ʻO ka Paraquat, Diquat, a me ka hoʻopaʻa ʻana i ka lāʻau herbicide: hoʻomaʻemaʻe koke a mālama.¶

ʻO nā lāʻau lapaʻau pāʻoihana a me ka mahiʻai (nā weed killers) mai nā mea ʻawaʻawa liʻiliʻi liʻiliʻi i hoʻoheheʻe ʻia i nā kīhāpai hale a hiki i kekahi o nā mea ʻawaʻawa a make loa ma ka Honua. ʻO ka mea mua loa ma waena o ia mau mea ʻo Paraquat (1,1'-dimethyl-4,4'-bipyridinium dichloride, kūʻai ʻia ma lalo o nā inoa ʻoihana mahiʻai e like me Gramoxone, Parazone, Firestorm, a me Helmquat) a me kona pili kemika Diquat (kūʻai ʻia ma nā mea kūʻai aku a me nā mea kanu wai, a me ****Reglone, a me Reglone, a me **** nā mea hoʻoponopono), me ka hoʻoheheʻe ʻia ʻo Glyphosate-Surfactant (e like me Roundup Pro / 41% Concentrate) a me Chlorophenoxy herbicides (2,4-D a me Dicamba). ʻO ka ʻai ʻana i ka ** hoʻokahi waha (10 a 15 milliliters, a i ʻole 1 punetune) o ka 20% wai paraquat, a i ʻole ka ʻai ʻana i ka paraquat ma o ka ʻili i ʻoki ʻia, ʻoki ʻia, a i ʻole nā ​​ʻili ʻeha i ka wā e kāpīpī ʻia ai ka ʻeke me ka mea pale ʻole, e hōʻeha ʻia ai ka puʻu a me ka esophagus, acute renal-tubular necrosis ** fibrosis ka mea e hoʻopio ai i nā māmā i nā lā a i nā pule.

Inā ʻoe a i ʻole kekahi mea kokoke i ʻai i kekahi herbicide, pipi i ka mea pepehi weed concentrated i ka maka a i ka ʻili, a i ʻole i inu ʻole ʻia i ka paraquat a i ʻole glyphosate i ninini ʻia i loko o ka hue inu, e kāhea i kāu helu pilikia kūloko (911 ma ʻAmelika Hui Pū ʻIa a me Kanada, 112 ma waena o ka European Union, 999 ma United Kingdom) ma o kā mākou. helu pilikia papa kuhikuhi koke, a nānā ʻona kōkua mua, kuni kemika, a ka lāʻau pesticide organophosphate. No ka i kēlā me kēia minuke o ka lohi e hiki ai i ka paraquat ke hoʻopaʻa ikaika iā ia iho i loko o nā pūpū māmā, ʻo ka holoi koke ʻana i ka ʻili, ka ʻai ʻana i kahi adsorbent waha i loko o 60 mau minuke mua, a ʻaʻa loa i ka oxygen hoʻonui maʻamau ke ʻole e loaʻa ka hypoxemia koʻikoʻi he hana koʻikoʻi ke ola a i ʻole ka make.

