Komela Manix (Linamarine Manioc bololo) mpe Noix ya Abricot (Amygdaline / Laetrile): Empoisonnement ya cyanure ya intestin na retard¶

Kolia oyo esili kopɔla malamu te to oyo elambami malamu te maniko ya bololo (Manihot esculenta, manioc/yuca), kotafuna noix ya abricot ya bololo, mabulu ya pêche/cerise/prune oyo enyatami, to amande ya bololo, to komela nkisi mosusu "Vitamine B17" (amygdalin to mpe laetrile) ba suppléments epesaka bomoi na likama Cyanure d'hydrogène gastro-intestinal retardé (HCN) kopesa ngɛngɛ. Benga nimero ya urgence ya esika ofandi (911 na Etats-Unis mpe Canada, 112 na Union européenne mobimba, 999 na Royaume-Uni) to tuna ya biso répertoire international ya ba numéros ya urgence mbala moko, mpe yebisa mopesi-biloko ete mobɛli asengeli kozwa Hydroxocobalamine intraveineuse (Cyanokit) to Kiti ya antidote ya cyanure ( .Sodium Thiosulfate / Sodium Nitrite). Ntango ozali kozela basali ya lisalisi ya liboso, bongisa lisalisi na yo ya mbala moko na oyo ya biso cyanure mpe gaz industriel inhalation guide ya lisalisi ya liboso, kokesenisa makila ya motane makasi ya toxicité ya cyanure na méthémoglobinemie ya langi ya mosaka ya chocolat, mpe bomibongisa mpo na status epilepticus ba crises oyo eumelaka mingi to mpe CPR ya CPR.

Na bokeseni na gaze ya cyanure d’hydrogène oyo epemamaka (oyo esalaka ete ekwea na kati 10 to 60 seconds), komela glycosides cyanogènes, mingimingi linamarin (na manioko ya bololo, na mbuma ya lima, mpe na mbuma ya lin) to amygdaline / prunasin (na mbuma ya abricot ya bololo, amande ya bololo, mabanga ya mbuma ya Rosaceae, mpe na bitape ya bamboo), ezali na 30-minute to 4-hour fenêtre ya latence sans symptôme. Na eleko wana ya kimia, ba enzymes beta-glucosidase mpe hydroxynitrile lyase ya banzete mpe ya misɔpɔ e hydrolyser ntango nyonso ba glycosides oyo emeli na kati ya intestin grêle alcaline mpe colon, mpe ebimisaka bomati ya cyanure d’hydrogène oyo ezali kolandana, oyo ebomaka (HCN) na kati ya makila ya portail. Cyanure absorbé ekangamaka na affinité ya makasi na ferrique (Fe3+) atome ya ebende ya mitochondriale cytochrome c oxidase ( .Complex IV), kopekisa mpenza kopema aérobie ya baselile atako misisa mpe misisa ya mobɛli etikalaka na oxygène (arterialization of venous blood). Kozanga kopesa noki oxygène supplémentaire 100%, décontamination gastro-intestinal, mpe Hydroxocobalamine intraveineuse (5 grams IV) to Thiosulfate de sodium ( .12.5 grams IV) + Nitrite ya sodium ( .300 mg IV), bato oyo bazwi yango bakómaka nokinoki na kizunguzungu, kosanza, mpe tachypnée ya kopema mozindo (Kussmaul breathing) na réfractaire ya haute-anion-espace acidose lactique ( .serum lactate > 8 to 10 mmol/L), ba crises généralisées, arrêt bradycardique, mpe liwa.

