ʻO Colchicine (Autumn Crocus) vs. Wild Garlic Foraging Poisoning and Water Hemlock (Cicutoxin) vs. Poison Hemlock (Coniine) Triage¶

ʻO ka kuhi hewa ʻana i kahi mea kanu ʻāhiu make no ka ʻōmaʻomaʻo puna a i ʻole ka lau ʻaʻa ʻo ia kekahi o nā pilikia olakino wikiwiki loa i ka leʻaleʻa waho a me ka kuke ʻana i ka home. Inā loaʻa kekahi maʻi nausea, ʻā ka waha, ʻūlū, lohi ka puʻuwai, nāwaliwali o ka ʻiʻo, a i ʻole ka hopu ʻana ma hope o ka ʻai ʻana i ke kālika hihiu (ramps), nā kāloti hihiu, a i ʻole nā parsnips hihiu, e kelepona i kāu helu ulia pōpilikia kūloko (911 ma United States a me Kanada, 112 ma waena o ka European Union, 999 ma United Kingdom) a i ʻole e nīnau i kā mākou papa kuhikuhi helu ulia pōpilikia honua koke. ʻOiai e kali ana i nā paramedic, e nānā i kā mākou ākea ʻāhiu hihiu a me nā mea kanu lāʻau ʻawaʻawa protocol ingestion, hoomakaukau no kūlana epilepticus hoʻopaʻa lōʻihi inā ua ʻai ʻia ka wai Hemlock, a mākaukau e hoʻomaka ka hoʻōla ʻana o ka puʻuwai puʻuwai (CPR) inā ʻo Poison Hemlock a i ʻole Autumn Crocus ke kumu o ka hopu ʻana i ka hanu a i ʻole ka puʻuwai.

Ma waena o ʻEulopa, ʻAmelika ʻĀkau, a me ʻAsia malū, ʻelua mau pahele like me nā mea kanu lāʻau kaulana e hōʻike nei i ka hapa nui o nā lāʻau ʻawaʻawa make: 1. Ka Pahele "Wild Garlic" Lau ākea: E ʻohi ana nā mea ʻai i nā mea ʻai ʻai Wāhiu / Ramsons (Allium ursinum) a i ʻole ʻAmelika ʻĀkau Ramps (Allium tricoccum) ma nā ululāʻau wai puna i ʻohi ʻole ʻia nā lau ʻōmaʻomaʻo o Autumn Crocus / Meadow Saffron (Colchicum autumnale) aiʻole False Hellebore (Veratrum album / Veratrum viride), e ulu ana ma ka ʻaoʻao ʻaoʻao ma ka lepo like. ʻOiai ʻo Veratrum hoʻoulu i ka luaʻi wikiwiki, bradycardia koʻikoʻi, a me ka hypotension i loko 30 to 120 minutes e pane nui ana i ka atropine, Colchicum autumnale loaʻa ka mitotic spindle poison colchicine, e hoʻohālike ana i ka maʻi maʻi ʻino ʻole no 24 hours ma mua o ka hoʻokuʻu ʻana i ka pōʻino o nā ʻōpū he nui, ka puʻuwai cardiogenic, a me ka aplasia iwi iwi me ka ʻole o ka lāʻau lapaʻau ākea. 2. Ka Umbellifer "Wild Carrot / Parsnip" Trap: Nā mea ʻai ʻai i nā lālā o ka ʻohana carrot/parsley (Apiaceae) hewa Wai Hemlock (Cicuta maculata, Cicuta virosa, a i ʻole Oenanthe crocata) a i ʻole ** Poison Hemlock (Conium maculatum)** no nā kāloti ʻāhiu (Queen Anne's lace), parsnip wild, angelica, a i ʻole celery hihiu. ʻOiai ua lawe lāua ʻelua i ka inoa "hemlock," ʻo kā lākou mau meaʻawaʻawa e kū'ē ana i ka maʻi: Water Hemlock he cicutoxin (a i ʻole oenanthotoxin), he GABA-A antagonist ikaika e hoʻoulu i ka refractory **status epilepticus i loko o 15 a 60 mau minuke **, ʻoiai ʻo ** Poison Hemlock ** i loaʻa i ka nicotinic alkaloid, are like me ka nicotinic. ʻO ka maʻi hanu ʻehaʻeha ʻoiai e makaʻala loa ka mea i hoʻopilikia ʻia a hiki i ka wā e komo ai ka hypoxia.

+-------------------------------------------------------------------------+
|        CRITICAL WILD FORAGING POISONING IDENTIFICATION MATRIX           |
+-------------------------------------------------------------------------+
|  GROUP A: SPRING BROAD-LEAF LOOKALIKES (MISTAKEN FOR WILD GARLIC/RAMPS) |
|  1. AUTUMN CROCUS (Colchicum autumnale) -> Toxin: COLCHICINE            |
|     * Onset: Delayed 2 to 24 hours (cholera-like vomiting & diarrhea)   |
|     * Day 2-7: Cardiogenic shock, ARDS, DIC, Bone Marrow Aplasia        |
|     * Treatment: Early Multi-Dose Activated Charcoal + ICU + G-CSF      |
|  2. FALSE HELLEBORE (Veratrum album / viride) -> Toxin: VERATRUM ALK.   |
|     * Onset: Rapid 30 minutes to 3 hours (violent vomiting & paresthesia|
|     * Hallmark: Bezold-Jarisch Triad (Severe Bradycardia + Hypotension) |
|     * Treatment: IV Atropine (0.5-1.0 mg) + IV Fluids + Charcoal        |
+-------------------------------------------------------------------------+
|  GROUP B: APIACEAE CARROT-FAMILY LOOKALIKES (HOLLOW STEMS, WHITE UMBLES)|
|  3. WATER HEMLOCK (Cicuta maculata / virosa) -> Toxin: CICUTOXIN        |
|     * Onset: Ultra-rapid 15 to 60 minutes after chewing root or stem    |
|     * Hallmark: Explosive, continuous Tonic-Clonic Status Epilepticus   |
|     * Treatment: IV Benzodiazepines -> Phenobarbital / Propofol         |
|  4. POISON HEMLOCK (Conium maculatum) -> Toxin: CONIINE                 |
|     * Onset: 30 minutes to 2 hours (burning mouth, salivation, tremors) |
|     * Hallmark: Ascending Flaccid Respiratory Paralysis (Clear Mind)    |
|     * Treatment: Mechanical Ventilation for 24-72 hours (100% recovery) |
+-------------------------------------------------------------------------+

