Paraquat, Diquat, na Ngosipụta ahịhịa ahịhịa etinyebere: mkpochapụ na nlekọta ozugbo.¶

Ọgwụ ahịhịa na-ere ahịa na nke ọrụ ugbo (ndị na-egbu ahihia) na-esite na nsi na-egbu egbu na-egbu egbu n'ubi onye nwe ụlọ ruo na ụfọdụ n'ime nsị ụlọ ọrụ na-emebi ngwa ngwa ma na-egbu egbu n'ụwa. Nke kachasị n'ime ndị a bụ ** Paraquat ** (1,1'-dimethyl-4,4'-bipyridinium dichloride, nke a na-ere n'okpuru aha aha ugbo dị ka GramoxoneParazoneFirestorm na Helmquat) na onye ikwu kemịkalụ ya na ndị ikwu kemịkalụ, ** Requat*** (erere ya na ndị na-azụ ahịa na aquatic). ụfọdụ ** Tribune *** ma ọ bụ usoro nhazi ala), n'akụkụ ọrụ ugbo gbadoro anya ** Glyphosate-Surfactant ** ngwọta (dị ka Roundup Pro / 41% Concentrate) na ** Chlorophenoxy herbicides (2,4-D na Dicamba). Iri ọbụna ** otu ọnụ ọnụ (10 ruo 15 milliliters, ma ọ bụ 1 tablespoon) nke 20% mmiri mmiri paraquat, ma ọ bụ na-etinye paraquat site na abraded, ịkpụ ma ọ bụ ọnya akpụkpọ n'oge ịgbasa akpa azụ na-enweghị ihe nchebe, na-akpata nnukwu ọkụ nke akpịrị na esophagus, nnukwu akwara na-enweghị isi. nke na-etufu ngụgụ site ụbọchị ruo izu.

Ọ bụrụ na gị ma ọ bụ onye nọ nso iloro ahịhịa ahịhịa ọ bụla, na-efesa ahịhịa na-egbu anụ n'anya ma ọ bụ na akpụkpọ ahụ, ma ọ bụ mmanya paraquat ma ọ bụ glyphosate na mberede nke a wụsara n'ime karama ihe ọṅụṅụ, kpọọ nọmba mberede mpaghara gị (911 na United States na Canada, 112 gafee European Union, 999 na United Kingdom). nọmba mberede ndekọ ozugbo, ma nyochaa nsi mbụ enyemaka, kemịkalụ ọkụ, na organophosphate na-egbu egbu. N'ihi na ** nkeji ọ bụla nke igbu oge na-enye ohere paraquat ịgbanye onwe ya n'ime mkpụrụ ndụ ngụgụ ***, ịsacha anụ ahụ ozugbo, ilo adsorbent ọnụ n'ime nkeji 60 mbụ **, na ** igbochi ikuku oxygen na-adịgide adịgide ma ọ bụrụ na hypoxemia siri ike pụtara bụ omume ndụ ma ọ bụ ọnwụ.