E hana i kēia i kēia manawa¶

1. Kahea koke iā 911 / 112 / 999 a makaʻala i ke kaʻa kaʻa he Paraquat paha ia: ʻO ka Paraquat a me nā lāʻau lapaʻau koʻikoʻi he mau pilikia olakino koʻikoʻi. E kāhea koke i nā lawelawe lapaʻau pilikia a me kāu kikowaena Poison Control (1-800-222-1222 ma US) i hiki i ka haukapila e hoʻomākaukau ai i Activated Charcoal (a i ʻole Fuller's Earth / Bentonite) a makaʻala i kā lākou nephrology/hemoperfusion a me nā hui mālama koʻikoʻi ma mua o kou hiki ʻana.
2. KIKI NO KA PARAQUAT: E haʻi aku i nā mea lapaʻau a me nā limahana ER ʻAʻole e hāʻawi i ka oxygen hoʻonui maʻamau: ʻAʻole like me nā pilikia olakino ʻē aʻe, ** hāʻawi i ka oxygen hou (O2) i ka mea hoʻomake i ka paraquat e like me ka ninini ʻana i ka ʻaila ma ke ahi**. Pepehi ʻo Paraquat i nā pūnaʻi māmā ma o ka hoʻohana ʻana i nā molekole oxygen e hana i nā radical manuahi superoxide (O2-). Pono nā poʻe paramedic a me nā limahana lumi pilikia ʻauʻa i ka oxygen hou ke ʻole ka pulse oximetry o ka mea maʻi (SpO2) hāʻule ma lalo o 85 pākēneka a hiki i 88 pākēneka (ke kaomi hapa o ka oxygen PaO2 < 50 mmHg).
3. E wehe i nā lole i hoʻohaumia ʻia a holoi i ka ʻili a me nā maka no 15 a 20 mau minuke: Inā pipi ʻia ka paraquat concentrated, diquat, a i ʻole glyphosate ma luna o ka ʻili a i hoʻomoʻi ʻia i loko o ka pālule a i ʻole nā ​​kāmaʻa i ka wā e pīpī ʻia, e hoʻokomo i ka nitrile a i ʻole nā ​​mīkina lima pulupulu, e wehe i nā lole i haumia a pau, a holoi mālie i ka ʻili me ka ** 0 mau minuke. Mai holoi ʻino i ka ʻili me kahi pulumu ʻoʻoleʻa: ʻo ka ʻili ʻana i ka ʻili e uhaʻi i ka pale epidermal a hoʻopau i ka hoʻoheheʻe ʻana o ka paraquat systemic ma ke kahe koko. E holoi i nā maka me ka wai mehana no ka liʻiliʻi he 15 a 20 mau minuke.
4. E hoʻomaopopo i ka "Golden 60-Minute Window" no ka hoʻopaʻa waha (Activated Charcoal / Fuller's Earth): Hoʻopili koke ʻia ka Paraquat mai ka ʻōpū liʻiliʻi, a hiki i ke kiʻekiʻe kiʻekiʻe o ke koko i loko o 60 a i 120 mau minuke, a laila kaomi ikaika ʻia i loko o ka māmā kahi mea hiki ke wehe. ʻO ka lawe ʻana i ka mea maʻi i kahi lumi ulia pōpilikia i loko o 60 mau minuke mua e loaʻa iā 50 a 100 grams o Activated Charcoal (a i ʻole 15% Fuller's Earth / 7% Bentonite pālolo kahi i hoʻopaʻa ʻia) ʻo ia ka hana kūpono loa e pale aku ai i ka make. (E hoʻomaopopo: Ma nā wahi mahiʻai mamao wale nō ma kahi o nā keʻena lapaʻau, ʻōlelo ʻia nā kuʻuna kahua o WHO inā ʻaʻole i loaʻa ka lāʻau lapaʻau, hāʻawi ʻia ka pālolo / bentonite a i ʻole ka lepo maʻemaʻe / lepo i loko o ka wai i hoʻohana ʻia ma ke ʻano he mea hoʻopaʻa hope hope loa no ka ʻai ʻana i ka paraquat, ʻoiai ke makemake mau ʻia ka lanahu hoʻōla ʻia i ka haukapila).
5. Mai hoʻoulu i ka luaʻi: ʻO nā mea hoʻoheheʻe paraquat concentrated, diquat, a me ka glyphosate-surfactant he kemika caustic corrosive e puhi ana i ka waha, pharynx, a me ka esophagus. ʻO ka hoʻoikaika ʻana i ke kanaka e ʻāʻī a luaʻi paha e hoʻihoʻi hou i ka lāʻau lapaʻau i ka esophagus i ka lua o ka manawa, e pilikia ana ka esophageal perforation a me ka aspiration make i loko o ka māmā.
6. E lawe mai i ka pahu herbicide a i ʻole ke kiʻi i ka lepili kemika pololei: E paʻi i ke kiʻi o ka pahu "Active Ingredients" a me ka EPA Registration Number ma ka hue (e pale i ka lawe ʻana i ka hue kemika i haumia i loko o ke kaʻa kaʻa kaʻa ke ʻole i hoʻopaʻa ʻia me ka plastik kaumaha). I loko o nā makahiki, ua hoʻololi nā brands e like me Roundup, Ortho, a me Weedol i nā mea hana ma waena o paraquat, diquat, glyphosate, glufosinate, a me 2,4-D.

lāʻau hoʻoholo: Paraquat, diquat, a me ka hoʻāʻo ʻana i ka herbicide concentrated¶

flowchart TD
    Start["Hōʻike ʻia i ka lāʻau lapaʻau i manaʻo ʻia (ʻai waha OR Concentrated Dermal/Ocular Splash)"] --> Identify["E nānā i ka Lepili pahu: Paraquat vs Diquat vs Glyphosate-Surfactant vs Glufosinate vs 2,4-D"]