E hana i kēia i kēia manawa¶

1. Kele koke i nā lawelawe ulia pōpilikia a me ka Poison Control. Kāhea iā 911 (US a me Kanada), 112 (Uni ʻEulopa), 999 (United Kingdom), 000 (Australia), a i ʻole 111 (New Zealand). Mai kali no ka hoʻomaka ʻana o nā hōʻailona inā ʻike kekahi ua moni lākou i ka Autumn Crocus, Water Hemlock, Poison Hemlock, a i ʻole Hellebore False: He hoʻopunipuni ka colchicine 2 to 12 hour ʻO ka manawa mālie i ka wā o ka hoʻomaʻamaʻa mua ʻana o ka ʻōpū o ka haukapila ʻo ia wale nō ka manawa e pale ai i ka lawe ʻana i ka cellular fatal.
2. E hōʻiliʻili a paʻi kiʻi i ka mea kanu paʻa, me ka ʻōpuʻu/aʻa, kumu kumu, a me nā lau. E hoʻokomo i kahi laʻana ʻaʻole i kuke ʻia o nā lau, nā ʻōpala, nā ʻōpala, a i ʻole nā ​​puʻupuʻu (me nā koena sopa, pesto, a i ʻole salakeke) i loko o kahi ʻeke pepa a i ʻole ipu a lawe pū me ka mea maʻi i ke keʻena pilikia. Hoʻohana ka poʻe toxicologists toxicologists a me ka poison center botanist on-call i nā keʻena aʻa, nā ʻōpala kumu, nā lau venation, a me ka ʻala kālika e ʻike ai i ke ʻawaʻawa pololei i loko o nā minuke.
3. Mai hoʻokomo i ka luaʻi ma ka home. Mai hāʻawi i ka syrup o ka ipecac, ka wai paʻakai, a i ʻole ka ʻae lima. Inā he Water Hemlock ka mea kanu (Cicuta), hiki ke hoʻopaʻa ʻia i loko 15 minutes ka ʻai ʻana, e hoʻomake ai i ka ʻōpū o ka ʻōpū inā luaʻi ke kanaka.
4. E hoʻomoe i ka mea maʻi ma ko lākou ʻaoʻao a hoʻomākaukau no ka hoʻopaʻa ʻana a i ʻole ka hanu ʻana.
5. Inā ʻai ke kanaka i ke aʻa i loko o ke keʻena ma kahi kahawai a i ʻole ka wai (Water Hemlock), e hoʻoneʻe i nā mea ʻoi aku a hoʻopaʻa i ko lākou poʻo no ka hoʻomākaukau ʻana no ka hoʻoulu ʻana o ka tonic-clonic.
6. Inā ʻai ke kanaka i ka ʻaʻa poni a i ʻole nā ​​lau like me ka fern (Poison Hemlock), e nānā pono i ka piʻi ʻana o kona umauma: inā kaumaha ko lākou mau wāwae a paʻu paha ko lākou hanu, e hoʻomaka koke i ka ** hoʻopakele hanu / ʻeke-valve-mask ventilation** (a i ʻole CPR piha inā ʻaʻole pulse) koke.
7. Inā ʻeha ke kanaka me ka puʻupuʻu lohi ma lalo 45 beats per minute ma hope o ka ʻai ʻana i nā lau ʻōmaʻomaʻo ākea (False Hellebore), e waiho palahalaha a hoʻokiʻekiʻe i nā wāwae 30 centimeters (12 inches) e kākoʻo i ka hoʻihoʻi ʻana o ke koko i ka puʻuwai a hiki i ka wā e hoʻoponopono ai ka poʻe lapaʻau i ka atropine.
8. E aʻo aku i nā mea ʻē aʻe i ʻai koke i ka ʻai. ʻAi pinepine ʻia ka pesto kālika hihiu, ka soup ramp, a me nā salakeke foraged i waena o nā ʻohana, nā malihini ʻaina, a i ʻole nā ​​hoa hoʻomoana. ʻO kēlā me kēia kanaka i ʻai i hoʻokahi lau a i ʻole punetune o ka hupa kuke (ʻo ka colchicine a me ka veratrum alkaloids ** ʻaʻole paʻa loa i ka wela** a liʻiliʻi i loko o ka wai sopa) pono e hele koke i ka haukapila inā maikaʻi lākou.