Mee nke a ugbu a¶

1. ** Kpọọ 911/112/999 ozugbo wee mee ka ụgbọ ihe mberede mara na ọ nwere ike ịbụ Paraquat *: Paraquat na ahịhịa ahịhịa na-etinye uche bụ oge mberede ahụike dị oke egwu. Kpọọ ndị ọrụ ahụike mberede na ebe njikwa nsi nke mpaghara gị (1-800-222-1222 na US) ozugbo ka ụlọ ọgwụ na-anata nwee ike ịkwadebe ** Ọrụ Charcoal (ma ọ bụ Fuller's Earth / Bentonite) wee dọọ aka na ntị nephrology/heoperfusion na ndị otu nlekọta ahụike tupu ị bịarute.
2. ** Ihe dị mkpa maka PARAQUAT: Gwa ndị ọrụ ahụike na ndị ọrụ ER ka ha ghara inye oxygen mgbakwunye oge niile : N'adịghị ka ihe mberede ahụike ọ bụla ọzọ, ** na-enye oxygen mgbakwunye (O2) ka onye na-egbu nsi na paraquat na-eme ka ịwụsa mmanụ ụgbọala n'ọkụ. Paraquat na-egbu mkpụrụ ndụ ngụgụ site na iji mkpụrụ ndụ oxygen na-emepụta radicals free superoxide (O2-). Ndị na-ahụ maka ahụike na ndị ọrụ ime ụlọ mberede ga- *kwụsị oxygen mgbakwunye ** belụsọ ma ọ bụrụ na oximetry pulse nke onye ọrịaSpO2) na-agbada ** n'okpuru 85 pasent ruo 88 pasent ** (nrụgide akụkụ nke oxygen PaO2 < 50 mmHg).
3. ** Yipụ uwe niile emerụ emerụ na kpochapụ akpụkpọ ahụ na anya maka nkeji 15 ruo 20 ***: Ọ bụrụ na paraquat, diquat, ma ọ bụ glyphosate gbasasịrị na akpụkpọ ahụ ma ọ bụ tinye ya na uwe ogologo ọkpa ma ọ bụ akpụkpọ ụkwụ mgbe ị na-efesa ya, yikwasị nitrile mmiri na-adịghị ma ọ bụ uwe rọba, yipụ uwe niile emetọtọ, wee saa akpụkpọ ahụ nke ọma maka nkeji 2 na ncha. **Ejila ahịhịa siri ike hichaa akpụkpọ ahụ nke ọma ***: ịkpachapụ anya akpụkpọ ahụ na-agbaji ihe mgbochi epidermal ma na-ebute nnabata paraquat na-egbu egbu site na ọbara. Jiri mmiri ọfụfụ na-ekpochapụ anya fesa anya ma ọ dịkarịa ala nkeji iri na ise ruo iri abụọ.
4. ** Ghọta "Ohere 60 nkeji nke ọla edo" maka ijikọ ọnụ (activated Charcoal / Fuller's Earth) ***: Paraquat na-abanye ngwa ngwa site na eriri afọ, na-eru ọkwa ọbara kacha elu n'ime ** 60 ruo 120 nkeji **, mgbe nke ahụ gasịrị, a na-agbanye ya na ngụgụ ebe ọ nweghị ihe nwere ike iwepụ ya. Ịnweta onye ọrịa ahụ n'ọnụ ụlọ mberede n'ime ** nkeji 60 mbụ ** iji nweta ** 50 ruo 100 grams nke Charcoal Activated ** (ma ọ bụ ** 15% Fuller's Earth / 7% Bentonite ụrọ *** ebe echekwara) bụ otu nzọụkwụ kachasị dị irè iji gbochie ọnwụ. * (Rịba ama: Naanị n'ime ebe ọrụ ugbo dịpụrụ adịpụ awa ole na ole site na ụlọ ọgwụ ahụike ọ bụla, usoro iwu ngalaba WHO na-ekwu na ọ bụrụ na enweghị unyi ọgwụ, na-enye ụrọ nri / bentonite ma ọ bụ ọbụna ala dị ọcha / apịtị dị na mmiri ka ejiri ya mee ihe dị ka onye na-ahụ maka ogige ikpeazụ na-achọsi ike maka ingestion paraquat, ọ bụ ezie na a na-ahọrọ unyi ụlọ ọgwụ na-arụ ọrụ mgbe niile).
5. ** Ewelitela ọgbụgbọ *: Paraquat, diquat, na ngwọta glyphosate-surfactant bụ ** kemịkalụ caustic na-emebi emebi na-ere ọnụ, pharynx, na esophagus ọkụ. Ịmanye onye ahụ ịgbakọ ma ọ bụ agbọpụta na-ebute ihe na-akpata ahịhịa na-eweghachite esophagus nke ugboro abụọ, na-etinye nsị nke esophageal na agụụ na-egbu egbu n'ime ngụgụ.
6. ** Weta akpa ahịhịa ahịhịa ma ọ bụ see foto nke akara kemịkalụ ziri ezi *: Were foto nke igbe "Ihe na-arụ ọrụ" na ** Nọmba Ndebanye aha EPA n'ime ite (zenarị ibu mmiri mmiri ọgwụ emetọọ n'ime ụgbọ ihe mberede ma ọ bụrụ na edochiri ya na rọba dị arọ). N'ime afọ ndị gafeworonụ, ụdị dị ka Roundup, Ortho, na Weedol agbanweela ihe ndị na-arụ ọrụ n'etiti paraquat **, **iquat , ** yphosate *, ** glufosinate, na 2,4-D.