+-------------------------------------------------------------------------+
|       CYANOGENIC GLYCOSIDE DELAYED GUT CYANIDE TRIAGE TIMELINE          |
+-------------------------------------------------------------------------+
|  0 TO 60 MINUTES (THE SILENT ENZYMATIC HYDROLYSIS WINDOW):              |
|  * Victim eats bitter Apricot Kernels, Laetrile, or Bitter Cassava      |
|  * Plant beta-glucosidase (emulsin/linamarase) + Human gut microflora   |
|    cleave Amygdalin/Linamarin -> Mandelonitrile/Acetone Cyanohydrin     |
|    -> Lethal HYDROGEN CYANIDE (HCN) absorbed across intestinal wall     |
|  * Immediate Action: Call 911/112/999; give Activated Charcoal (< 1-2h) |
+-------------------------------------------------------------------------+
|  30 MINUTES TO 4 HOURS (ONSET OF CELLULAR HYPOXIA / HISTOTOXIC SHOCK):  |
|  * Early Signs: Headache, dizziness, anxiety, nausea/vomiting, cherry-  |
|    red flushed skin, tachycardia, and deep gasping hyperventilation     |
|  * Late Signs: Coma, tonic-clonic seizures, hypotension, bradycardia    |
|  * Lab Clues: Venous blood looks bright "cherry-red" (PvO2 > 50-60 mmHg)|
|    + Serum Lactate > 8 to 10 mmol/L (confirms acute cyanide poisoning)  |
+-------------------------------------------------------------------------+
|  DEFINITIVE HOSPITAL ANTIDOTAL RESCUE:                                  |
|  * Give 100% High-Flow Oxygen (ALWAYS safe & beneficial in cyanide)     |
|  * 1st Choice Antidote: IV Hydroxocobalamin (Cyanokit) 5 g (70 mg/kg)   |
|    + IV Sodium Thiosulfate 12.5 g (25% solution, 50 mL) for slow release|
|  * 2nd Choice Antidote: IV Sodium Nitrite (300 mg) + Sodium Thiosulfate |
+-------------------------------------------------------------------------+

Sala boye sikoyo¶

1. Benga ba services ya urgence mpe Poison Control mbala moko, ata soki mutu azali kaka koyoka normalement normal. Benga 911 (Etats-Unis mpe Canada), 112 (Union européenne), 999 (Royaume-Uni), 000 (Australie), to 111 (Nouvelle-Zélande). Yebisa dispatcher substance ya sikisiki oyo ameli (bitter apricot kernels, . laetrile / amygdalin tablets, . bitter cassava / manioc, to bitter almonds), ba tafunaki noix to gramme boni, mpe tango ya komela mpo lopitalo oyo ezwaki yango ekoki kobongisa Hydroxocobalamin (Cyanokit) mpe Thiosulfate de sodium na baie ya réanimation yambo ete mobɛli akwea.
2. Kosala ata moke te kosanza, mpe kosala ata moke te réanimation ya monoko na monoko kozanga masque ya barrière. Soki mobɛli oyo ameli ba glycosides cyanogènes to mungwa ya cyanure asanza, acide gastrique ebongoli cyanure na volatile cyanure hydrogène (HCN) gaz ( .which smells weakly like bitter almonds to the 40% to 60% of people genetically able to detect the odor). Soki mobɛli atiki kopema, salelá sac-valve-mask (BVM) to masque CPR ya poche oyo ezali na nzela moko oyo ezali na oxygène oyo ezali koleka mingi na esika ya kokutana na monoko na monoko mbala moko.
3. Kopesa Oxygène 100% ya débit makasi noki soki ba paramédicaux bakomi. Ata soki oxymétrie pulsaire (SpO2) ekotanga 98% to 100% mpo baselile oyo ezali na ngɛngɛ ekoki te kobimisa oxygène na makila, kopesaka ** .100% oxygène normobarique** ematisaka tension ya oxygène ya plasma dissous, e compétitionner na cyanure na ba sites ya liaison ya cytochrome c oxidase, mpe ematisaka synergie antidotale ya thiosulfate de sodium na hydroxocobalamine.
4. Kokanga Vitamine C ya monoko (Ascorbic Acid) suppléments. Soki mutu ameli ba noix ya abricot to oral laetrile, tala soki bamelaki pe Vitamine C ya dose makasi. Vitamine C oyo ezwami na dose monene (> 1 to 3 grams).
5. Bomba emballage, sac ya mboto, to misisa ya manioko oyo etikali. Mema récipient ya ba graines ya abricot, B17 molangi ya kobakisa, to tuberculose ya manioko ya mbindo na departema ya urgence. Tanga to kanisa motango ya sikisiki ya ba noix oyo baliaka: kotafuna kaka ** .5 to 10 bitter apricot kernels na mwana moke** to ** .20 to 60 bitter apricot kernels (0.5 to 3.5 mg/kg ya oyo ekokani na cyanure) na mokóló** ekoki kobimisa ngɛngɛ ya cyanure oyo ekoki koboma ye to oyo ebomaka.