Ka lāʻau hoʻoholo: ʻike lāʻau lāʻau a me ka hoʻāʻo ʻana i ka toxidrome¶

flowchart TD
    A["ʻO ka maʻi nui a i ʻole ka ʻai ʻana ma hope o ka ʻai ʻana i nā mea kanu hihiu"] --> B{"He aha ke ʻano mea kanu i ʻohi ʻia?"}
    B -->|"ʻO nā lau ʻōmaʻomaʻo maʻemaʻe ākea (Mistened for Wild Garlic / Ramps)"| C{"E nānā i ka hoʻomaka ʻana o ka hōʻailona a me ka piʻi ʻana o ka naʻau"}
    B -->|"ʻO nā lau like me ka Fern a i ʻole nā pua Umbrella keʻokeʻo / Aʻa (Mistened for Wild Carrot / Parsnip)"| D{"E nānā i ka hōʻailona Neurological Dominant"}
    C -->|"Hoʻomaka wikiwiki (30-120 min) + Bradycardia koʻikoʻi (HR <45) + Hypotension"| E["FALSE HELLEBORE (Veratrum album / viride) - Bezold-Jarisch Reflex"]
    C -->|"Hoʻopaneʻe ka hoʻomaka ʻana (2-24 mau hola) + ʻO ka maʻi maʻi maʻi kolera-like + Tachycardia"| F["AUTUMN CROCUS (Colchicum autumnale) - Colchicine Mitotic Poisoning"]
    E --> G["Hāʻawi i ka Lahu Hana (<1-2h); IV 0.9% Saline + IV Atropine (0.5-1.0 mg q3-5m) -> Dopamine/Phenylephrine inā pono"]
    F --> H["ʻO ka ʻāhu hoʻāhu hoʻoneʻe ʻana i ka nui o ka nui (MDAC q4-6h) + ʻO ka hoʻihoʻi hou ʻana o ka Volume ICU mua + G-CSF no Pancytopenia"]
    D -->|"ʻO ke kūlana maʻi epilepticus i loko o 15-60 mau minuke"| I["WATER HEMLOCK (Cicuta maculata / virosa / Oenanthe crocata) - Cicutoxin"]
    D -->|"Piʻi ʻana i ka ʻiʻo Flaccid a me ka maʻi hanu me ka noʻonoʻo maopopo"| J["POISON HEMLOCK (Conium maculatum) - Coniine Nicotinic Blockade"]
    I --> K["Mālama i ke Alanui; Nā Benzodiazepine IV kiʻekiʻe-kiʻekiʻe -> Phenobarbital a i ʻole Propofol + Hoʻomaʻamaʻa ikaika + Bicarbonate no Rhabdomyolysis"]
    J --> L["Hoʻokomo koke ʻia Endotracheal & Ventilation Mechanical no nā hola 24-72 (E pale iā Succinylcholine) + Lahu Hoʻōla"]

ʻO ka hoʻohālikelike ʻana i nā lāʻau a me nā lāʻau lapaʻau o ka 4 lethal foraging syndromes¶

Mahele 1: Ka Wild Garlic Lookalikes: Autumn Crocus (Colchicine) vs. False Hellebore (Veratrum)¶

ʻO kēlā me kēia pūnāwai ma ʻEulopa, UK, a me ʻAmelika ʻĀkau, ʻai nā tausani o ka poʻe i nā ululāʻau maloʻo wai no ** Wild Garlic (Allium ursinum)** aiʻole Ramps (Allium tricoccum) no ka hana ʻana i ka pesto kālika ʻāhiu, ka sopa, a i ʻole nā ʻōmaʻomaʻo sautéed. No ka mea, ulu mai ke kālika ʻāhiu i loko o nā ʻōpala paʻapū ma nā ʻāpana o Autumn Crocus (Colchicum autumnale) a me False Hellebore (Veratrum album ma ʻEulopa; Veratrum viride ma ʻAmelika ʻĀkau), i loko o ka lima hoʻokahi o nā lau i hopu pinepine ʻia nā ʻano ʻano ʻekolu. Eia kekahi, ke uhi ʻia nā manamana lima o ka mea ʻai i ka wai kālika ʻāhiu i ʻoki ʻia, ʻala ko lākou mau lima e like me ke kālika, e hoʻopunipuni ana i ka "ho'āʻo honi" ke nānā lākou i nā lau ma hope.

Syndrome 1A: Autumn Crocus (Colchicum autumnale) a me Glory Lily (Gloriosa superba): ʻAi ʻona ʻo Colchicine¶

ʻO nā ʻāpana a pau o Colchicum autumnale (lau, corm/bulb, ʻanoʻano, a me nā pua hāʻule) a me nā ʻuala Gloriosa superba ʻo nā ʻuala i loko o nā ʻano kiʻekiʻe (0.1% to 0.6%) o ka alkaloid colchicine. ʻOi aku ma mua o 0.5 mg/kg o ka colchicine (roughly 2 to 5 fresh leaves of Autumn Crocus no ke kanaka makua, a i ole 1 leaf no ke keiki) make pinepine, a ua oi aku ka nui 0.8 mg/kg kumu kokoke 100% ka make ʻana mai ka haʻalulu cardiogenic a me ka hāʻule ʻole o nā ʻāpana he nui.

ʻO ka pathophysiology a me ka 3 mau lāʻau lapaʻau o Colchicine toxicity¶

Hoʻopaʻa paʻa ʻole ʻo Colchicine i nā **alpha- a me beta-tubulin dimer i loko o ke kino, e pale ana iā lākou mai ka polymerizing i microtubules. Me ka ʻole o nā microtubules hana, ʻaʻole hiki i nā keena ke hana i ka milo milo e puʻunaue (hoʻopaʻa ʻia i nā pūnaewele puʻunaue wikiwiki a pau i metaphase), a me nā pūnaewele hoʻokaʻawale ʻole (e like me nā myocytes cardiac a me nā aʻalolo peripheral) nalowale ka lawe ʻana i nā vesicle intracellular a me ka contractility.

+-------------------------------------------------------------------------+
|            THE 3 CLINICAL STAGES OF COLCHICINE POISONING                |
+-------------------------------------------------------------------------+
|  STAGE 1 (2 TO 24 HOURS POST-INGESTION): GASTROINTESTINAL / CHOLERAIC   |
|  * Mucosal crypt cells of the small intestine divide faster than any    |
|    other tissue; mitotic arrest causes massive mucosal sloughing        |
|  * Profuse, intractable vomiting, fiery abdominal pain, and liters of   |
|    watery/bloody cholera-like diarrhea -> Severe hypovolemic shock      |
|  * Marked initial leukocytosis (white blood cell count > 20,000/mm3)    |
+-------------------------------------------------------------------------+
|  STAGE 2 (DAYS 2 TO 7): MULTI-ORGAN FAILURE & BONE MARROW APLASIA       |
|  * Direct myocardial microtubule poisoning -> Refractory Cardiogenic    |
|    Shock, malignant arrhythmias, and sudden cardiac arrest (Days 2-4)   |
|  * ARDS (non-cardiogenic pulmonary edema), rhabdomyolysis, acute renal  |
|    failure, hepatic necrosis, DIC, and ascending metabolic neuropathy   |
|  * Bone marrow collapse (Days 4-8): Profound Pancytopenia / Agranulo-   |
|    cytosis (WBC < 500/mm3, Platelets < 10,000/mm3) -> Fulminant Sepsis  |
+-------------------------------------------------------------------------+
|  STAGE 3 (DAYS 7 TO 21+): MARROW RECOVERY & ANAGEN ALOPECIA             |
|  * If the patient survives Stage 2, rebound leukocytosis occurs along   |
|    with sudden, complete, reversible scalp hair loss (Alopecia)         |
+-------------------------------------------------------------------------+

