fitiniw na minnu ka kunsɛmɛ ni sugunɛ girinya hakɛ ka ca walima balodɛsɛ bɛ minnu na), sugunɛ b’a ɲini ka sukaro kura sɔrɔ ka bɔ laktati, alanini ani gilisirɔli la gluconeogenesis fɛ. Nka, gluconeogenesis ka anzimu fɔlɔ min bɛ dan sigi hakɛ la, n’o ye piruvate carboxylase ye, o bɛ asetil-CoA wajibiya i n’a fɔ allosterique activateur wajibiyalen ani ATP + NADH (min bɛ sɔrɔ asidi fatɔ beta-oxydation fɛ) walasa ka boli. Ka fara o kan, asili-CoA ɛsitɛriw ni... MCPA-CoA sequester bɛɛ hɔrɔnya mitokondriyaw Coenzyme A ( .CoA-SH) ani L-karnitini. Ni a ma kɛ ATP, . NADH, . acetyl-CoA, walima fu CoA-SH, sugunɛbilenni bɛ sɔgɔsɔgɔ fo ka jɔ pewu.
3. Asidi organique bolocilenw ni cakɛda surunw dalajɛli: Beta-oxydation balili ni asidi aminiki katabolisme bɛ kɛ sababu ye ka asidi tuluma cakɛda surun ni cakɛda cɛmancɛ wulibaliw (butyric, isobutyric, isovaleric, 2-methylbutyric, glutaric, adipic, suberic, ani sebacic acids) caya kosɛbɛ. O asidi organique ninnu bɛ kunsɛmɛnasumaya pɔnpew bali minnu bɛ mɔgɔ tanga, ka chemorecepteur trigger zone daminɛ kunsɛmɛ na (o bɛ kɛ sababu ye ka fɔɔnɔ barikama bɔ), ka senfagabana mitokondriyaw fara ɲɔgɔn kan, ka sɔrɔ ka sitotokisi **sɔgɔsɔgɔninjɛ ** lase mɔgɔ ma min tɛ joli sukaro dɔgɔyali yɛrɛ la.

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Ka Jamayika fɔɔnɔbana (Ackee) ni Sunɔgɔ Lychee Encephalopathy suma ɲɔgɔn na¶

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Dɔgɔtɔrɔso kɔrɔtɔko protocole senfɛ-senfɛ¶

Ni denmisɛn walima baliku sera ni fɔɔnɔ ye, ni hakili cogoya Changé, walima ni kirinni kɛra ackee walima lychee dunni kɔfɛ, sukarodunbana furakɛbali ni asidi organique miniti o miniti, o bɛ dɔ fara a ka kunsɛmɛ tiɲɛni banbali kan walima kunsɛmɛnasumaya min bɛ mɔgɔ faga.

1. Dextrose 10% (D10W) Lakununni¶

Aw kana a jira ko laboratuwari ka chimie panneaux ka segin ka sɔrɔ sani aw ka dextrose di aw ma; aw bɛ teliya ka dilan kɛrɛfɛ bolokɔni joli sukaro sɛgɛsɛgɛli kɛ (ani ka joli tubabufura bilenman/bilen/bilen-sanfɛla dɔ ja walasa ka toxicologie/acylcarnitine profiling kɛ ni a bɛ se ka kɛ, k’a sɔrɔ aw ma furakɛli bila kɔfɛ hali 60 seconds).