Nzete ya mokano: Triage ya glycoside cyanogène ya intestin oyo ezongisami sima mpe kopona antidote¶

flowchart TD
    A["Komela Manix ya bololo, mbuma ya Abricot ya bololo, mabulu ya mbuma, to Laetrile (Amygdalin) ."] --> B{"Nini Ezalaki Ingesté & Ndenge nini?"}
    B -->|"1-3 Mabulu ya Cerise/Prune/Preche oyo enyatami te mobimba to mwa Mboto ya Pomme"| C["Likama moke: Kazaka ya mboto oyo ebebi te epekisaka ete Amygdaline ebima; Talá na ndako longola kaka soki otafuna"]
    B -->|"Ba Noix ya Abricot ya bololo oyo batafunaki/oyo baniki, ba amande ya bololo, ba tablettes ya Laetrile, to Manix ya bololo"| D["RISQUE MAKASI PONA POISONING YA HCN YA INTEPAI RETARÉ (Latence 30 min à 4 heures)"]
    D --> E["Benga na 911/112/999; Pakola Oxygène oyo ezali na 100% ya koleka mingi; Pesa Charbon Activé (1 g/kg kino 50-100 g) soki < 1-2 Heures mpe Lamuka"]
    E --> F["Order Stat Gaz ya makila ya misisa (VBG), Gaz ya makila ya artérielle (ABG), Lactate ya sérum, mpe Panneau métabolique ya base"]
    F --> G{"Tala Gravité Clinique & Lactate ya Sérum"}
    G -->|"Ezali na bilembo te & Lactate < 3,0 mmol/L"| H["Tala na ED/ICU na boumeli ya Ngonga 6 kino 12 (Hydrolyse ya intestin retardée); Zongela Lactate q1-2h"]
    G -->|"Ezalela ya makanisi oyo ebongwanaki, Ba crises, Hypotension, Tachypnée, TO Lactate >= 8-10 mmol/L"| I["KOPESA ANTIDOTE NOKI (Kozela TE niveau ya cyanure ya laboratoire)"]
    I --> J{"Antidote nini ya Cyanure Ezali Noki?"}
    J -->|"Hydroxocobalamine (Cyanokit) Ezali (1er Choix)"| K["Infuser Hydroxocobalamine 5 g IV (70 mg/kg na bana mike) na boumeli ya 15 min + Bakisa Thiosulfate de sodium 12,5 g IV mpo na kobimisama ya misɔpɔ oyo ezali kokoba"]
    J -->|"Kaka Kit ya Nitrite + Thiosulfate nde Ezali"| L["Pesa Nitrite de sodium 300 mg IV (10 mL ya 3%) na 2-4 min (Tala liboso Hémoglobine) -> Landa na Thiosulfate de sodium 12,5 g IV"]

Physiopathologie: Ndenge nini ba glycosides ya banzete ebongwanaka Cyanure d’hydrogène (HCN) na kati ya misɔpɔ ya moto¶

Koleka 2,500 ba espèces ya milona e synthétiser glycosides cyanogènes lokola défense chimique naturelle contre ba herbivores. Na nkasa, misisa to mboto ya molona oyo ebebi te, glycoside cyanogène ebombamaka malamu na kati ya ba vacuoles ya baselile, oyo ekabwani na nzoto na ba enzymes hydrolytiques na yango oyo esalaka ete esala (beta-glucosidase mpe hydroxynitrile lyase), oyo efandaka na efelo ya baselile ya banzete to na cytoplasme.