ʻO ka mālama ʻana i ka Halemaʻi ʻanuʻu i ka ʻona ʻo Colchicine¶

1. ** Ka hoʻomaʻemaʻe ʻana i ka ʻōpū koke a me ka hana hou ʻana (Even if Presenting Late):** Ma muli o ka loaʻa ʻana o ka colchicine i ka enterohepatic recirculation (huna ʻia i loko o ka bile a hoʻopaʻa hou ʻia i loko o ka ʻōpū liʻiliʻi) a hoʻolōʻihi i ka neʻe ʻana o ka ʻōpū, e hāʻawi i ka ** aspiration/lavage mua o ka ʻōpū** (inā i loko. 1 to 2 hours o ka ʻai ʻana i nā lau) a hoʻomaka i Multi-Dose Activated Charcoal (MDAC: 50 grams mua, alaila 25 grams kēlā me kēia 4 to 6 hours no ka mea 24 to 48 hours). Hoʻopaʻa paʻa ka lanahu hoʻōla i ka colchicine i loko o ka lumen o ka ʻōpū a ʻo ia ke ana ʻoi loa e hōʻemi i ka lethality systemic.
2. Aggressive Hemodynamic a me ICU Resuscitation: Hoʻokomo i ka nui o nā crystalloids kaulike ma ka pae 1 e pani ai. 5 to 10 liters o ka lilo ana o ka wai GI e like me kolera. E hana i ka echocardiography mua o ka moe: i ka wā e hoʻololi ai ka haʻalulu hypovolemic i ka pae 1 i Stage 2 i ka haʻalulu cardiogenic pololei (typically at 24 to 72 hours), e hoʻololi mai ka wai nui i nā inotropes (norepinephrine + dobutamine a i ʻole epinephrine) a e noʻonoʻo mua Veno-Arterial Extracorporeal Membrane Oxygenation (V-A ECMO) ma mua o ka puka ʻana o ka asystole refractory.
3. Granulocyte Colony-Stimulating Factor (G-CSF / Filgrastim): E nānā i nā helu koko piha ʻelua i kēlā me kēia lā. ʻO ka manawa ke koko keʻokeʻo (WBC) hoʻomaka ka helu i kona hāʻule pali (typically Day 3 to 4), hoʻomaka i ka subcutaneous Filgrastim (G-CSF, 5 micrograms/kg/day) a waiho i ka mea maʻi i loko o kahi kaʻawale neutropenic pale me nā lāʻau antibiotic intravenous ākea ākea a me ka hoʻololi platelet e ola ai i ka iwi aplasia nadir.
4. No ke aha i hāʻule ʻole ai ka Dialysis a me nā ʻāpana Fab: No ka mea, komo wikiwiki ka colchicine i nā cell a he nui ka puʻupuʻu (2 to 12 L/kg), hemodialysis a hemoperfusion **ʻaʻole ** wehe i ka colchicine (ʻoiai CRRT hoʻohana ʻia no ka hōʻino ʻana o ka renal a me ka acidosis). ʻO ka hoʻāʻo colchicine-specific ovine Fab antibody fragments hoʻohuli nui i nā mea ʻawaʻawa i nā haʻawina lāʻau lapaʻau, ʻoiai ua kaupalena ʻia ka waiwai kūʻai ma ka honua holoʻokoʻa; e nīnau koke iā Poison Control e nānā i ka loaʻa ʻana o ka noiʻi.

Syndrome 1B: False Hellebore (Veratrum album, Veratrum viride, Veratrum californicum): ʻO ka Bezold-Jarisch Bradycardia Syndrome¶

ʻAʻole like me ka lohi o ka make ʻana o Autumn Crocus, ʻo ka ʻai ʻana i nā lau False Hellebore (a i ʻole ka inu ʻana i ka liqueur gentian homemade i hana hewa ʻia me nā aʻa Veratrum album) hoʻoulu i nā hōʻailona koʻikoʻi i loko o 30 minutes to 3 hours.