Osisi mkpebi: Paraquat, diquat, na nleba anya nke ahịhịa ahịhịa¶

flowchart TD
    Start["Mkpughe ahịhịa enyo enyo (nri ọnụ ma ọ bụ nhụsianya nke anụ ahụ)"] --> Identify["Lelee akara akpa: Paraquat vs Diquat vs Glyphosate-Surfactant vs Glufosinate vs 2,4-D"]

    Identify --> RouteSplit{"Kedu ihe bụ ụzọ ngosi?"}

    RouteSplit -->|Skin or Eye Splash (Especially Backpack Sprayer Leak or Broken Skin)| DermalCare["1. Nnapụta Gloves On; Yipu akwa niile ozugbo\n2. Jiri ncha na mmiri saa akpụkpọ ahụ nke ọma maka nkeji 15 ruo 20 (Ọ BỤGHỊ ịhịa aka n'ahụ)\n3. Agba Anya 15-20 Min; Nlele ụlọ ọgwụ maka nnabata sistemu ma ọ bụrụ na ebibiri/ọkụ"]

    RouteSplit -->|Oral Ingestion (Intentional OR Accidental Storage in Drink Bottle)| ClassTriage{"Kedu ihe na-arụ ọrụ e iloro?"}

    ClassTriage -->|1. Paraquat (Gramoxone, Parazone)| ParaquatPath["ỌNWỤRỤ EKPERE (Ohere elekere 1 ọla edo):\n1. Ejidere Oxygen mgbakwụnye (Dobe SpO2 85-88% belụsọ PaO2 <50 mmHg)\n2. Unyi arụgoro ngwa ngwa (1 g/kg ruo 50-100 g) ma ọ bụ ụwa Fuller n'ime nkeji 60\n3. Agressive IV Crystalloids + Ọsọ ọkụ unyi Hemoperfusion / Hemodialysis n'ime awa 2-4\n4. Mgbochi ICU Immunosuppressive/Antioxidant (IV Methylprednisolone + Cyclophosphamide + NAC)"]

    ClassTriage -->|2. Diquat (Reward, Reglone, Tribune)| DiquatPath["Nnukwu Caustic + Renal + CNS Nsị:\n1. Unyi arụrụ ọrụ ozugbo / Ụwa Fuller + Mweghachi Fluid IV na-eme ihe ike\n2. Nyochaa maka Ileus siri ike Paralytic (Mkpokọta mmiri na-ahụ n'ime eriri afọ), nnukwu akụrụ akụrụ, Mkpịsị aka/Ọnyà Pontine Braintem\n3. Hemodialysis n'oge maka ọdịda gbasara gbasara akụrụ (oke akpa ume ahọpụtara nke ọma karịa Paraquat, ka na-ezere oke O2)"]

    ClassTriage -->|3. Concentrated Glyphosate-Surfactant (41% Roundup Pro) or Glufosinate| GlyPath["Caustic + Surfactant Mitochondrial Toxicity:\n1. Emela ka agbọpụta; Lelee okporo ụzọ ụgbọ elu maka edema Pharyngeal\n2. Mmiri IV na-eme ihe ike maka Hypovolemic/Cardiogenic Shock; Meziwanye Hyperkalemia siri ike & Metabolic Acidosis\n3. Hemodialysis n'oge ma ọ bụrụ na ọdịda akụrụ Oliguric, Acidosis, ma ọ bụ ihe ịma jijiji na-emepe emepe\n4. Maka Glufosinate: Nyochaa 24-48h maka Coma na-egbu oge, Apnea, na Ọdụdọ Refractory"]

Tụnyere klaasị ise nke ahịhịa ahịhịa na nsị mmadụ¶

Ọ bụ ezie na ọtụtụ ọgwụ herbicides dị, ** klas kemịkalụ ise *** na-akpata ihe fọrọ nke nta ka ọ bụrụ ihe mberede ọrụ ubi na igbu ahịhịa na-eyi ndụ n'ụwa niile:

Mkpu miri emi: Paraquat nsi: Pathophysiology, Clinical Stages, and the Oxygen Iwu¶