1. Kokabwana ya enzymatique na ba étapes mibale ya Amygdaline na Linamarine¶

+-------------------------------------------------------------------------+
|       BIOCHEMICAL CONVERSION OF AMYGDALIN & LINAMARIN TO CYANIDE        |
+-------------------------------------------------------------------------+
|                                                                         |
|  PATHWAY 1: APRICOT KERNELS, BITTER ALMONDS, PEACH/CHERRY PITS, LAETRILE|
|  Amygdalin (D-mandelonitrile-beta-D-gentiobioside)                      |
|      |                                                                  |
|      |  Step 1: Beta-Glucosidase (Plant 'Emulsin' when chewed OR        |
|      |          Human intestinal microflora beta-glucosidase in gut)    |
|      v                                                                  |
|  Prunasin + Glucose  --->  Mandelonitrile + Glucose                     |
|                                  |                                      |
|                                  |  Step 2: Hydroxynitrile Lyase OR     |
|                                  |  Spontaneous dissociation in         |
|                                  |  alkaline duodenum (pH > 6.5)        |
|                                  v                                      |
|              Benzaldehyde  +  HYDROGEN CYANIDE (HCN)                    |
|              (Almond odor)    (Lethal Complex IV inhibitor)             |
|                                                                         |
+-------------------------------------------------------------------------+
|  PATHWAY 2: BITTER CASSAVA (MANIOC / YUCA), LIMA BEANS, BAMBOO SHOOTS   |
|  Linamarin (alpha-hydroxyisobutyronitrile-beta-D-glucopyranoside)       |
|      |                                                                  |
|      |  Step 1: Linamarase (plant beta-glucosidase) OR Gut bacteria     |
|      v                                                                  |
|  Acetone Cyanohydrin + Glucose                                          |
|      |                                                                  |
|      |  Step 2: Hydroxynitrile Lyase OR Spontaneous breakdown at pH > 5 |
|      v                                                                  |
|  Acetone  +  HYDROGEN CYANIDE (HCN)                                     |
+-------------------------------------------------------------------------+

• Mpo na nini na monoko Laetrile / . Amygdalin ezali na ngɛngɛ mbala 40 koleka oyo batyaka na misisa Laetrile: Ba promoteurs fraudulents ya "Vitamine B17" historiquement balobaki que laetrile ezalaki sûr mpo ba injections intraveineuses na ba nyama epesaki toxicité minimale immédiate. Tango ba injecter yango na misisa, amygdaline stérile e contourner voie digestive mpe ebimaka > 90% ebongwanaka te na makila mpo makila mpe misisa ya moto ezangi ba enzymes beta-glucosidase. Kasi, soki ezwami na monoko, bactérie ya colon mpe ya intestin grêle ya moto ezali na activité ya beta-glucosidase mingi. Ata soki moto alambi mbuma ya abricot mpo na ko dénaturer oyo ya molona yango moko emulsin enzyme, to ba hirondelles purifiés pharmaceutique laetrile ba tablettes, bactérie na bango moko ya intestin ekabolaka glycoside 1 to 4 hours na nsima na ileum ya nse mpe na colon, kotondisa misisa ya portale na cyanure d’hydrogène oyo ebomaka (HCN).
• Mpo na nini Manoko ya bololo epesaka mabota poison na tango ya kokauka mpe bozangi bilei: Ba cultivars ya manioko etangami na maniko ya sukali" (< 50 milligrams ya HCN oyo ekokani na kilo moko ya misisa ya sika, oyo ezwami mingimingi na nsuki ya libanda) mpe maniko "ya bololo" (100 to > 500 milligrams ya HCN na kilo moko oyo ekabolami na mosuni mobimba oyo ezali na amidon). Na tango ya kokauka makasi, milona ya manioko ematisaka linamarin na yango mbala misato to mitano. Bobongisi ya bonkoko ya bozangi likama ya manioko ya bololo esengaka kokata yango, kosala grille/konyata, kosopa/ko fermenter na mayi pendant 3 à 5 jours (ko permettre endogène linamarase mpo na kobongola linamarine na cyanohydrine ya acétone), mpe na nsima kokaukisa na moi to kotumba yango na molunge makasi mpo na kosala ete cyanohydrine ya acétone ezala volatiliser mpe HCN gaz. Soki libota oyo ezali na nzala elambi misisa ya manioko ya bololo oyo ekɔtisami te mpo na kaka 20 minutes, to alyaka manioko oyo ekɔtisami ndambo na kati 24 hours, molunge yango e dénaturer ba linamarase enzyme yambo linamarine epanzana, kotika linamarine na acétone cyanohydrine intact na bilei. Soki bamɛli yango, cyanohydrine ya acétone epɔlaka yango moko mpe ekómaka oyo ebomaka HCN na kati ya duodénum alcalin, nzokande bactérie ya misɔpɔ e hydrolyser linamarine oyo etikali na oyo elandi 2 to 6 hours.