• Mechanism: Veratrum ʻano he steroidal veratrum alkaloids (veratridine, protoveratrine A and B, germerine, a jervine). Hoʻopaʻa ʻia kēia mau mea hiki ke hoʻoheheʻe ʻia i ka lipid e wehe i voltage-gated sodium (Na+) nā ala i loko o ke aʻalolo vagus, carotid sinus baroreceptors, a me nā mechanoreceptors ventricular hema, e pale ana i ka hana ʻole ʻana o ke kahawai sodium. ʻO ke kī ʻana mau ʻana o ka puʻuwai sensory vagal fibers e hoʻāla ai i ka Bezold-Jarisch reflex: ʻike ka lolo i ka hoʻopaʻa ʻia ʻana o ka puʻuwai a pane ʻia ma ka hoʻokuʻu ʻana i ka parasympathetic nui vagal leo i ka wā e pani ana i ka leo vascular sympathetic.
• Hōʻike Kauka: Loko 30 to 120 minutes, hoʻomohala ka mea maʻi i ka wela hope loa, ka luaʻi ikaika, ka ʻeha a me ke kani ʻana a puni ka waha a me nā manamana lima (paresthesia), pilikia ike maka (xanthopsia), bradycardia sinus hohonu (heart rate 30 to 45 beats per minute), atrioventricular (AV) poloka naʻau, a me ke kuhiakau ʻaʻa koʻikoʻi (systolic BP < 60 to 70 mmHg).
• Lapaʻau i manaʻo ʻia:
• Ahu Lahu Hoʻolā hoʻokahi-dose (50 grams waha ina maloko 1 to 2 hours a palekana ke ala ea) + antiemetics (ondansetron).
• Nā Bolus Intravenous Fluid: Hoʻoponopono 1 to 2 liters o 0.9% paʻakai maʻamau.
• Atropine Intravenous (The Specific Physiologic Antagonist): Hooponopono Atropine 0.5 to 1.0 mg IV pana i kēlā me kēia 3 to 5 minutes (up to 3 mg total i nā mākua; 0.02 mg/kg i nā keiki). Hoʻopaʻa ʻo Atropine i ka muscarinic vagal receptors ma ka sinoatrial a me atrioventricular nodes, e hoʻohuli koke i ka bradycardia a me ka puʻuwai.
• Vasopressors for Persistent Hypotension: No ka Bezold-Jarisch reflex ke kumu hoʻi i ka hoʻihoʻi ʻana o ke kikowaena sympathetic (peripheral vasodilation) ma ka ʻaoʻao o ka bradycardia, hiki ke emi iki ke koko ma hope o ka hoʻihoʻi ʻana o ka atropine i ka puʻuwai maʻamau; hoʻohui i kahi phenylephrine haʻahaʻa, dopamine, a i ʻole norepinephrine infusion no 12 to 24 hours a hiki i ka ho'ōla hou 'ana (virtually 100% of Veratrum patients recover fully within 24 to 48 hours with supportive care).

Mahele 2: Ka ʻohana Kāroti (Apiaceae) Likelikes: Wai Hemlock (Cicutoxin) vs. Poison Hemlock (Coniine)¶

ʻO ka ʻohana botanical Apiaceae (Umbelliferae) me nā mea ʻai meaʻai ʻono (kāloti, parsnips, celery, parsley, fennel, dill, coriander) ma ka ʻaoʻao o nā mea kanu neurotoxic ʻelua make loa ma ka ʻĀpana ʻĀkau: Water Hemlock (Cicuta ʻano a me Oenanthe crocata) a me Poison Hemlock (Conium maculatum). Loaʻa nā puʻupuʻu keʻokeʻo keʻokeʻo me ka ʻano umbrella (compound umbels), nā ʻōpuʻu ami ʻāwaha, a me nā lau hui pū ʻia.

+-------------------------------------------------------------------------+
|     HOW TO TELL WATER HEMLOCK vs. POISON HEMLOCK AT THE BEDSIDE         |
+-------------------------------------------------------------------------+
|  WATER HEMLOCK (Cicuta maculata / Cicuta virosa / Oenanthe crocata):    |
|  * Habitat: Grows IN or right along stream banks, marshes, wet ditches  |
|  * Root Cut Open: Chambered bamboo-like compartments leaking yellow oil |
|  * Toxin: CICUTOXIN (Polyacetylenic alcohol -> GABA-A receptor blocker) |
|  * Clinical Effect: CENTRAL EXCITATORY -> Violent Status Epilepticus    |
|    within 15 to 60 minutes; patient is unconscious and convulsing       |
+-------------------------------------------------------------------------+
|  POISON HEMLOCK (Conium maculatum - The Plant That Killed Socrates):    |
|  * Habitat: Dry roadsides, waste ground, field edges, disturbed soil    |
|  * Stem & Odor: Smooth hairless stem with PURPLE BLOTCHES; mousey odor  |
|  * Toxin: CONIINE (Piperidine alkaloid -> Nicotinic AChR blocker)       |
|  * Clinical Effect: PERIPHERAL PARALYTIC -> Ascending curare-like       |
|    flaccid respiratory paralysis; patient is AWAKE until hypoxia hits   |
+-------------------------------------------------------------------------+

ʻO Syndrome 2A: Hemlock Wai (Cicuta maculata, Cicuta virosa) a me Hemlock Water Dropwort (Oenanthe crocata): Cicutoxin Status Epilepticus¶

Ua manaʻo nui ʻia ʻo Water Hemlock ʻo ia ka mea kanu maoli ʻona loa ma ʻAmelika ʻĀkau a me ʻEulopa ʻĀkau. He wai mānoanoa, melemele, ʻaila i loko o ka cicutoxin (a i ʻole oenanthotoxin ma Oenanthe crocata, maʻamau ma waena o UK a me Western Europe), he aliphatic unsaturated. C17 waiʻona polyacetylenic. Hoʻokahi nahu (2 to 3 centimeters) o kahi aʻa Water Hemlock, a i ʻole ke keiki e hoʻohana ana i ke kumu ʻaʻa ma ke ʻano he peashooter a i ʻole whistle, hiki ke hāʻawi i kahi maʻi make.