1. Ihe kpatara Paraquat ji họrọ ibibi akpa ume (Ọnyà Transporter Polyamine)¶

Mgbe paraquat na-abanye n'ọbara site na eriri afọ ma ọ bụ site na akpụkpọ ahụ mebiri emebi, a na-ekesa ya na akụkụ ahụ niile, na-ebute necrosis n'oge na ** proximal renal tubules nke akụrụ ** na ** imeju. Agbanyeghị, ** ngụgụ *** na-enwe ọnọdụ pụrụ iche, na-egbu egbu: - ** Ụdị nke Mbụ na Ụdị II cell epithelial alveolar *** na ngụgụ mmadụ nwere usoro mbufe akpụkpọ anụ na-adabere na ume nke a na-akpọ ** polyamine uptake system ** (nke a na-ejikarị ebubata polyamines endogenous dị ka putrescine na spermine). - N'ihi na anya dị n'etiti abụọ nitrogen atom nke ọma na molekul paraquat (0.7 nanometers) bụ n'ụzọ structurally yiri polyamines eke, ** ngụgụ na-ezighị ezi na-ekpochapụ paraquat si n'ọbara megide a oke ntinye uche gradient , na-eru ngụgụ anụ ahụ ntachi obi ** 10 ka 50 ugboro elu karịa plasma ọkwa ** n'ime awa. - Ozugbo tọrọ atọ n'ime sel alveolar, paraquat (PQ2+) na-anabata elektrọn site na ** NADPH (nke NADPH-cytochrome P450 reductase mere ya) ka ọ bụrụ ** paraquat monocation free radicalPQ.+). - Radikal a na-ebufe ngwa elektrọn ya gaa na ** oxygen oxygen (O2, na-emegharị paraquat ion mbụ (PQ2+) mgbe ị na-eke oke mbibi ** superoxide anion radical (O2.-, ** hydrogen peroxide (H2O2* na ** hydroxy radicals (OH.)**. - Ịgba ígwè ** redox a na-aga n'ihu na-eri ihe niile ** NADPH *** na ** glutathione **, na-eme ka lipids cell membranes, na-ebute nnukwu alveolitis (mbufụt ngụgụ) ** n'ime awa 24 ruo 72, ma na-akpali mmụba nke ** fibroblasts na collagen ** nke na-atụgharị spongy nke anụ ahụ na-abụghị nke ikuku ikuku. ( mmanụ a honeyụ pulmonary fibrosis) karịrị ụbọchị 5 ruo 21.

2. Ihe kpatara nlanarị akụrụ ji ekpebi ịlanahụ akpa ume¶

Paraquat adịghị eme metabolized ** n'ime ahụ mmadụ; ** ihe karịrị pasentị 90 nke paraquat na-etinye obi n'ime ya bụ akụrụ na-apụ n'anya na-agbanweghị site na nzacha glomerular yana nzuzo tubular na-arụ ọrụ n'ime awa 12 ruo 24 mbụ *, ma ọ bụrụhaala na ọrụ akụrụ na-adịkwa mma. - Agbanyeghị, paraquat n'otu oge na-akpata acute tubular necrosis (ATN) nke akụrụ n'ime awa 24 mbụ. - Ozugbo akụrụ dara, mpụ nke mmamịrị paraquat na-akwụsị, ọkwa paraquat plasma na-ebuli elu ruo ụbọchị ole na ole, ngụgụ na-aga n'ihu na-ekpochapụ paraquat n'ọbara ruo mgbe e nwetara ibu na-egbu egbu. - Ya mere, ** mgbake mmiri na-eme ihe ike iji nọgide na-amịpụta mmamịrị dị elu ** na ** ultra-early extracorporeal ọbara ọcha (Charcoal Hemoperfusion or Hemodialysis within 2 to 4 hours of ingestion) dị mkpa iji kpochapụ paraquat n'ọbara * tupu ọdịda akụrụ akpọchi ya n'ime ahụ.

3. Usoro atọ nke dabere na Clinical Tiers nke Ingestion Paraquat¶

4. Akpụkpọ anụ (akpụkpọ anụ) na ihe ize ndụ mkpughe nke anya Paraquat¶

Elelịla ikpughe akpụkpọ ahụ na paraquat: - Mgbe ọ na-adịchaghị mma, akpụkpọ ahụ dị mma na-eji nwayọọ nwayọọ na-amịkọrọ paraquat, ** ogologo oge na uwe ogologo ọkpa ma ọ bụ akpụkpọ ụkwụ paraquat (dị ka ihe na-agbapụta akpa azụ n'azụ onye ọrụ ugbo, n'úkwù, na scrotum)** na-ebute ọkụ ọkụ na-egbu egbu ozugbo na ọnya akpụkpọ ahụ. - Ozugbo a na-agba ọkụ stratum corneum dị n'èzí ọkụ, bepụ, kpụchaa, ma ọ bụ eczematous, ** paraquat na-abanye ngwa ngwa n'ime ọbara sistemu site na akpụkpọ ahụ mebiri emebi **, na ọtụtụ ikpe na-egbu egbu nke fibrosis pulmonary sitere na ** dermal backpack-sprayer leaks ** na-enweghị otu dobe na-eloda. - ** Anya splashes ** na itinye uche paraquat kpatara igbu oge, siri ike ** corneal na conjunctival epithelial sloughing ** na-arị elu awa 12 ruo 48 ka ekpughere ya, na-achọ mmiri / saline ogbugba mmiri n'ime nkeji 20 ozugbo na nlekọta anya anya ngwa ngwa iji gbochie ọnya corneal na-adịgide adịgide na ìsì.