• Mun na 10% Dextrose (D10W) ka fisa ni Dextrose 25% walima 50% ye denmisɛnw na: A ka ca 50% dekstrose ( 1 ) .D50W, . 2,525 mOsm/L) bɛ joli-sira-funu jugumanba lase mɔgɔ ma, wa a bɛ joli-sira-funu jugumanba bila mɔgɔ la, ka farikolo yɔrɔw sɔgɔsɔgɔ ni a bɔra joli-sira-funu na, ani ka joli-sira-funu teliya faratilenw bila denmisɛnw ka joli-sɔgɔsɔgɔninjɛ balilan dɔ kan min ka gɛlɛn. Standard (Standard) ye 5% dekstrose ( 1 ) .D5W) tɛ sukaro caman di walasa ka asidi tuluma kɔnɔna na mobilizasiyɔn bali. Dextrose 10% (D10W, . 100 mg of glucose per mL) ye sanu ye boloci fɔlɔw ni ladonni basigilenw bɛɛ la.
• Bolusi IV hakɛ fɔlɔ:
• Denmisɛnw: A di 2 to 5 milliliters per kilogram (2 to 5 mL/kg, ka di 0.2 to 0.5 grams/kg ka sukaro) ka 10% Dekstrose ( .D10W) jolisira fɛ ka tɛmɛ 2 to 5 minutes.
• Balikuw: A di 250 milliliters ka 10% Dekstrose ( .D10W) (walima 50 milliliters ka 50% Dekstrose [ 1 ].D50W]) ka don jolisira fɛ.
• Wajibiya ka taa a fɛ ka taa a fɛ 10% Dextrose pikiri kɛli (To Shut Down Lipolysis):
• Farakolo sariya kɔrɔlen: Dextrose bolo kelen bɛ sukaro wuli joli la dɔrɔn 20 to 30 minutes. Min ka jugu ni o bɛɛ ye, o ye ko Hypoglycin A ni MCPG baga la, dextrose furakɛli kuntilenna tɛ a tɛ dɔrɔn ka joli sukaro to a cogo la 70 mg/dL, nka ka kɔnɔnatumu caman lawuli insuline bɔli la walasa ka lipase min bɛ ɔrimɔni sɛgɛsɛgɛ pewu tulumafɛnw na, o datugu. Ni farikolo b’a ɲini ka asidi tuluma gansanw lajɛ ka bɔ tulumafɛnw marayɔrɔw la, o ye baga ye MCPA-CoA, . MCPF-CoA, ani asidi organique cakɛda surun minnu bɛ wuli, olu bɛ taa a fɛ ka dalajɛ mitokondriyaw kɔnɔ ka baga don hakili la.
• Pikiri hakɛ (Glucose Infusion Rate [GIR]): Aw bɛ teliya ka ** pikiri kɛli daminɛ jolisira fɛ min tɛ ban.10% Dextrose (Dextrose) bɛ sɔrɔ 0.9% Saline Normal (D10NS)** (walima D10 1/2NS ni potasiyɔmu bɛnnen ye ni sugunɛ kɛcogo sɛgɛsɛgɛra) ni Glucose Infusion Rate (GIR) ka 6 to 8 milligrams per kilogram per minute (roughly 3.6 to 4.8 mL/kg/hour ka D10W), titrating walasa ka serum glucose mara ** ni ɲɔgɔn cɛ .100 and 150 mg/dL (5.5 to 8.3 mmol/L)** ka kɛɲɛ ni ** ye .24 to 48 hours**.

2. Metaboliki Cofacteur ni Conjugation Kisi (L-Carnitine, . Glycine, ani Riboflavin) .¶

Sabula MCPA-CoA ani MCPF-CoA jaan bɛɛ hɔrɔnya mitokondriyaw Coenzyme A (CoA-SH) ni karinitini ka sɔrɔ ka flavini adenini dinukiliyɔtidi ( ) tiɲɛ.FAD) cofactors , clinical toxicology protocols bɛ baara kɛ ni farikoloɲɛnajɛ dɛmɛnan saba laɲinitaw ye walasa ka toxic intermediates saniya :