• Mechanism: Ke hele wikiwiki nei ʻo Cicutoxin i ka pale koko-lolo a hoʻopaʻa pono ʻole i ka picrotoxin pūnaewele ma waena o ka GABA-A receptor-ionophore complexes, e ālai loa ana i ka conductance channel chloride. Me ka ʻole o ka GABA inhibition, ʻo nā neurons cortical a me brainstem depolarize mau.
• ** Hōʻike hōʻike kino (15 to 60 minutes):** Iloko 15 minutes ʻO ka ʻai ʻana i ke aʻa, ʻike ka mea i pepehi ʻia i ka nausea, ka nui o ka salivation, ka ʻeha epigastric, dizziness, a me nā haumāna ākea (mydriasis), ukali koke 'ia e ** ka ho'opa'a 'ana i ka tonic-clonic ma'amau (status epilepticus)**. He ikaika loa ka ma'i a hiki i ka po'e ma'i ke 'eha pinepine i ke alelo, opisthotonos, vertebral compression fracture, extreme hyperthermia (> 41 degrees Celsius), nui rhabdomyolysis (creatine kinase > 50,000 U/L), koʻikoʻi kiʻekiʻe-anion-gap lactic acidosis (pH < 6.9), hōʻino ʻole ka myoglobinuric renal, a me ka hopu ʻana i ka naʻau hypoxic.
• Hooponopono Halema'i ulia pōpilikia:
• Ea koke a me GABA-Agonist Seizure Control: Mai hoʻopau manawa me ka phenytoin (ineffective against GABA-A blockade). Hāʻawi i nā lāʻau lapaʻau kiʻekiʻe benzodiazepines (lorazepam 4 mg IV a i ʻole diazepam 10 mg IV), e piʻi koke ana i ka intravenous phenobarbital (15 to 20 mg/kg) a i ʻole ka hoʻokomo ʻana i ke kaʻina wikiwiki me ka hoʻokomo ʻana i ka propofol a i ʻole midazolam.
• Neuromuscular Blockade and Active Cooling for Rhabdomyolysis: Inā mau ka ʻiʻo o ka ʻiʻo a me ka hyperthermia me ka hohonu o ka GABA-agonist sedation, e hāʻawi i kahi non-depolarizing neuromuscular blocker (rocuronium a i ʻole vecuronium; pale i ka succinylcholine ma muli o ka pilikia hyperkalemia) ma lalo o ka nānā ʻana i ka EEG e hoʻopau koke i ka hoʻoulu ʻana i ka wela o ka ʻiʻo iwi a me ka hoʻokuʻu ʻana i ka myoglobin.
• Aggressive Sodium Bicarbonate and Fluid Diuresis: Infuse isotropic intravenous crystalloids and intravenous sodium bicarbonate no ka hoʻoponopono ʻana i ka metabolic acidosis koʻikoʻi a me ka alkalinize i ka mimi (target urine pH > 6.5), ka pale ʻana i ka hoʻokahe ʻana o ka myoglobin i loko o nā tubules renal. E hana i ka hemodialysis mua inā loaʻa ka hyperkalemia refractory, acidosis, a i ʻole ka anuric renal failure.

ʻO ka maʻi maʻi 2B: Poison Hemlock (Conium maculatum): Coniine Piʻi ʻana o ka hanu maʻi¶

Hemlock Poison (Conium maculatum), kaulana i ka mōʻaukala kahiko e like me ka mea make o ke akeakamai Socrates ma 399 BCE, aia i loko o ʻewalu mau mea hoʻoheheʻe piperidine alkaloids, ka nui o coniine a me gamma-coniceine. Ma muli o ka like o kona lau lacy, like me ka fern me ka lau palahalaha, chervil, a i ʻole nā ​​lau kāloti hihiu (a ʻo kona ʻaʻa keʻokeʻo e like me ka parsnip), ʻai pinepine ka poʻe mākaʻikaʻi a me nā māla home me ke kuhihewa.

• Mechanism (Biphasic Nicotinic Blockade): He ʻano kemika ko Coniine a me ka hana lāʻau lapaʻau like loa me nicotine a me curare. Hana ia i ʻelua ʻāpana ʻokoʻa ma nā ganglia autonomic a me ka ** skeletal muscle neuromuscular junction (nicotinic acetylcholine receptors [nAChR])**:
• Phase 1 (Hoʻomaka i ka hoʻoulu ʻana i ka Nicotinic, 15 to 60 minutes): Ke ʻā ʻana ma ka waha a me ka ʻāʻī, ka salivation nui, nausea, ka luaʻi ʻana, ka ʻōpū o ka ʻōpū, ka tachycardia, ke kiʻekiʻe kiʻekiʻe, nā haumāna ākea, a me nā fasciculations / haʻalulu.
• Phase 2 (Depolarizing/Non-depolarizing Neuromuscular Blockade, 1 to 4 hours): Hoʻopau ka hoʻopaʻa ʻana i ka mea hoʻopaʻa hoʻomau a hoʻopaʻa i nā mea loaʻa nicotinic acetylcholine ma ka ʻaoʻao hope o ka kaʻa, e hana ana i kahi maʻi maʻamau piʻi curare-like flaccid paralysis.
• ** ʻO ka "Socrates Sign" (Ascending Paralysis with Clear Consciousness):** Hoʻomaka ka maʻi lolo ma nā wāwae a me nā wāwae (e kū ai i ka ataxia a me ka hiki ʻole ke kū), e piʻi mau ana ma nā ʻūhā, kumu, a me nā lima, a ma hope e hoʻopau i ka ** ʻiʻo intercostal a me ka diaphragm **, ʻoiai **. A hiki i ka wā e hiki mai ai ka hypoxia cerebral koʻikoʻi mai ka hopu ʻana i ka hanu, noho ka mea maʻi ** me ka makaʻala loa, ka makaʻu, a me ka makaʻu, ʻaʻole hiki ke neʻe a hanu **. Hiki i ka Coniine ke hana i ka rhabdomyolysis pololei a me ka necrosis tubular acute.
• Hooponopono Halema'i ulia pōpilikia:
• ** Hoʻokomo ʻia ʻo Endotracheal mua a me ka hoʻoheheʻe ʻana i ka mīkini (The Definitive Cure):** ʻAʻohe lāʻau antidote kemika no ka coniine (a ʻaʻole pono e hāʻawi ʻia nā anticholinesterases e like me neostigmine a i ʻole physostigmine**, no ka mea hiki iā lākou ke hoʻonui i ka depolarizing nicotinic blockade a hoʻoulu i ka pilikia cholinergic). Akā, ʻo ** ʻo ka ventila mechanical he 100% mālama ola**. E hoʻokomo koke i ka mea maʻi i ka wā e nāwaliwali ai ka ikaika o ka hanu a i ʻole ka ikaika hoʻoikaika kino (avoid succinylcholine), hāʻawi i kahi hoʻomaha kūpono (propofol/midazolam no laila, ʻaʻole e ala ka mea maʻi maʻi maʻi maʻi ma luna o ka ventilator), e hāʻawi i ka ** lanahu hoʻōla ʻia ** ma o ka paipu nasogastric, a e hoʻoheheʻe ʻia no 24 to 72 hours. I ka manawa e hoʻololi ai ke ake a me ka māmā i ka coniine, e hoʻi hou ka ikaika neuromuscular me ka loaʻa ʻole o nā sequelae neurological mau loa.