Comparaison ya ba sources ya glycoside cyanogène alimentaire na toxicité clinique¶

Diagnostic ya pembeni ya mbeto: Ndenge nini ko confirmer empoisonnement aigu ya Cyanide avant ba laboratoires ya référence ezonga¶

Test quantitative ya cyanure ya makila mobimba ezuaka bangonga to mikolo na ba laboratoires ya référence mpe ezali jamais na tango pona ko guider réanimation ya urgence. Ba cliniciens ba confirmer empoisonnement aigu ya cyanure ya intestin na côté ya mbeto na 5 minutes kosalela ba empreintes misato ya misapi ya diagnostic mbala moko:

1. "Artérialisation" ya Makila ya misisa (Makila ya misisa ya rouge-cerise mpe ya étroite A-V O2 Esika ya bokeseni)¶

• Mecanisme: Po cyanure ekanga mitochondriale cytochrome c oxidase (Complex IV) na oxydé na yango ( .Fe3+) , ba tissus périphériques ekoki te kobimisa oxygène na oxyhémoglobine oyo ezali koleka.
• Elembo ya pembeni ya mbeto: Tango infirmier to phlébotomiste azui échantillon ya makila ya périphérique échantillon ya makila ya misisa, makila ya misisa emonanaka "rouge-cerise" ya kongenga (ekoki kokesana te na makila ya artérielle) na esika ya kozala rouge violet-rouge foncé.
• Confirmation ya gaz ya makila: Kokanisa na mbala moko Gaz ya makila ya artérielle (ABG) mpe central/périphérique Gaz ya makila ya misisa (VBG):
• Alors que artérielle PaO2 mpe oxymétrie ya pulsation ( .SpO2) kotikala normal (97% to 100%) na ebandeli, saturation ya oxygène ya misisa ( .ScvO2 to mpe SvO2) eleki 85% to 90% mpe na misisa PvO2 eleki 50 to 60 mmHg **.
• Bokeseni ya oxygène ya misisa ya misisa ( .A-V O2 gradient) ekómaka moke tii na nse ya 1 to 2 vol%, oyo ezali komonisa ete baselile ezali na hypoxie histotoxique (shared only by cyanide, hydrogen sulfide, sodium azide, and high-oxygen resuscitation).
• Confirmation fundoscopique: Ophtalmoscopie directe ya rétine elakisaka ba veine ya rétine oyo ezali exactement ndenge moko na couleur rouge ya kongenga na ba artéries ya rétine.