1. L-Carnitine min bɛ kɛ jolisira fɛ walima a da la (Levocarnitine):
2. Fɛɛrɛ: L-carnitine faralen ɲɔgɔn kan, o bɛ mitokondriyaw minɛlenw siri MCPA-CoA, . MCPF-CoA, isovaleryl-CoA, ani asili-CoA cakɛda cɛmancɛ mɔlikuluw karitini asilitransferazi fɛ, k’u sɛmɛntiya ka kɛ asilikarnitini ɛsitɛriw ye minnu bɛ se ka wuli ji la (MCPA-carnitine) minnu bɛ bɔ mitokondriyaw la ka bɔ sugunɛ na, ka kɔrɔlenw hɔrɔnya CoA-SH ka ɲɛsin Krebs ka cycle ma.
3. A tata hakɛ: 100 milligrams per kilogram per day (100 mg/kg/day) jolisira fɛ (walima da la ni a kununna) tilalen kelen-kelen bɛɛ 6 to 8 hours (up to 2 to 3 grams/day).
4. Glicine da la walima kɔnɔbara la:
5. Fɛɛrɛ: Mitokondriyaw ka anzimu glycine N-acyltransferase bɛ ɲɔgɔn sɔrɔ MCPA-CoA ani MCPF-CoA ni asidi aminiki glycine ye walasa ka MCPA-glycine ni MCPF-glycine dilan minnu tɛ baga ye, olu bɛ saniya joona sugunɛ fɛ.
6. A tata hakɛ: 150 to 250 milligrams per kilogram per day da la walima nasogastric tube fɛ tilalen kelen-kelen bɛɛ 6 to 8 hours.
7. Riboflavine hakɛ caman (Vitamin B2):
8. Fɛɛrɛ: Sabula MCPA-CoA kovalɛn bɛ kɛ sababu ye ka FAD asili-CoA dehydrogenases kulu prothétique, min bɛ Riboflavin hakɛ caman di (the direct precursor of FAD and FMN, 100 milligrams da la walima NG tubabukan fɛ siɲɛ 2 fo siɲɛ 3 don o don) bɛ active (active) seginni teliya MCAD ani SCAD enzymes (enzymes) minnu bɛ sɔrɔ.

3. Ka kirinni, kunsɛmɛnasumaya ani asidɔni kunbɛn¶

• Kɔnɔboli kunbɛnni: Ka sukarodunbana latilen ni 10% Dextrose bɛ kirinni dabila o yɔrɔnin bɛɛ banabagatɔ caman na minnu bɛ na joona. Ni kirinni bɛ to sen na hali ni joli sukaro hakɛ bɛ a cogo la (due to already-established cerebral edema or organic acid neurotoxicity), aw bɛ lorazepam ( ) kɛ jolisira fɛ ( .0.1 mg/kg IV), midazɔlamu (0.1 to 0.2 mg/kg IV/IM), walima levetiracetam (Keppra, . 20 to 40 mg/kg IV) (strictly avoid Valproic Acid [Depakote], which itself sequesters carnitine, inhibits mitochondrial beta-oxidation, and worsens hyperammonemia and cerebral edema).
• Sugunɛbilenni furakɛli: Aw bɛ dilan kun kɔrɔta ka se 30 degrees, ka normokarbi ( ) mara ( .PaCO2 35 to 40 mmHg) ni endotracheal intubation ye joona ni Glasgow Coma Scale (GCS) ye < 8, ani ka 3% Hypertonic Saline (3 to 5 mL/kg IV ka tɛmɛ 15 to 20 minutes) walima Manitɔli (0.5 g/kg IV).
• Bicarbonate de sodium: Ni farikolojidɛsɛ jugumanba don farikolo la (arterial pH < 7.15), aw bɛ bikarbonati sodiyɔmu kɛ jolisira fɛ ni hakilisigi ye ka sɔrɔ ka sukaro pikiri kɛli to sen na.

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Bana kunbɛncogo: Ackee mɔlen lakananen dɔncogo ni Ackee mɔbali toxic ye, ani Lychee lakananen sariyaw denmisɛnw ye¶

1. Safe Sanuman 4 minnu bɛ Ackee labɛncogo lakananen kan¶

+-------------------------------------------------------------------------+
|         VISUAL GUIDE: TOXIC UNRIPE vs. SAFE RIPE ACKEE FRUIT            |
+-------------------------------------------------------------------------+
|  TOXIC UNRIPE ACKEE (DO NOT EAT - 1,000 ppm HYPOGLYCIN A):              |
|  [ (=======) ]  Pod is completely closed, green, or only slightly split |
|                 Forced open with a knife or cracked by hitting ground   |
|                 Arils are hard, pale cream, or small seeds are soft/red |
+-------------------------------------------------------------------------+
|  SAFE NATURALLY RIPE ACKEE (< 10 ppm HYPOGLYCIN A WHEN CLEANED):        |
|    /   |   \    Pod turned bright red/yellow-orange and YAWNED WIDE     |
|   | (O)|(O) |   OPEN naturally on the tree branch in full sunlight      |
|    \   |   /    3 large glossy black seeds are fully exposed to view    |
|                 Yellow aril flesh is firm-soft; remove all seeds & pink |
|                 membrane, wash thoroughly, and DISCARD BOILING WATER    |
+-------------------------------------------------------------------------+