ʻO nā kuʻina ulia pōpilikia a me ka hoʻomalu ʻona¶

• ** ʻAmelika Hui Pū ʻIa a me Kanada:** Kāhea koke iā 911 a kāomi iā 1-800-222-1222 (Kōkua ʻAmelika Hui Pū ʻIa) a i ʻole 1-844-POISON-X (1-844-764-7669 ma Kanada). Ma ʻAmelika ʻĀkau, Water Hemlock (Cicuta maculata a Cicuta douglasii), Poison Hemlock (Conium maculatum), a me False Hellebore / Corn Lily (Veratrum viride a Veratrum californicum) ua laha ma na aina wai, na ulu mauna, a me na alanui; Mālama nā Poison Centers āpana 24/7 i nā pūnaewele loiloi kiʻi kiʻi me ka nīnau ʻana i nā toxicologists a me nā botanist no ka ʻike ʻana i nā mea kanu kiʻi i hoʻouna ʻia mai nā lumi pilikia.
• United Kingdom a me ʻEulopa: Kāhea iā 999 (UK) a i ʻole 112 (EU). Ma waena o Kelemānia, Austria, Switzerland, Palani, Italia, Slovenia, a me UK, ke ulu nei ka huikau ma waena o Bärlauch / Ramsons (Allium ursinum) a me Herbstzeitlose (Colchicum autumnale) a i ʻole Weißer Germer (Veratrum album) ke kumu o ke komo ʻana a me ka make o ka ICU i kēlā me kēia ʻApelila a me Mei. Ma UK a me kahakai komohana o ʻEulopa, ** Hemlock Water Dropwort (Oenanthe crocata, "Nā Mana Manawa o ke Kanaka Make")** ʻO nā ʻuala i holoi ʻia ma kapa kahawai a me nā kahakai ke kumu o ke kūlana oenanthotoxin epilepticus e like me Cicuta. Pono nā kauka lapaʻau e nīnau iā NPIS / TOXBASE (UK) a i ʻole nā kikowaena ʻona o EU (Giftnotruf / Tox Info Suisse / CAPTV) koke.
• Australia a me New Zealand: E kelepona iā 000 (Australia) a i ʻole 111 (New Zealand), a e nīnau i ka Poisons Information Center (13 11 26 ma Australia; 0800 764 766 ma Aotearoa). Hoʻokomo ʻia Poison Hemlock (Conium maculatum) a me ka nani Gloriosa Lily (Gloriosa superba, waiwai i ka colchicine) nā kumu nui o ka lāʻau make ma nā ʻāina ʻelua.
• ** ʻAsia a me nā ʻāpana Tropical:** Ma waena o India, Sri Lanka, a me Asia Hikina Hema, nā ʻuala o ka Flame Lily / Glory Lily (Gloriosa superba) ke kumu nui o ka ʻona nui o ka colchicine (ʻaʻole hoʻi a me ka manaʻo), mālama ʻia me ka Multi-Dose Activated Charcoal, ICU hemodynamic, a me ka protocol G-CSF i hoʻohana ʻia no Colchicum autumnale.

Nīnau pinepine¶

Pehea e huikau ai ka poʻe i ka Autumn Crocus a i ʻole False Hellebore me ka Wild Garlic hiki ke ʻai?¶

I ka pūnāwai mua ma mua o ka puka ʻana o nā pua, hoʻouna ʻo Wild Garlic (Allium ursinum) a me Ramps (Allium tricoccum) i nā lau ākea, ʻōmaʻomaʻo, ʻano ʻano ihe i loko o nā ʻāina nahele pulu ma ka ʻaoʻao o nā lau ʻōmaʻomaʻo o Autumn Crocus (Colchicum autumnale) a me False Hellebore (Veratrum album a viride). Ke hopu ka mea ʻai i ka lima o nā lau kālika hihiu i ka manawa hoʻokahi, ʻohi maʻalahi lākou i ka lau Autumn Crocus a i ʻole False Hellebore e ulu ana i waenakonu o ka pā, a no ka mea ua uhi ʻia ko lākou mau lima i ka ʻaila kālika, ʻike ʻia nā lau ʻawaʻawa ʻole e like me ke kālika.

Pehea e hiki ai i ke kauka ke haʻi inā ua ʻai ka mea ʻai ʻai ʻāhiu ʻāhiu i ka Autumn Crocus a i ʻole False Hellebore?¶

Hoʻokaʻawale koke ka manawa a me ka puʻuwai puʻuwai i nā mea ʻelua: Hoʻopaʻa koke ʻo False Hellebore (Veratrum) i loko o 30 mau minuke a 3 mau hola, e hoʻoulu ai i ka luaʻi ikaika i hui pū ʻia me ka puʻuwai lohi weliweli (severe sinus bradycardia ma lalo o 45 bpm) a me ke koko haʻahaʻa e hoʻohuli koke me ka atropine intravenous. Loaʻa i ka Autumn Crocus (colchicine) he 2 a 24 hola lohi ma mua o ka hoʻoulu ʻana i ka maʻi koko e like me kolera a me ka wikiwiki o ka puʻuwai (tachycardia), e holomua ana i nā lā 2 a hiki i ka 7 i ka haʻalulu cardiogenic make a me ka hāʻule ʻana o ka iwi iwi.