    Identify --> RouteSplit{"He aha ke alahele o ka hōʻike?"}

    RouteSplit -->|Skin or Eye Splash (Especially Backpack Sprayer Leak or Broken Skin)| DermalCare["1. Nā mīkina lima hoʻopakele ma; Wehe koke i na lole a pau\n2. Holoi malie i ka ili me ke kopa a me ka wai no 15-20 min (NO ka holoi 'ole)\n3. Irrigate Maka 15-20 Min; Ka Loiloi Halema'i no ka ho'ohana 'ana i ke kino inā 'oki/Puhi ka 'ili"]

    RouteSplit -->|Oral Ingestion (Intentional OR Accidental Storage in Drink Bottle)| ClassTriage{"ʻO wai ka mea hana i ʻai ʻia?"}

    ClassTriage -->|1. Paraquat (Gramoxone, Parazone)| ParaquatPath["KAHIKI LOA (Golden 1-Hour Window):\n1. HOAE I KA OXYGEN SUPLEMENT (E mālama iā SpO2 85-88% Inā ʻaʻole PaO2 <50 mmHg)\n2. Lahu Lahu Kokoke (1 g/kg a hiki i 50-100 g) a i ʻole Fuller's Earth i loko o 60 Min\n3. Hoʻopaʻapaʻa IV Crystalloids + Urgent Charcoal Hemoperfusion / Hemodialysis i loko o 2-4 mau hola\n4. Pūʻulu ICU Immunosuppressive/Antioxidant (IV Methylprednisolone + Cyclophosphamide + NAC)"]

    ClassTriage -->|2. Diquat (Reward, Reglone, Tribune)| DiquatPath["ʻO ke ʻano ʻino + ʻino + CNS ʻona:\n1. Lahu Ho'ā Koke / Ka Honua o Fuller + Ho'ōla hou ʻana i ka wai ʻawaʻawa IV\n2. Nānā no ka Severe Paralytic Ileus (Fluid Sequestration in Gut), Acute Kidney Failure, Pontine Brainstem Infarction/Seizures\n3. ʻO ka hemodialysis mua no ka hāʻule ʻana o ka renal (ʻoi aku ka liʻiliʻi o ka lawe ʻana i ka ʻoluʻolu ma mua o ka Paraquat, e pale mau i ka O2 keu)"]

    ClassTriage -->|3. Concentrated Glyphosate-Surfactant (41% Roundup Pro) or Glufosinate| GlyPath["ʻO ka ʻawaʻawa o ka Mitochondrial Caustic + Surfactant:\n1. MAI hooulu i ka luai; E nānā i ke ala ea no ka Pharyngeal Edema\n2. ʻO nā waiʻawaʻawa IV no ka Hypovolemic/Cardiogenic Shock; Hoʻoponopono i ka Hyperkalemia Koʻikoʻi & Metabolic Acidosis\n3. ʻO ka hemodialysis mua inā hoʻomaka ʻo Oliguric Renal Failure, Acidosis, a i ʻole Refractory Shock \n4. No Glufosinate: Nānā 24-48h no ka hoʻopaneʻe ʻana i ka Coma, Apnea, a me ka Refractory Seizures"]

Ke hoʻohālikelike ʻana i nā papa nui ʻelima o nā lāʻau herbicide i ka ʻona kanaka¶

ʻOiai he mau kakini lāʻau herbicide, ** ʻelima mau papa kemika** e pili ana i nā pilikia e pili ana i ka mahiʻai a me ka hoʻomake ʻana i ka nahele home ma ka honua holoʻokoʻa.

Ka Luʻu Hohonu: ʻO ka ʻawaʻawa Paraquat: ʻO ka maʻi maʻi, nā pae maʻi, a me ke kānāwai oxygen.¶