1. A to pod "yawn" ka da jiri kan a yɛrɛ la: Aw kana ackee pod tigɛ walima ka tobi abada min ma tila ka da a yɛrɛ la k'a sɔrɔ a sirilen bɛ jiri la hali bi. Aw kana jiribolo datugulen da wuli ni fanga ye abada, ani aw kana jiribolo datugulenw to tile fɛ finɛtiri walima so sanfɛ abada ka u makɔnɔ u ka da ka bɔ jiri la (jiri minnu bɔra ɲɔgɔn na, olu tɛ Hypoglycin A bɔ arilw la ka taa kisɛw la ka ɲɛ).
2. Aw bɛ kisɛ kelen-kelen bɛɛ ni ɲɛgɛnɛsira pinki/bilen nɔ bɛɛ bɔ (raphe): Kisɛ nɛrɛma manamanananw ni fiɲɛ bilenman pinki-bilen min bɛ aril jɛman nɔrɔ kisɛda la, o bɛ to baga ye kudayi (containing high levels of Hypoglycin A and B) hali jiriden mɔlenw na. Aw bɛ ɲɛgɛn pinki bɛɛ bɔ ka aril jɛmanw ko ka ɲɛ ji nɛnɛman na sani aw ka tobi.
3. Aw bɛ tobi u dan na ani ka tobilikɛji fili TAMAYƆRƆ: Aw bɛ ackee arils saniyalenw tobi ji gansan na fɔlɔ, ka u ji bɔ colander kɔnɔ, ka aw bɛ ji tobilen bɔn ka ɲɛ ka jigin jibolisira la. Aw kana tiga, shɔ, bananku, dumunikɛminɛn walima suman tobi abada ji kelen na min bɛ kɛ ka ackee tobi.
4. Ackee minnu bɛ na ni bidon kɔnɔ, olu lakanani: Ameriki, Kanada, Angletɛri, ani EU, jagokɛla ka ackee bidonw ladonni bɛ kɔlɔsi kosɛbɛ Amerika FDA fɛ ani dumuni lakanani ɲɛmɔgɔw fɛ walasa k’a dɔn ko Hypoglycin A hakɛ bɛ duguma 100 parts per million (ppm (ppm) ye). Hali ni jagokɛla ka ackee bidon kɔnɔ, aw bɛ jisuma bɔ ka a ko sani aw ka a tobi ni kɔgɔji ye.

2. Foroba kɛnɛya sariya 3 minnu ye denmisɛnw ka hakiliɲagami banaw ban¶

Endi jamana ka banaw kɛlɛli baarada (NCDC) ni Amerika CDC ka jɛkafɔba kɛlen kɔfɛ, Muzaffarpur, Bihar (denmisɛn kɛmɛ caman tun bɛ sa yɔrɔ min na mɛkalo ni zuwɛnkalo o zuwɛnkalo lisɛ tigɛ waati la), foroba kɛnɛyako ɲɛmɔgɔw ye denbaya sariya nɔgɔman saba sigi senkan minnu ye dɔ bɔ mɔgɔ sataw la ka tɛmɛ 80%: 1 . 1. Aw kana a to denmisɛnw ka taa u da abada ni aw ma wulada dumuni tobilen dun (sufɛdumuni): Ni aw ye wulada dumuni nɔgɔman dun min falen don witaminiw na, o bɛ sugunɛbilenni glycogène marayɔrɔw fa walasa den sugunɛ kana a jigi da asidi tuluma beta-oxydation bloqué kan abada su fɛ. 2. Aw bɛ dan sigi denmisɛnni fitiniw ka lisɛw dunni na, ani ka aw yɛrɛ tanga jiriden mɔbaliw/minɛnnenw ma: Aw kana a to denmisɛnw ka lisi mɔbali walima lisi mɔbali tilancɛw balo ka bɔ duguma jiriden nakɔw kɔnɔ, barisa MCPG ni Hypoglycin A hakɛ ka ca ni MCPG ni Hypoglycin A hakɛ ye min bɛ sɔrɔ jiriden bilenman mɔlenw na, o hakɛ ka ca ni fila ye. 3. Aw bɛ sukaro di da la joona ani ka teliya ka taa dɔgɔtɔrɔso la ni Dextrose 10% ye sɔgɔmada taamasiɲɛ fɔlɔ la: Den o denmisɛn bɛ lychee walima ackee yɔrɔ la, ni a kununna fɔɔnɔ, sɛgɛn, walima kirinni, o ka kan ka ** ta.10% Dextrose** lɛrɛ fɔlɔ kɔnɔ (administering D10W within 4 hours of symptom onset reduces fatality from > 44% to < 5%).