Hospitallọ ọgwụ Stepwise na ICU Protocol maka Paraquat na Diquat¶

1. ** Mgbochi oxygen siri ike (SpO2 Ebumnuche 85% ruo 88%) ***:
2. Debe akara n'akụkụ ihe ndina a na-ahụ anya n'elu isi onye ọrịa: "PARAQUAT POISONING: ADMINISTER PROPLEMENTAL OXYGEN belụsọ SpO2 <85% (PaO2 <50 mmHg)."
3. Mee ka onye ọrịa na-eku ume ** ikuku ụlọ (FiO2 21%*** dị ka o kwere mee.
4. ** Mwepu eriri afọ ozugbo (n'ime nkeji 60) ***:
5. Onye nchịkwa ** Unyi arụrụ arụ ọrụ (1 to 2 g/kg, ma ọ bụ 50 to 100 grams n'ime ndị okenye) *** ọnụ ma ọ bụ site na nke a na-etinye nke ọma na tube nasogastric dị nro (ọzọ ** 15% Fuller's Earth.100 to 150 g*** ma ọ bụ ** 7% Bentonite ** gbakwunyere cathartic dị ka mannitol / sorbitol ma ọ bụrụ na ị na-eji ụrọ). Ọmụmụ toxicology nke ụlọ ọgwụ nke oge a na-akwado na ** Ọrụ Charcoal na-arụ ọrụ dị ka Fuller's Earth ** ma na-echekwa ya na ngalaba mberede ọ bụla; egbula oge icheku icheku iji chọta Fuller's Earth.
6. ** Zere ịsacha afọ ọsịsa oge niile mgbe ọ gbasasịrị caustic paraquat n'ihi nnukwu ihe ize ndụ nke ** perforation esophageal **, ọ gwụla ma emere ya nwayọ site na agụụ nasogastric n'ime nkeji 30 ruo 60 nke oke mmiri mmiri.
7. ** Mmiri mmiri Crystalloid na-eme ihe ike ***:
8. Na-etinye kristal isotonic (0.9% Normal Saline ma ọ bụ Lactated Ringer'sna ** 150 ruo 250 ml / awa *** iji nọgide na-enwe mmepụta mmamịrị brisk (1.5 to 3 mL/kg/hour) ma na-ebulikwa mkpochapụ akwara endogenous paraquat n'ime awa 24 mbụ dị oke mkpa.
9. **Hemoperfusion mbụ nke unyi (HP) ma ọ bụ hemodialysis (HD): Ohere elekere 2 ruo 4 ***:
10. ** unyi hemoperfusion (ma ọ bụ High-Flux Hemodialysis)** nwere ike ikpochapụ paraquat na ọbara ọbara, mana ọ bụ naanị mgbe paraquat ka na-ekesa na plasma tupu akpọchi ya n'ime mkpụrụ ndụ ngụgụ.
11. Iji meziwanye nlanarị na ingestion na-egbu egbu, ** A ga-amalite n'ime awa 2 ruo 4 (ma ọ bụghị mgbe e mesịrị karịa awa 6) mgbe ingestion gasịrị, na-esochi ya na-aga n'ihu Venovenous Hemofiltration (CVVH). Ozugbo awa 12 ruo 24 gafere, ọkwa paraquat ọbara adịlarị ala n'ihi na nsị dị n'ime ngụgụ, dialysis na-arụkwa ọrụ naanị iji kwado nnukwu ọdịda akụrụ.
12. ** Nkwenye nchọpụta nchọpụta n'akụkụ akwa ngwa ngwa (Urine Sodium Dithionite Urine & Plasma Nomogram) ***:
13. ** Urine Sodium Dithionite Colorimetric Test ***: Na-agbakwunye ** gram 1 nke sodium bicarbonate ** na ** 1 gram nke sodium dithionite ** na ** 10 ml nke mmamịrị onye ọrịa ** na-ebelata paraquat na ion na-acha anụnụ anụnụ na-acha anụnụ anụnụ (ma belata ** diquat ** na ** ion na-acha odo odo-acha akwụkwọ ndụ akwụkwọ ndụ).
    • Ọ bụrụ na mmamịrị ahụ tụgharịa ** ọchịchịrị ojii na-acha anụnụ anụnụ ma ọ bụ na-acha anụnụ anụnụ ** n'ime awa 6 ruo 24 nke oriri, ọ na-akwado nnukwu ibu paraquat sistemu nwere oke ọnwụ.
    • Ọ bụrụ na mmamịrị ahụ nọrọ ** doro anya ma ọ bụ na-acha anụnụ anụnụ na-acha anụnụ anụnụ **, nnabata sistemu dị obere ma enwere ike ịlanarị ya.
14. ** Quantitative Plasma Paraquat Nomogram (Proudfoot / Hart Nomograms)**: Na-akpa nkata kpọmkwem mkpokọta paraquat plasma.mcg/mL ma ọ bụ mg/L) megidere awa kemgbe ingestion na-ebu amụma ihe gbasara ike ịdị ndụ.
15. **Immunosuppressive na Antioxidant ICU usoro nnapụta ***:
16. Iji mebie pulmonary alveolitis na fibroblast collagen deposition, ọtụtụ ụlọ ọrụ toxicology mba ụwa (karịsịa n'ofe Asia-Pacific na WHO / NPIS na-ahụ maka ọgwụgwọ ụlọ ọgwụ) na-enye usoro izizi ** immunosuppressive na antioxidant ** na nsi paraquat na-agafeghị oke na nke siri ike:
    • ** Methylprednisolone nke eriri afọ15 mg/kg/day ma ọ bụ 1,000 mg IV daily for 3 days) + ** Cyclophosphamide n'intervenous* (15 mg/kg/day IV for 2 days), sochiri ya Dexamethasone (8 mg IV every 8 hours).
    • N-Acetylcysteine ​​dị elu nke ukwuu (NAC) *** (iji mejupụta glutathione intracellular), ** Vitamin C (Ascorbic Acid) dị elu, ** Vitamin E ***, na ** Sodium salicylate ** (nke chelates ígwè, na-egbochi radicals hydroxyl, na-egbochi ya). NF-kappaB mbufụt ngụgụ).
17. ** Enyemaka Mgbu na Nlekọta Ọkpụkpọ ***:
18. Caustic onu, pharyngeal, na esophageal ọnya ("paraquat ire") na-akpata oké mgbu; na-enye mmesapụ aka ** analgesia intravenous opioid analgesia (morphine ma ọ bụ fentanyl)** na lidocaine viscous oral rinses, ma debe onye ọrịa ahụ site n'ọnụ (NPO) nri nri parenteral ma ọ bụrụ na ọkụ esophageal siri ike dị.