1. No ke aha e hoʻopau ai ka Paraquat i nā māmā (The Polyamine Transporter Trap)¶

Ke komo ka paraquat i ke kahe koko mai ka ʻōpū a i ʻole ma o ka ʻili poino, e puʻunaue ʻia i nā ʻōpū a pau, e hoʻomaka ai ka necrosis i loko o ka ** tubules renal proximal o nā puʻupaʻa ** a me ka ** ate . Eia naʻe, loaʻa i nā māmā kahi hopena kūʻokoʻa a make: - ** ʻAno I a me Type II alveolar epithelial cell i loko o ka māmā kanaka loaʻa kahi ʻōnaehana lawe membrane pili i ka ikehu i kapa ʻia ʻo polyamine uptake system (hoʻohana mau ʻia no ka lawe ʻana mai i nā polyamines endogenous e like me putrescine a me spermine). - No ka mea, ʻo ka mamao ma waena o nā ʻātoma nitrogen i hoʻopaʻa maikaʻi ʻia ma ka mole paraquat (0.7 nanometers) ua like ke kino me nā polyamines maoli, ke kuhi hewa ʻana o nā māmā i ka paraquat mai ke kahe koko e kūʻē i kahi gradient kaʻina nui, a hiki i ka neʻe ʻana o ka ʻiʻo māmā 10 a 50 mau manawa kiʻekiʻe ma mua o nā pae plasma i loko o nā hola. - I ka wā e paʻa ai i loko o nā pūnaewele alveolar, ka paraquat (PQ2+) e ʻae i kahi electron mai NADPH (catalyzed e NADPH-cytochrome P450 reductase) e lilo i paraquat monocation free radical (PQ.+). - Hoʻololi koke kēia radical i kāna electron hou i ** oxygen molecular (O2), e hana hou ana i ka ion paraquat mua (PQ2+) oiai e hana ana i ka superoxide anion radical (O2.-), hydrogen peroxide (H2O2), a me ** nā radical hydroxyl (OH.). - ʻO kēia kaʻa holo kaʻa redox hoʻopau i nā kelepona ** NADPH ** a me ** glutathione , peroxidizes cell membrane lipids, hoʻoulu i ka ** alveolitis (ka mumū o ka māmā) ** i loko o 24 a 72 mau hola, a hoʻoulu i ka hoʻonui nui ʻana o fibroblasts a me collagen e hoʻohuli i nā ʻeke ea spongy o ka ʻiʻo non-bremonary solid i loko o ka ʻiʻo non-bremonary. fibrosis) ma luna o 5 a 21 lā.

2. No ke aha e ho'oholo ai ke ola kino i ke ola o ka māmā¶

ʻAʻole i hoʻololi ʻia ka Paraquat i loko o ke kino kanaka; ** ʻoi aku ma mua o 90 pākēneka o ka paraquat i hoʻopaʻa ʻia e hoʻololi ʻia e nā puʻupaʻa** ma o ka kānana glomerular a me ka huna ʻana o ka tubular ikaika i loko o ka 12 a i ka 24 hola mua, inā mau ka hana maʻamau. - Eia naʻe, ʻo ka paraquat ke kumu i ka ** acute tubular necrosis (ATN)** o nā puʻupaʻa i loko o nā hola 24 mua. - I ka wā e pau ai nā puʻupaʻa, pau ka hoʻokuʻu ʻana o ka paraquat mimi, piʻi ke kiʻekiʻe o ka plasma paraquat no nā lā, a hoʻomau ka māmā i ka hoʻomaʻemaʻe ʻana i ka paraquat mai loko mai o ke koko a hiki i kahi kaumaha pulmonary lethal. - No laila, hoʻomaʻemaʻe koko i loko o ka wai i loko o 2 a 4 mau hola o ka ʻai ʻana) ** a me ka ** hoʻomaʻemaʻe koko ultra-early extracorporeal (Charcoal Hemoperfusion a i ʻole Hemodialysis i loko o 2 a 4 mau hola) he mea nui ia e hoʻomaʻemaʻe i ka paraquat mai ke koko *ma mua o ka hoʻopaʻa ʻana o ka renal i loko o ke kino.

3. ʻEkolu Dose-Dependent Clinical Tiers o Paraquat Ingestion¶

4. ʻO Dermal (Ka ʻili) a me ka Ocular Paraquat Exposure Poe¶

Mai hoʻohaʻahaʻa i ka ʻike ʻana i ka ʻili i ka paraquat: - ʻOiai paʻa, hoʻopaʻa mālie ka ʻili olakino i ka paraquat, pili lōʻihi me nā pālule a i ʻole nā ​​kāmaʻa i hoʻomoʻi ʻia i ka paraquat (e like me ka mea hoʻoheheʻe ʻeke hope ma ke kua o ka mea mahiʻai, ka ʻāʻī, a me ka scrotum) e hoʻoulu ai i ke ahi a me ka ʻeha o ka ʻili. - Ke puhi ʻia ka stratum corneum o waho, ʻoki ʻia, ʻokiʻoki, a i ʻole eczematous, ** komo wikiwiki ka paraquat i loko o ke kahe o ke koko ma o ka ʻili i poino , a ua nui nā maʻi make o ka pulmonary fibrosis i loaʻa mai ka ** dermal backpack-sprayer leaks me ka ʻole o ka ʻai ʻia ʻana. - Pupuʻi maka me ka paraquat concentrated ke kumu i lohi ai, koʻikoʻi korneal a me ka conjunctival epithelial sloughing piʻi i ka 12 a 48 mau hola ma hope o ka hoʻolaha ʻana, pono e hoʻoheheʻe koke ʻia i ka wai 20 mau minuke a me ka mālama ophthalmology koʻikoʻi e pale i ka ʻili mau a me ka makapō.