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Sigidaw ka kɔrɔtɔko ni baga kɛlɛli sariyaw¶

• Jamaika ni Karayibu: Aw bɛ 119 (Jamaica Ambulance / Polisiw) wele walima 911 / 999 (Karibi jamanaw bɛɛ kɔnɔ) ka teliya ka taa dɔgɔtɔrɔso kɔrɔtɔko yɔrɔ la min ka surun aw la, walasa ka a bila jolisira fɛ 10% Dextrose (Dextrose) bɛ sɔrɔ. Jamaika ka kɛnɛyako ni kɛnɛya minisiriso bɛ jɔli jugumanba Ackee Poisoning (Jamaica Vomiting Sickness) lakununni sariyaw mara pariti dɔgɔtɔrɔsow ni kɛnɛyaso bɛɛ la.
• Amerika ani Kanada: Aw bɛ 911 wele joona ani ka 1-800-222-1222 (US Poison Help) walima 1-844-POISON-X (1-844-764-7669 Kanada jamana na). Ackee kura bɛ falen Floride saheliyanfan fɛ (where trees are occasionally harvested by residents unfamiliar with the "natural yawn" rule), ani ackee min bɛ kɛ nɛnɛ na/min bɛ kɛ bidon kɔnɔ, o bɛ feere Karayibu suguw la Ameriki Woroduguyanfan bɛɛ la.
• Endi, Vietnam, Bangaladeshi, ani Azi Saheli-Kɔrɔn: Aw bɛ 108 walima 112 (Endi), 115 (Vietnam), walima 999 (Bangladesh/Malaysia) wele. Mɛkalo ka se Zuluyekalo ma lychee (litchi), longan, ani rambutan suman tigɛ waati, kɛnɛyaso fɔlɔ minnu bɛ Bihar (Endi) ani Vietnam woroduguyanfan fɛ, olu bɛ dilan kɛrɛfɛ glukomɛtiriw mara ani 10% Dextrose foroko kɛrɛnkɛrɛnnenw denmisɛnw ka sukarodunbana kunsɛmɛnasumaya kisi teliya la.
• Repibliki Uni, Erɔpu tɔnba, ani Afiriki Tlebi: Aw bɛ wele 999 (UK), 112 (EU), walima 112 / 199 (Nizeri, Gana, Côte d’Ivoire, Burkina Faso, yɔrɔ min na Blighia sapida bɛ falen kosɛbɛ, wa a bɛ kɛ sababu ye ka denmisɛnw ka baga bila waati kɔnɔ min bɛ wele ko "ackee poisoning" walima "finsan" toxicité (banakisɛ)). Dɔgɔtɔrɔ minnu bɛ Angletɛri/EU la, olu ka kan ka taa NPIS / TOXBASE walima jamana ka baga furakɛli yɔrɔw la walasa ka sugunɛbilenni asilikarnitini/asidi organique sɛgɛsɛgɛli dafalen sɔrɔ ani L-carnitine fura tata hakɛ.