Glyphosate-Surfactant gbadoro anya ("Roundup") Triage nsị¶

N'ihi na glyphosate bụ ahịhịa ahịhịa a na-ejikarị eme ihe n'ụwa, ebe ndị na-egbu egbu na-amata ọdịiche dị n'etiti ** ịgbanye sprays onye nwe ụlọ dị njikere iji mee ihe ** na ** ebe nchekwa ọrụ ugbo ***:

• ** Onye nwe ụlọ dị njikere iji (RTU) fesa (1% to 2% Glyphosate): ilo ihe mberede nke nwatakịrị ma ọ bụ okenye na-ebu ọnụ na-ebute naanị ** ọnụ na-amachi onwe ya, ọgbụgbọ dị nro, ọgbụgbọ, ma ọ bụ afọ ọsịsa nke na-eji mmiri ọnụ na nleba anya edozi.
• ** Ọrụ ugbo / azụmahịa (41% to 50%+ Glyphosate + 15% POEA Surfactant***:
• Iri ** ihe karịrị 85 ml ruo 100 ml (3 ounces)** nke etinyere 41% glyphosate-surfactant bụ ihe mberede nlekọta ahụike ** na-eyi ndụ egwu ** yana ọnụ ọgụgụ ọnwụ nke 10 ruo 30 pasent na ụma ịdoụbiga mmanya ókè.
• Ọzọkwa, ụfọdụ usoro glyphosate azụmahịa siri ike na-eji ** Glyphosate Potassium Salt (K+ nnu)** kama nnu isopropylamine: ilo ngwaahịa potassium-glyphosate gbadoro anya na-ebuga nnukwu ibu potassium ibu nke nwere ike ibute ** njide obi hyperkalemic na-egbu egbu ozugbo n'ime awa 1 ruo 3.
• ** Nlekọta ụlọ ọgwụ ***: Mee nasopharyngoscopy na-agbanwe ngwa ngwa na ** intubation mmalite endotracheal ** ma ọ bụrụ na mmiri ara ehi, stridor, ma ọ bụ edema pharyngeal dị; weghachite ọbara mgbali na ** ike ike IV crystalloids na norepinephrine **; na-agwọ hyperkalemia ozugbo na ** IV calcium, insulin-dextrose, na sodium bicarbonate ***; ma bido ** hemodialysis nke mbụ *** ma ọ bụrụ na refractory metabolic acidosis, hyperkalemia, oliguric nnukwu mmerụ ahụ akụrụ, ma ọ bụ ujo na-aga n'ihu.