ʻO ka Halemai Stepwise a me ka ICU Protocol no Paraquat a me Diquat¶

1. ** ʻOkoʻa Oxygen Restriction (SpO2 Manaʻo 85% i 88%)**:
2. E kau i kahi hōʻailona ʻike ʻia ma ka ʻaoʻao moe ma luna o ke poʻo o ka mea maʻi: "PARAQUAT POISONING: MAI HOʻOPONO I KA OXYGEN SUPPLEMENTAL KO ʻAʻole SpO2 <85% (PaO2 <50 mmHg)."
3. E hoomau i ka hanu o ka ma'i ke ea lumi (FiO2 21%) i ka lōʻihi e hiki ai.
4. Hoʻopau koke i ka ʻōpū o ka ʻōpū (ma loko o 60 mau minuke):
5. Hoʻoponopono Hānahu Hana (1 to 2 g/kg, a i ʻole 50 to 100 grams i loko o nā mākua) ma ka waha a i ʻole ma o kahi paipu nasogastric palupalu i hoʻonohonoho pono ʻia (ʻo 15% Fuller's Earth [100 to 150 g] a i ʻole 7% Bentonite me kahi cathartic e like me ka mannitol/sorbitol inā hoʻohana ʻia ka pālolo). Ua hōʻoia ʻia nā haʻawina lāʻau toxicology o kēia wā ʻo Activated Charcoal e like me ka mana o Fuller's Earth a ua hoʻopaʻa ʻia i kēlā me kēia keʻena pilikia; mai lohi i ka lanahu e kali ana e huli i ka Honua o Fuller.
6. E hōʻalo i ka hoʻomaʻemaʻe ʻōpū maʻamau ma hope o ka ʻai ʻana i ka paraquat caustic no ka nui o ka pilikia o ka esophageal perforation, ke ʻole e hana mālie ʻia ma o ka nasogastric aspiration i loko o 30 a 60 mau minuke o ka inu wai nui.
7. ** Hoʻoheheʻe ʻia ʻo Crystalloid Intravenous **:
8. Infuse isotonic crystalloids (0.9% Normal Saline a i ʻole Lactated Ringer's) ma 150 a 250 mL/hola no ka mālama ʻana i ka mimi wikiwiki (1.5 to 3 mL/kg/hour) a hoʻonui i ka hoʻomaʻemaʻe paraquat renal endogenous i nā hola 24 mua koʻikoʻi.
9. Early Charcoal Hemoperfusion (HP) a i ʻole Hemodialysis (HD): ʻO ka puka makani 2-a-4-Hour:
10. ** Hiki i ka Charcoal Hemoperfusion (a i ʻole High-Flux Hemodialysis)** ke hoʻomaʻemaʻe i ka paraquat mai ke kahawai ʻo ** koko**, akā WALE nō ke kaapuni ʻana o ka paraquat i loko o ka plasma ma mua o ka laka ʻana i loko o nā pūnaʻi māmā.
11. No ka hoʻomaikaʻi ʻana i ke ola ʻana i ka ʻai ʻana i nā palena-makemake, Charcoal Hemoperfusion (a i ʻole Hemodialysis) pono e hoʻomaka i loko o 2 a 4 mau hola (a ʻaʻole ma mua o 6 mau hola) ma hope o ka ʻai ʻana, a ukali pinepine ʻia e Continuous Venovenous Hemofiltration (CVVH). I ka hala ʻana o 12 a 24 mau hola, ua haʻahaʻa ke kiʻekiʻe o ka paraquat koko no ka mea aia ka ʻona i loko o ka māmā, a ʻo ka dialysis ke kākoʻo wale nei i ka hiki ʻole o ka renal.
12. Hoʻopaʻa Hoʻopaʻa ʻana i ka ʻaoʻao moe (Rapid Bedside Diagnostic Test (Urine Sodium Dithionite Test & Plasma Nomogram):
13. Urine Sodium Dithionite Colorimetric Test: ʻO ka hoʻohui ʻana i ka 1 gram sodium bicarbonate a me 1 gram of sodium dithionite i ka 10 mL o ka mimi o ka mea maʻi e hoʻemi ana i ka paraquat i kona ion blue free-radical ion (a e hoʻemi i ka diquat i kahi melemele-ʻōmaʻomaʻo ion).
    • Inā lilo ka mimi i ʻeleʻele navy a i ʻole uliuli-ʻeleʻele i loko o 6 a 24 mau hola o ka ʻai ʻana, hōʻoia ia i ke kaumaha o ka paraquat systemic me ka nui o ka make.
    • Inā noho ka mimi akaka a ʻulaʻula ʻulaʻula paha, he haʻahaʻa ka hoʻomoʻa ʻana o ka ʻōnaehana a hiki ke ola.
14. Quantitative Plasma Paraquat Nomogram (Proudfoot / Hart Nomograms): Ka hoʻolālā ʻana i ka ʻike kikoʻī kikoʻī o ka plasma paraquat (mcg/mL a i ʻole mg/L) e pili ana i nā hola mai ka wānana ʻana i ka hiki ke ola.
15. Immunosuppressive a me Antioxidant ICU Rescue Regimen:
16. No ka hoopau ana i ka pulmonary alveolitis a me ka fibroblast collagen deposition, he nui na kikowaena toxicology honua (kokoi aku ma Asia-Pacific a ma WHO/NPIS clinical guidance) e lawelawe mua i ka immunosuppressive a me antioxidant protocol i ka ma'i 'awa'awa 'o'ā a me ke ko'iko'i.
    • Methylprednisolone Pulse Intravenous (15 mg/kg/day a i ʻole 1,000 mg IV daily for 3 days) + ** Cyclophosphamide i loko o ke koko** (15 mg/kg/day IV for 2 days), ukali ʻia e Dexamethasone (8 mg IV every 8 hours).
    • High-Dose Intravenous N-Acetylcysteine ​​(NAC) (e hoʻopiha hou i ka intracellular glutathione), High-Dose Vitamin C (Ascorbic Acid), Vitamin E, a me Sodium Salicylate (kahi e hoʻopaʻa ai i ka hao, e hoʻopaʻa i nā radical hydroxyl, a e pale aku. NF-kappaB ʻāʻā o ka māmā).
17. Hoʻopau i ka ʻeha a me ka mālama ʻana i ka ʻeha:
18. ʻO ka maʻi ʻeha o ka waha, pharyngeal, a me esophageal ulcer ("paraquat tongue") ke kumu o ka ʻeha nui; hāʻawi i ka intravenous opioid analgesia (morphine or fentanyl) a me ka lidocaine viscous waha holoi, a mālama i ka mea maʻi nil-by-mouth (NPO) me ka meaʻai makua inā loaʻa nā esophageal nui.