He aha ka ʻokoʻa ma waena o Water Hemlock (Cicuta) a me Poison Hemlock (Conium)?¶

ʻOiai he mau lālā lāua ʻelua o ka ʻohana kāloti me nā pua umbrella keʻokeʻo a me nā ʻōpuʻu puʻupuʻu, hoʻouka lākou i ka ʻōnaehana nerve ma nā ʻano like ʻole. ʻO ka wai Hemlock (Cicuta species) ulu i loko o ka pulu pulu, he keʻena keʻena oozing aila melemele, a loaʻa cicutoxin, ka mea poloka lolo GABA-A receptors e kumu explosive, mau kūlana epilepticus hopu i loko o 15 a 60 minuke. Ulu ka Poison Hemlock (Conium maculatum) ma ka ʻāina maloʻo, he ʻōniʻoniʻo kona mau kumu, a aia ka coniine, ka mea e ālai ai i nā ʻiʻo o ka ʻiʻo peripheral i mea e piʻi ai ka maʻi maʻi ʻeha i ka wā e ala ana ka mea maʻi.

No ke aha he mea koʻikoʻi loa ka Multi-Dose Activated Charcoal inā ʻai kekahi iā Autumn Crocus?¶

Ke komo ka colchicine i ka ʻiʻo puʻuwai a me nā pūnaewele iwi iwi a laka i ka tubulin intracellular, ʻaʻole hiki i ka hemodialysis ke wehe a ʻaʻohe lāʻau antidote maʻamau i loaʻa ākea. Eia naʻe, hūnā mau ʻia ka colchicine e ke ake i loko o ka bile a hoʻopaʻa hou ʻia i loko o ka ʻōpū liʻiliʻi; ka hāʻawi ʻana i nā kīʻaha hou o Activated Charcoal i kēlā me kēia 4 a 6 mau hola e paʻa ai i ka colchicine i loko o ka lumen o ka ʻōpū, hoʻopau i ka hana hou ʻana o ka biliary, a hiki ke pale i ka hopu ʻana i ka maʻi maʻi Stage 2.

Hiki i kekahi ke ola i ka Poison Hemlock (Conium maculatum) inā pau ko lākou hanu?¶

ʻAe, me ka mālama ulia pōpilikia o kēia wā, ʻaneʻane 100% ke ola ʻana mai ka Poison Hemlock inā hoʻomaka ka hanu hoʻopakele a me ka hoʻokuʻu ʻana i ka haukapila ma mua o ka hiki ʻana mai o ka poino o ka lolo hypoxic. No ka mea, ʻaʻole e hoʻopōʻino mau ʻia ka coniine i ka lolo a i ʻole nā ​​aʻalolo, e kau ana i ka mea maʻi ma luna o kahi ventilator mechanical me ka hoʻomaha ʻana no nā hola 24 a hiki i 72 e hiki ai i ke kino ke metabolize a hoʻokuʻu i ka ʻawaʻawa a hiki i ka hoʻi ʻana o ka ikaika o ka ʻiʻo.

ʻO ka hoʻolapalapa ʻana a i ʻole ka kuke ʻana i nā ʻōmaʻomaʻo ʻāhiu e hoʻopau i nā toxins i ka Autumn Crocus a i ʻole Hemlock?¶

ʻAʻole, ʻo ka kuke ʻana, ka paila, ka palai, a me ka hoʻomaloʻo ʻana ʻaʻole ia e luku i ka colchicine, veratrum alkaloids, a i ʻole cicutoxin. ʻO ka ʻoiaʻiʻo, ʻo ka hoʻolapalapa ʻana i ka lau Autumn Crocus a i ʻole False Hellebore i loko o ka sopa a i ʻole ka wai pasta e unuhi pololei i nā mea hiki ke hoʻoheheʻe ʻia i ka wai i loko o ka wai kuke, e ʻona i ka mea e ʻai i ka hupa.

No ka noho maluhia ʻana i ka wā leʻaleʻa waho a me nā pilikia pilikia o ka wao nahele, e noʻonoʻo e lawe i ke kōkua mua a me ka papa CPR mai ke Keʻa ʻulaʻula, St John Ambulance, a i ʻole kahi mea hoʻolako lāʻau lapaʻau i ka wao nahele.

Nā alakaʻi pili¶

• ʻAi ʻAi ʻAhiu (Amatoxin) a me ka ʻai ʻana i nā mea kanu ʻona
• ʻO ke kūlana Epilepticus, ka hopu lōʻihi, a me nā lāʻau hoʻopakele
• CPR: Hoʻōla ʻana i ka Cardiopulmonary Step-by-Step
• ʻAi ʻAi ʻAi, ʻAi ʻAi ʻAi ʻAi, a me ka Dehydration
• Kokua Mua a me ka Ho'oma'ema'e 'ana i ka 'ona

Nā kumu a me ke alakaʻi kūhelu¶

• U.S. Nā Center for Disease Control and Prevention (CDC): Morbidity and Mortality Weekly Report (MMWR): Water Hemlock (Cicuta maculata), Poison Hemlock (Conium maculatum), a me False Hellebore (Veratrum viride) Poisonings Associated with Foraging (United States).
• ** Ke Keʻena Federal German no ka Assessment Risk (BfR) & Swiss Toxicological Information Center (Tox Info Suisse):** Ka ʻōlelo aʻo a nā mea kūʻai aku a me ke alakaʻi ʻana i ke kauka no ka huikau ʻana i ka Wild Garlic (Allium ursinum) me ka Autumn Crocus (Colchicum autumnale) a me White Hellebore (Veratrum album) (European Union a me Switzerland).
• ** ʻO UK National Poisons Information Service (NPIS) / TOXBASE:** Clinical Management of Colchicum autumnale (Colchicine), Oenanthe crocata (Hemlock Water Dropwort), a me Conium maculatum Ingestion (United Kingdom).
• Finkelstein Y, Aks SE, Hutson JR, Juurlink DN, et al.: Ka ʻona ʻana o Colchicine: ka ʻaoʻao ʻeleʻele o kahi lāʻau lapaʻau kahiko (Clinical Toxicology).
• Schep LJ, Slaughter RJ, Becket G, Beasley DM: Ka ʻona ma muli o ka wai hemlock (Cicuta species) a me ka lāʻau make (Conium maculatum) (Clinical Toxicology / New Zealand National Poisons Center).