Mgbochi: Ihe #1 Ihe Na-ebute Ingestion nke ahịhịa ahịhịa na-egbu ihe mberede¶

Nọmba mberede mpaghara na ụkpụrụ ụlọ ọrụ¶

Ajụjụ a na-ajụkarị¶

Kedu ihe kpatara na ndị na-ahụ maka ahụike na ndị dọkịta na-ahụ maka mberede na-egbochi oxygen mgbakwunye n'aka onye loro paraquat?¶

Paraquat na-egbu mkpụrụ ndụ ngụgụ site na usoro kemịkalụ a na-akpọ redox cycling, nke na-eji ikuku oxygen dị n'ime ngụgụ na-emepụta ọtụtụ nde superoxide na-ebibi ihe na hydroxyl free radicals. N'ihi na ngụgụ na-arụsi ọrụ ike na-agbapụta paraquat n'ọbara ruo ugboro 10 ruo 50 dị elu karịa ebe ọ bụla ọzọ n'ime ahụ, na-enye ikuku oxygen na-enyekwu mmanụ ọkụ na mmeghachi omume kemịkal ahụ ma na-eme ka ọnyá ngụgụ na-egbu egbu dị ngwa ngwa ( fibrosis pulmonary ). Ndị otu ahụike ga-edobe ndị ọrịa paraquat na-ekuku ikuku ụlọ nkịtị ma na-enye naanị oxygen mgbakwunye ma ọ bụrụ na saturation oxygen (SpO2) dara n'okpuru 85 ruo 88 pasent (PaO2 n'okpuru 50 mmHg).

Kedu ihe kpatara na nkeji 60 mbụ mgbe ilochara paraquat na-akpọ "oge elekere ọla edo"?¶

Paraquat na-abanye ngwa ngwa site na eriri afọ, na-eru ọkwa kachasị elu n'ọbara n'ime nkeji 60 ruo 120, wee gbanye ya nke ọma n'ime mkpụrụ ndụ ngụgụ ebe ọ nweghị ọgwụ mgbochi ma ọ bụ dialysis igwe nwere ike ịdọpụ ya azụ. Unyi na-arụ ọrụ (ma ọ bụ Fuller's Earth / Bentonite ụrọ) n'ime nkeji 60 mbụ na-ejikọta paraquat mmiri n'ime afọ na eriri afọ tupu ya abanye n'ọbara, nke nwere ike ịpụta ọdịiche dị n'etiti nlanarị na fibrosis ngụgụ na-egbu egbu.

Ị nwere ike nweta nsị paraquat na-egbu egbu naanị site na ịwụfu ya na akpụkpọ gị na-elodaghị nke ọ bụla?¶

Ee. Paraquat na-etinye uche bụ kemịkalụ na-emebi emebi nke na-ere ọkụ na ọnya akpụkpọ na kọntaktị. Ọ bụrụ na paraquat na-esi n'akpa akpa akpa na-adaba n'azụ, ụkwụ, ma ọ bụ ukwu ukwu onye ọrụ, ma ọ bụ fesa na akpụkpọ ahụ nke nwere mgbawa, ncha, abrasions, ma ọ bụ rashes, ọ na-agafe ngwa ngwa site na mgbochi akpụkpọ ahụ mebiri emebi n'ime ọbara wee gaa na ngụgụ, na-eme ka otu ihe ahụ na-egbu egbu na-egbu egbu fibrosis dị ka nsị. Ọ bụrụ na paraquat metụrụ akpụkpọ ahụ, yipụ uwe niile ozugbo wee jiri ncha na mmiri na-asọ asọ saa nwayo maka nkeji 15 ruo 20 na-ejighi aschachara nke ọma (ịchacha akpụkpọ ahụ na-agba ọsọ ọsọ).