2. Lactate ya sérum >= 8 to 10 mmol/L (Marqueur surrogate ya Norme ya Or)¶

• Po aérobie ATP synthèse ekangami (producing only 2 ATP molecules per glucose via anaerobic glycolysis instead of 36 ATP), baselile ebongoli pyruvate nokinoki na acide lactique.
• Boyekoli ya toxicologie clinique (Baud et al., New England Journal of Medicine) emonisaki ete na mobeli oyo azali na empoisonnement oyo azali kopema milinga te, concentration ya lactate na plasma ya >= 8 mmol/L (72 mg/dL) (to >= 10 mmol/L na kopema milinga) azali na ** .> 90% sensibilité mpe spécificité mpo na empoisonnement aigu ya cyanure makasi** (blood cyanide > 40 micromoles/L to mpe > 1.0 mg/L) mpe ezali na boyokani na ndenge ya linéaire na bozito ya cyanure intracellulaire.

3. Courbe Hémodynamique mpe Respiratoire Biphasique¶

• Eteni 1 (Simulation ya liboso ya ba chimiorécepteurs, 30 to 90 minutes): Cyanure e stimulaka directement ba chimiorécepteurs ya nzoto ya carotide, e déclenchaka "jape ya cyanure" ya mbalakaka oyo elandi na marqué hyperventilation / tachypnée (Kussmaul breathing), sinus tachycardie, hypertension, motó mpasi, vertigo, mobulungano, mpe kopumbwapumbwa.
• Phase 2 (Décompensation Hypoxique na tard, 1 to 4 hours): Lokola na kati ya baselile ATP kokweya na tronche ya cerveau mpe na myocarde, mobeli a transition brusquement na apnée / bradypnée, bradycardie profonde sinus to blocage AV, hypotension artérielle grave, ba crises toniques-cloniques généralisées, posture décérébrée, mpe activité électrique sans pulsation (PEA) to na asystole.

Protocole ya antidote ya lopitalo mpe ya décontamination étape par étape¶

Pamba te hydrolyse ya intestin ya amygdaline na linamarine ekobaka pendant heures na kati ya traitement gastro-intestinal (contrairement na inhalation ya mbala moko ya HCN gaz), kosalisa empoisonnement glycoside cyanogène ya banzete esengaka ezala kobikisa antidote intraveineux mbala moko MPE décontamination gastro-intestinal oyo ezali kosalama + infusion prolongée ya soufre-donneur.

+-------------------------------------------------------------------------+
|       TWO COMPLEMENTARY ANTIDOTAL MECHANISMS FOR GUT CYANIDE            |
+-------------------------------------------------------------------------+
|  1. HYDROXOCOBALAMIN (CYANOKIT - VITAMIN B12a PRECURSOR):               |
|     Hydroxocobalamin (Co3+ - OH)  +  Cyanide (CN-)                      |
|                     |                                                   |
|                     v  (Direct equimolar chelation in blood & cells)    |
|     Cyanocobalamin (Vitamin B12 - Non-toxic, excreted in crimson urine) |
|     * Pros: Instant onset, does NOT lower blood pressure, does NOT form |
|       methemoglobin (safe in children, pregnancy, and anemia)           |
+-------------------------------------------------------------------------+
|  2. SODIUM THIOSULFATE (SULFUR DONOR FOR HEPATIC RHODANESE):            |
|     Thiosulfate (S2O3 2-) + Cyanide (CN-) ---[Rhodanese]---> Thiocyanate|
|     * Pros: Provides continuous sulfur substrate to detoxify ongoing    |
|       slow release of HCN from apricot kernels or cassava in the gut    |
|     * CRITICAL RULE: Infuse Hydroxocobalamin and Sodium Thiosulfate     |
|       through SEPARATE IV lines (or flush thoroughly between them)      |
+-------------------------------------------------------------------------+