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Ɲininkali minnu bɛ kɛ tuma caman na¶

Mun na denmisɛn minnu baga bɛ lichew walima ackee mɔbali fɛ, a ka c’a la, olu bɛ bana sɔgɔmada joona fɛ?¶

Hypoglycine A ni MCPG bɛ mitokondriyaw ka anzimuw bali minnu ka kan ka farikolo tulu jeni ani ka sukaro kura dilan (gluconeogenesis), nka u tɛ sugunɛ bali ka glycogène min maralen don kaban, o bɔ. Ni den ye ackee mɔbali dun walima ni a ye lychees dun ka taa sunɔgɔ ni sufɛdumuni tɛ, u ka sugunɛbilenni glycogène maralen bɛ a joli sukaro to a cogo la sanga 4 fo lɛri 10 fɔlɔ kɔnɔ sɔgɔma 3:00 ni sɔgɔma 8:00 cɛ, sugunɛbilenni bɛ ban pewu, o bɛ kɛ sababu ye ka joli sukaro jigin ka tɛmɛ miligaramu 20 kan dL kɔnɔ ka sɔrɔ asidi tuluma baga cɛmancɛw bɛ ji labɔ kunsɛmɛ na.

Mun na Glucagon pikiri kɔrɔtɔlen tɛ baara kɛ Ackee walima Lychee sukarodunbana na?¶

Glucagon bɛ sukaro wuli dɔrɔn ni a bɛ yamaruya di sugunɛ ma a ka glycogène maralen tiɲɛ ani ka glucose kura dilan gluconeogenesis fɛ. Ackee ni lychee baga la, banabagatɔ ka sugunɛ glycogène lankolon don pewu kaban ani u ka gluconeogenic enzymes bɛ datugu biyokimiki la MCPA-CoA ni MCPF-CoA fɛ, o kɔrɔ ye ko glucagon tɛ nɔ zeru la banabagatɔ ka kan ka sukaro tilennen ta da la (ni a kununna) walima ka Dextrose 10% ta joli la.

Mun na asidi Valproïque (Depakote) farati ka bon kirinni ma min bɛ sɔrɔ Ackee walima Lychee baga fɛ?¶

Asidi valproiki ye asidi fatɔ ye min bɛ cakɛda bolofara la, a yɛrɛ bɛ mitokondriyaw ka L-carnitine dun, ka asidi tuluma beta-oxydation enzymes bali, ka joli amoniyɔmu kɔrɔta. Ni aw ye asidi valproïki di banabagatɔ ma, min ka beta-oxydation sira baga bɛ a la kaban ni Hypoglycin A walima MCPG ye, o bɛ farikolojidɛsɛ juguya kosɛbɛ, amoniyɔmu camanba, ani kunsɛmɛ na min bɛ mɔgɔ faga dɔgɔtɔrɔw ka kan ka bɛnzoyazepiniw, levetiracetam (Keppra), walima fenobarbital kɛ ka fara Dextrose 10% kan o nɔ na.

Aw bɛ se k’a dɔn cogo di ni Ackee jiriden kura bɛ se ka tigɛ ka tobi?¶

Ackee pod kura bɛ lakana dɔrɔn ni a kɛra bilen jɛman ye ani a kɛra jɛman ye-orange ani a tilalen don kosɛbɛ a yɛrɛ la ("yawned") k’a sɔrɔ a sirilen bɛ jiri la hali bi tile fɛ, ka kisɛ nɛrɛma saba manamananan bɔ kɛnɛ kan pewu. Aw kana jiribulu jɛman dabɔbali tobi abada, aw kana foroko da wuli ni muru ye abada, aw bɛ kisɛ nɛrɛmaw ni a fɛnɲɛnamafagalan pinki-bilen bɛɛ bɔ tuma bɛɛ, ani ka ji tobilen bɔn jibolisira la tuma bɛɛ.

Mun na dɔgɔtɔrɔw bɛ Dextrose IV 10% jibɔlan to a la fo lɛri 24 fo lɛri 48 hali ni sukaro seginna a cogo kɔrɔ la?¶

Ni aw ye sukaro bololanɛgɛ kelen di aw ma, o bɛ sukaro dɔgɔyali labɛn miniti 20 fo miniti 30 dɔrɔn kɔnɔ. Ni aw bɛ Dextrose 10% pikiri kɛ ka a to a hakɛ caman na (a bɛ kɛ miligaramu 6 fo 8 ye kilogaramu kelen o miniti kelen kɔnɔ) o bɛ joli sukaro wuli dɔɔni (miligaramu 100 fo 150/dL), o bɛ banabagatɔ yɛrɛ ka inisɔndiya bila ka tulumafɛnw tiɲɛni dabila tulumafɛnw na ani ka farikolo bali ka asidi organique cakɛda surun caman bɔ farikolo la fo ka se sugunɛw ka kɛnɛya.