ʻO ka Glyphosate-Surfactant ("Roundup") Hoʻolāʻau ʻona¶

No ka mea, ʻo ka glyphosate ka lāʻau herbicide i hoʻohana nui ʻia ma ka honua, ʻokoʻa loa nā kikowaena o nā mea make ma waena o ka hoʻoheheʻe ʻia i mākaukau no ka hoʻohana ʻana i ka mea hale a me koke mahiʻai:

• Homeowner Mākaukau-e-Hoohana (RTU) Spray (1% to 2% Glyphosate): ʻO ka ʻai wale ʻia ʻana o ka waha e ke keiki a i ʻole ke kanaka makua ke kumu maʻamau wale nō ** ka hoʻomake ʻana o ka waha ponoʻī, ka nausea haʻahaʻa, ka luaʻi, a i ʻole ka maʻi maʻi ʻana** i hoʻonā ʻia me ka wai waha a me ka nānā ʻana.
• Ai'ai / Kalepa Concentrate (41% to 50%+ Glyphosate + 15% POEA Surfactant):
• ʻO ka ʻai ʻana ** ʻoi aku ma mua o 85 mL a i 100 mL (3 auneke)** o ka 41% glyphosate-surfactant i hoʻopaʻa ʻia he **e hoʻoweliweli i ke ola koʻikoʻi mālama pilikia ** me ka nui o ka make ʻana o 10 a 30 pākēneka i ka manaʻo nui.
• Eia kekahi, ke hoʻohana nei kekahi mau mea hana glyphosate kālepa ikaika kiʻekiʻe ** Glyphosate Potassium Salt (K+ paʻakai)** ma kahi o ka paʻakai isopropylamine: ʻo ka ʻai ʻana i kahi huahana potassium-glyphosate i hoʻopaʻa ʻia e hāʻawi i kahi ** hoʻouka pāpauma nui nui i waho e hiki ai ke hoʻopiʻi i ka ** hoʻopaʻa puʻuwai hyperkalemic make koke ** i loko o 1 a 3 mau hola.
• Hoʻokele Halemai: E hana koke i ka nasopharyngoscopy hikiwawe a me ka ** hoʻokomo ʻana i ka endotracheal mua** inā loaʻa ka drooling, stridor, a i ʻole ka edema pharyngeal; ho'iho'i hou i ke koko me 'a'e IV crystalloids a me norepinephrine; e mālama koke i ka hyperkalemia me IV calcium, insulin-dextrose, a me ka sodium bicarbonate; a hoʻomaka ** hemodialysis mua ** inā mau ka refractory metabolic acidosis, hyperkalemia, oliguric acute kidney injury, a i ʻole ka haʻalulu.