Etape 1: Kolongola bosoto na misɔpɔ (Activated Charcoal mpe Gastric Lavage) .¶

• Atako makala activé ezali na makoki ya gramme na gramme moke mpo na cyanure de potassium inorganique ya peto (1 gram of charcoal adsorbs -35 mg of KCN), ba dose ya mokóló oyo bato mingi basalelaka (50 to 100 grams ya makala activé) e adsorber facilement ba quantités letale ya milligrammes ya amygdaline non hydrolysé, linamarine, mpe liberée HCN na libumu mpe kobongisa mingi kobika na ba poisons expérimentales mpe cliniques.
• Soki mobeli azali ko présenter na kati ya ** .1 to 2 hours** ya komela ba noix ya abricot bololo oyo enyatami, ba tablettes ya laetrile, to manioko ya bololo, kokanga nzela ya mopepe (intubater soki obtunde) mpe kosala aspiration gastrique/lavage mpo na kolongola na nzoto biteni ya mboto oyo etikali, elandi mbala moko na Makala activé (1 gram/kg, kino na 50 to 100 grams).

Etape 2: Antidote ya liboso oyo ekɔtisami na misisa: Hydroxocobalamine (Cyanokit) .¶

Eloko oyo babengi hydroxocobalamine (Cyanokit) ezali antidote ya liboso oyo bato nyonso balingaka mingi mpo na empoisonnement aigu ya cyanure na Amérique du Nord, Europe, Royaume-Uni, mpe Australie mpo ekangisaka directement cyanure intracellulaire mpe intravasculaire mpo na kosala cyanocobalamine oyo ezali na likama te (Vitamin B12) kozanga kosala ete hémoglobine oyo ememaka oxygène ezala na likama to kosala choc vasoplégique oyo euti na nitrites.

• Dose ya mikóló: Kozongisa 5 gramme (one 5 g vial to mpe two 2.5 g vials) ya Hydroxocobalamine na 200 milliliters ya 0.9% chlorure de sodium mpe kokɔtisa yango na misisa likoló ya ** .15 minutes (-15 mL/minute)**.
• Dose ya bana: Infuse 70 milligrams per kilogram (70 mg/kg, kino na dose ya ebandeli ya likolo ya 5 grams) na misisa likolo ya ** .15 minutes** **.
• Dosage ya kozongela obligatoire mpo na Hydrolyse ya intestin retardée: Na empoisonnement ya noix ya abricot, laetrile, to ya manioko ya bololo, ba malades bazuaka mbala mingi rebound surge ya cyanure 2 to 6 hours nsima ya oyo ya liboso 5 g Dose ya hydroxocobalamine lokola bactérie ya intestin ezali kokoba kokabola ba glycosides oyo ezwami te na kati ya colon. Soki acidose lactique ( .> 4 mmol/L), hypothénormose, to coma ezongaka to ewumeli, infuser un second 5 gram (70 mg/kg pediatrique) dose ya Hydroxocobalamin likolo 15 minutes to 2 hours.
• Effet secondaire oyo ezelamaka (Chromaturie sans danger & Interférence ya laboratoire): Hydroxocobalamine ezali pigment rouge bourgogne makasi. Ebongoli mbala moko loposo ya mobɛli, mai ya miso, motoki, plasma, mpe urine motane makasi ya motane makasi (chromaturia) mpo na 2 to 7 days (mpe kino na 28 days na makila). Kebisa laboratoire que hydroxocobalamine e interférer spectrophotométriquement na ba tests colorimétriques pona co-oxymétrie ya créatinine, bilirubine, transaminases, magnésium, na carboxyhémoglobine/méthémoglobine, benda ba tubes ya makila ya base mbala moko avant ya kobanda infusion rouge.