Yala sow ni wuluw fana bɛ baga sɔrɔ Hypoglycin A ni MCPG fɛ ka bɔ jirikisɛw la wa?¶

Ɔwɔ, sow minnu bɛ balo baganmarayɔrɔw la sɛnɛ ni samiyɛ waatiw la, olu ka teli ka bana dɔ sɔrɔ min bɛ mɔgɔ faga joona, n’o bɛ wele ko Equine Atypical Myopathy (Erɔpu/Angletɛri) walima Seasonal Pasture Myopathy (Amerika Woroduguyanfan na) u kɛlen kɔ ka Sycamore Maple (Acer pseudoplatanus) ani Box Elder (Acer negundo) kisɛw dun minnu kamanw bɛ u la. jiriw, minnu bɛ Sapindaceae denbaya kelen na ni ackee ni lychee ye ani Hypoglycin A hakɛ caman bɛ u la.

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Walasa ka denmisɛnw, farikoloɲɛnajɛ ani baga kɔrɔtɔlenw jaabi ka ɲɛ, aw bɛ a lajɛ ka bololabaarakɛlaw ka dɛmɛ fɔlɔ ni CPR kalan kɛ ka bɔ Croix Rouge la, St John Ambulance fɛ, walima sigida ka kɔrɔtɔko kalan kɛbaga dɔ fɛ.

Gafe minnu bɛ tali kɛ o ko la¶

• Sulfonylurea (Glipizide, Glyburide) tata hakɛ caya kojugu, sukarodunbana seginni, ani Octreotide Triage
• Status Epilepticus, Kɔnɔboli kuntaalajan, ani Kisili furaw
• Kɔnɔboli: Dɛmɛ fɔlɔ ni fiɲɛbɔyɔrɔw lakanani
• Dumuni baga, kɔnɔboli jugumanba, ani farikolojidɛsɛ
• Baga caman sɔrɔli Dɛmɛ fɔlɔ ni nɔgɔ bɔli

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Sosow ani ɲɛmɔgɔyaso ka bilasiralikan¶

• U.S. ka baarakɛyɔrɔ la. Banaw kunbɛnni ni u kunbɛnni baaradaw (CDC) & Banaw kɛlɛli baarada jamana (NCDC, Ɛndujamana): Shrivastava A, et al.: Senfalopathie toxic acute ni litchi dunni jɛɲɔgɔnya don banakisɛ dɔ la Muzaffarpur, Ɛndujamana na, san 2014: banaw kɛlɛli sɛgɛsɛgɛli (The Lancet Global Health).
• Jamaika & Karayibu jamana ka kɛnɛyako ni kɛnɛyako minisiriso (CARPHA): Ackee baga (Jamaika fɔɔnɔ bana / Hypoglycin A dɔlɔmin) (Kingston, Jamayika).
• AN. Dumuni ni furaw ɲɛnabɔli (FDA): Import Alert 21-11 & Compliance Policy Guide: Ackee min bɛ kɛ bidon kɔnɔ walima min bɛ kɛ ni konfirɛ ye, o minɛni min kɔnɔ, Hypoglycin A ka ca ni 100 ppm ye (Amerika).
• Diɲɛ kɛnɛyatɔn (OMS) / FAO ka dɔnnikɛlaw jɛkulu min bɛ dumuni faralenw kan: Dumuni nɔgɔlen dɔw lakanani jateminɛ: Hypoglycin A min bɛ Ackee jiridenw na (Blighia sapida) ani MCPG min bɛ Sapindaceae jiridenw na (Jenève).
• Sherratt HSA / Tanaka K, Isselbacher KJ: Hypoglycine, o ye ackee jiriden mɔbali baga ye: biyokimiki fɛɛrɛ min bɛ beta-oxydation ni gluconeogenesis bali (Biochemical Pharmacology / New England Journal of Medicine).