Kāohi: ʻO ke kumu #1 o ka ʻai ʻana i ka lāʻau lapaʻau make¶

Nā helu ulia pōpilikia āpana a me nā protocols oihana¶

Nīnau pinepine¶

No ke aha e ʻauʻa ai nā kauka lapaʻau a me nā kauka pilikia i ka oxygen hou mai ka mea i ʻai i ka paraquat?¶

Pepehi ʻo Paraquat i nā pūnaʻi māmā ma o ke kaʻina hana kemika i kapa ʻia ʻo redox cycling, e hoʻohana ana i nā molekole oxygen i loko o ka māmā e hana ai i nā miliona o nā superoxide luku a me nā radical manuahi hydroxyl. No ka mea, ʻo ka māmā e puhi ikaika ana i ka paraquat mai ke kahe koko a hiki i ka 10 a 50 manawa kiʻekiʻe ma mua o nā wahi ʻē aʻe o ke kino, e hāʻawi ana i ka oxygen hou i ka wahie i kēlā hopena kemika a wikiwiki loa i ka maʻi maʻi maʻi (pulmonary fibrosis). Pono nā hui lapaʻau e mālama i nā poʻe maʻi paraquat e hanu ana i ka ea lumi maʻamau a hāʻawi wale i ka oxygen hou inā hāʻule ka saturation oxygen koko (SpO2) ma lalo o 85 a 88 pakeneka (PaO2 ma lalo o 50 mmHg).

No ke aha i kapa ʻia ai nā minuke 60 mua ma hope o ka ʻai ʻana i ka paraquat ʻo "Golden Hour"?¶

Hoʻopili koke ʻia ka paraquat mai ka ʻōpū liʻiliʻi, a hiki i ka pae kiʻekiʻe o ke kahe koko i loko o 60 a 120 mau minuke, a laila kaomi ikaika ʻia i loko o nā puʻupuʻu māmā kahi hiki ʻole i ka lāʻau antidote a me ka mīkini dialysis ke huki hou i waho. ʻO ka ʻai ʻana i ka Lahu Hoʻōla (a i ʻole Fuller's Earth / Bentonite pālolo) i loko o nā minuke 60 mua e hoʻopaʻa ai i ka paraquat wai i loko o ka ʻōpū a me ka ʻōpū ma mua o ke komo ʻana i ke kahe koko, ʻo ia ke ʻano o ka ʻokoʻa ma waena o ke ola a me ka fibrosis māmā make.

Hiki iā ʻoe ke loaʻa i ka ʻawaʻawa paraquat ma muli o ke kahe ʻana i kou ʻili me ka ʻole o ka ʻai ʻole ʻana?¶

ʻAe. ʻO ka paraquat concentrated he mea ʻino ia e ʻā a pohū ka ʻili i ka hoʻopili ʻana. Inā hāʻule ka paraquat mai ka pahu pahu i ke kua o ka mea hana, nā wāwae, a i ʻole ka ʻāʻī, a i ʻole ka pāpaʻi ʻana i ka ʻili i ʻoki mua ʻia, ʻoki ʻia, abrasions, a i ʻole ʻāwīwī paha, hele koke ia i loko o ka pale ʻili i poino i loko o ke kahe koko a hele i ka māmā, e like me ka fibrosis pulmonary make e like me ka ʻai ʻana i ka maʻi. Inā pā ka paraquat i ka ʻili, e wehe koke i nā lole a pau a holoi mālie me ke kopa a me ka wai kahe no 15 a 20 mau minuke me ka ʻole o ka holoi ʻana i ka ʻili.