Kedu ihe dị iche n'etiti ịgbasa Roundup na-adị njikere iji ya na itinye uche n'ọrụ ugbo ma ọ bụrụ na eloro ya na mberede?¶

karama ịgba mmiri nke ụlọ dị njikere iji nwere naanị 1% ruo 2% glyphosate diluted na mmiri; obere ilo ihe mberede na-ebute naanị iwe ọnụ dị nro ma ọ bụ afọ iwe. N'ụzọ dị iche, ihe ọkụkụ ahịhịa ma ọ bụ nke azụmahịa nwere 41% ruo 50% glyphosate agwakọta ya na ihe ndị na-etinye uche (dị ka POEA) na mgbe ụfọdụ potassium salts dị elu. Iri ihe karịrị 85 ml (ihe dị ka 3 ounces) nke 41% glyphosate-surfactant nwere ike ime ka akpịrị na-ere ọkụ, ọzịza ikuku, potassium ọbara dị elu na-eyi ndụ egwu (hyperkalemia), metabolic acidosis, ọdịda akụrụ, na ujo chọrọ nlekọta siri ike.

Kedu ihe bụ "ire paraquat" na olee mgbe ọ pụtara?¶

N'ihi na paraquat na diquat na-etinye uche bụ kemịkalụ caustic siri ike, ilo ọbụna ntakịrị ihe na-akpata nnukwu ọkụ ọkụ nke ọnụ, ire, na akpịrị. N'ime awa 24 ruo 48 ka e risịrị nri, elu ire na-aza, ọnya, na slough, na-ekpuchi ya na plaques necrotic na-acha ọcha-acha odo odo na-egbu mgbu na ọnya na-agba ọbara nke a maara nke ọma dị ka "ire paraquat." Ọbụlagodi na onye ọrịa ahụ na-agbapụta ọtụtụ mmiri mmiri, ọdịdị nke ọkụ ọnụ na-egosi ikpughe ma na-achọ nnabata ụlọ ọgwụ ozugbo iji nyochaa ọrụ akụrụ na ngụgụ.

Ntuziaka emetụtara¶

• Organophosphate pesticide, onye na-ahụ maka akwara, na nsị ụmụ ahụhụ
• Nri nsi oke: Superwarfarin, bromethalin, na zinc phosphide
• Enyemaka mbụ nsi na nchikota nsi
• Ọkụ na ọkụ enyemaka mbụ (gụnyere ọkụ ọkụ)
• Mmeri akụrụ dị oke njọ, rhabdomyolysis, na mbelata mmamịrị gbara ọchịchịrị

Isi mmalite na nduzi ọchịchị¶

• United States Environmental Protection Agency (EPA): Nkwenye na njikwa nke nsị pesticide (mbibi nke isii): Paraquat, Diquat, Glyphosate, na Chlorophenoxy Herbicides.
• Òtù Ahụ Ike Ụwa (WHO) & Òtù Na-ahụ Maka Nri na Ọrụ Ugbo (FAO): * Nlekọta ahụike nke Paraquat na Bipyridylium Herbicide Poisoning*.
• Ụlọ Ọrụ Maka Nchịkwa na Mgbochi Ọrịa (CDC): * Njikere na Nzaghachi Mberede: Eziokwu Banyere Paraquat Chemical Emergency and Decontamination*.
• Ọrụ Ozi Nsi nke Mba (NPIS, United Kingdom): TOXBASE Clinical Management of Paraquat, Diquat, Glyphosate, na Glufosinate Poisoning.
• EXTRIP (Ọgwụgwọ Extracorporeal na nsi) & Ntuziaka Clinical Toxicology International: * Hemoperfusion mbụ, Hemodialysis, na Immunosuppressive Therapy na Paraquat na Chlorophenoxy Herbicide nsi*.

*Nduzi a bụ maka ebumnuche ozi na anaghị edochi nyocha ahụike ọkachamara, ndụmọdụ nchịkwa nsi, ma ọ bụ nlekọta ahụike ụlọ ọgwụ. N'ihi na mkpughe nke ahịhịa ahịhịa nwere ike ime ka ọkụ ikuku ngwa ngwa, ujo, na ọdịda iku ume, anyị na-akwadosi ike ka ị nweta enyemaka enyemaka mbụ na CPR site na International Federation of Red Cross and Red Crescent Societies (IFRC), Red Cross obodo gị, St John Ambulance, ma ọ bụ onye na-eweta mpaghara.