He aha ka ʻokoʻa ma waena o ka home mākaukau e hoʻohana i ka Roundup spray a me ka Roundup concentrate mahiʻai inā ale ʻia?¶

He 1% a 2% wale nō ka glyphosate i hoʻoheheʻe ʻia i loko o ka wai i loko o nā ʻōmole hoʻoheheʻe hale. ʻO ka moni liʻiliʻi wale nō e hoʻoulu ai i ka ʻeha waha a i ʻole ka ʻōpū ʻeha. ʻO ka ʻokoʻa, loaʻa nā jugs herbicide mahiʻai a i ʻole kālepa he 41% a 50% glyphosate i hui pū ʻia me nā surfactants concentrated (e like me POEA) a i kekahi manawa nā paʻakai pāpaʻa kiʻekiʻe. ʻO ka ʻai ʻana ma mua o 85 mL (ma kahi o 3 auneke) o ka 41% glyphosate-surfactant paʻa hiki ke hōʻeha nui i ka ʻāʻī, ka pehu ʻana o ke ea, ka pāpaʻa koko kiʻekiʻe e hoʻoweliweli i ke ola (hyperkalemia), ka acidosis metabolic, ka hōʻino ʻole ʻana, a me ka haʻalulu e pono ai ka mālama koʻikoʻi.

He aha ka "ʻōlelo paraquat" a i ka manawa hea e ʻike ʻia ai?¶

No ka mea, ʻo ka paraquat concentrated a me ka diquat he mau mea hoʻoheheʻe ikaika loa ia, ʻo ka ʻai ʻana i kahi mea liʻiliʻi e hoʻopau ai i ke ahi koʻikoʻi o ka waha, ke alelo, a me ka ʻāʻī. I loko o 24 a 48 mau hola ma hope o ka ʻai ʻana, pehu ka ʻili o ke alelo, ʻōhū, a hū aʻe, uhi ʻia i nā plaques necrotic keʻokeʻo melemele ʻeha a me nā ʻeha koko i ʻike ʻia ma ke ʻano he "paraquat tongue." ʻOiai inā e kuha ka mea maʻi i ka hapa nui o ka wai, ʻo ke ʻano o ke kuni waha e hōʻoiaʻiʻo i ka ʻike a koi ʻia ke komo koke ʻana i ka haukapila e nānā i ka hana o ka puʻupaʻa a me ka māmā.

Nā alakaʻi pili¶

• ʻO ka pesticide organophosphate, ka mea aʻalolo, a me ka lāʻau make
• ʻO ka ʻai ʻana i ka ʻiole: Superwarfarin, bromethalin, a me ka zinc phosphide
• ʻO ke kōkua mua a me ka hoʻāʻo ʻana i ka lāʻau make
• ʻO ke ahi a me ka ʻā ʻana o ke kōkua mua (me ke ahi kemika)
• ʻO ka ʻeha ʻeha ʻeha, rhabdomyolysis, a me ka hoʻāʻo ʻana i ka mimi ʻeleʻele

Nā kumu a me ke alakaʻi kūhelu¶

• ʻOihana Hoʻomalu Kaiapuni o ʻAmelika Hui Pū ʻIa (EPA): Ka ʻike ʻana a me ka mālama ʻana i nā mea ʻawaʻawa pesticide (6^th Edition): Paraquat, Diquat, Glyphosate, a me Chlorophenoxy Herbicides.
• ʻO ka World Health Organization (WHO) & Food and Agriculture Organization (FAO): Hoʻoponopono Klinika o Paraquat a me Bipyridylium Herbicide Poisoning.
• Nā kikowaena no ka hoʻopaʻa ʻana a me ka pale ʻana i ka maʻi (CDC): Hoʻomākaukau a me ka pane ʻana i ka pilikia: Nā ʻoiaʻiʻo e pili ana i ka Paraquat Chemical Emergency and Decontamination.
• ʻOihana Hoʻonaʻauao ʻĀpana Lahui (NPIS, United Kingdom): TOXBASE Clinical Management of Paraquat, Diquat, Glyphosate, a me Glufosinate Poisoning.
• EXTRIP (Extracorporeal Treatments in Poisoning) & International Clinical Toxicology Guidelines: Early Hemoperfusion, Hemodialysis, and Immunosuppressive Therapy in Paraquat and Chlorophenoxy Herbicide Poisoning.

• ʻO kēia alakaʻi no ka ʻike ʻike a ʻaʻole ia e pani i ka loiloi lapaʻau ʻoihana, kūkākūkā Poison Control, a i ʻole ka mālama koʻikoʻi o ka haukapila. No ka mea hiki i ka hoʻolaha ʻana i ka herbicide ke hoʻoulu i ke ahi wikiwiki, ka haʻalulu, a me ka hāʻule ʻana o ka hanu, manaʻo nui mākou e lawe i kahi kōkua mua a me ka papa CPR i ʻae ʻia ma o ka International Federation of Red Cross and Red Crescent Societies (IFRC), kou lāhui Red Cross Society, St John Ambulance, a i ʻole kahi mea lawelawe kūloko i hōʻoia ʻia.*