Etape 3: Kopesa elongo Thiosulfate de sodium na misisa (12.5 Grams) .¶

Mpamba te enzyme naturelle ya nzoto oyo elongolaka cyanure, rhodanese mitochondriale (thiosulfate sulfurtransferase) na foie mpe na muscle ya mikuwa, esilaka noki ba donateurs endogènes ya soufre na tango ya absorption prolongée ya glycoside ya intestin, kopesa Thiosulfate de sodium intraveineux epesaka fourniture inexhaustible ya soufre sulfane mpo na ko convertir cyanure na thiocyanate sans danger (SCN-), oyo ebimaka na ba reins: * Dose ya mikóló: 12.5 grams (50 milliliters ya a 25% Solution ya Thiosulfate de sodium) oyo ekɔtisami na misisa likoló ya ** .10 to 30 minutes** **. * Dose ya bana: 250 milligrams per kilogram (1.0 mL/kg ya 25% solution, to 412.5 mg/kg [1,65 mL/kg] engebene na hydration ya formulation, kino 12.5 grams) na nzela ya misisa likolo 10 to 30 minutes.

Etape 4: Protocole ya antidote alternatif (Ntango Hydroxocobalamine ezali te): Nitrite de sodium + Thiosulfate de sodium (Nithiodote) to Edetate ya Dicobalt (Kelocyanor) .¶

Na bitúká mingi oyo ezali naino na bozwi mingi te epai kuna bokono ya manioko ya bololo esalemaka, to na ba cliniques ya mike mike ya bamboka oyo ezali na yango te Cyanokit, minganga basalelaka régime classique ya deux étapes Nitrite + Thiosulfate: 1. Nitrit d’amyl (Pont inhalé avant accès IV): Konyata ampoule ya nitrite amyl (0.3 mL) na gaze mpe simbá yango na nse ya zolo ya mobɛli (to likoló ya bokɔti ya sac-valve-mask) mpo na 15 to 30 seconds ya miniti nyonso ntango bazali kotya nzela ya kokɔta na IV. 2. Nitrit de sodium na misisa (3% solution): * Mecanisme: Ezali ko oxyder 10% to 20% ya hémoglobine ferreuse oyo ezali kotambolatambola ( .Fe2+) na kati ya méthémoglobine ferrique ( .Fe3+). Po cyanure eza na affinité ya likolo pona Fe3+, méthémoglobine ebendaka cyanure na cytochrome c oxidase mitochondrial mpo na kosala cyanméthémoglobine. * Dose ya mikóló: 300 milligrams (10 milliliters ya 3% Nitrite de sodium) oyo ekɔtisami na misisa likoló ya ** .2 to 4 minutes** (tala tansiɔ́ malamu, mpamba te ba nitrites esalaka ete vasodilation makasi mpe hypothénormose). * Dose ya bana (Must Adjust for Hemoglobin to Prevent Fatal Methemoglobinemia): ** .6 to 10 mg/kg (0.2 to 0.33 mL/kg ya 3% solution, maximum 300 mg)**, ekitisami mpenza soki mwana azali na anémie (hemoglobin < 10 g/dL). Tala niveau ya méthémoglobine na 30 minutes mpe bomba méthémoglobine totale strictement na se 20% to 30% **. 3. Thiosulfate de sodium na kati ya misisa (25% solution): Bolanda mbala moko (after flushing the line) elongo 12.5 grams (50 mL ya 25% solution; monganga ya bana 1.0 to 1.65 mL/kg) mpo na kobongola cyanméthémoglobine mpo na libela na thiocyanate urinaire. 4. Edetate ya Dicobalt (Kelocyanor - Stock ya libula ya Royaume-Uni/Commonwealth): Etambwisami lokola 300 mg (20 mL) IV likolo 1 minute elandaki mbala moko na 50 mL ya 50% Dextrose oyo ezali na kati. Lokola cobalt ya ofele epesaka ba arrhythmies cardiaques makasi, œdème ya elongi/laryngé, mpe hypothénormose soki cyanure ezali te na makila, Esengeli kopesa Dicobalt Edetate KAKA na ba maladi oyo bazali na empoisonnement clinique clinique ya makasi (coma, apnée, to choc), jamais prophylactiquement na ba maladi oyo bazali na bilembo te.

Bobongisi ya Manix na ndenge ya malamu mpe ndelo ya mibeko na ba Noix ya Abricot¶

• Ndenge nini ko détoxifier Manix bololo na ndako (The OMS / FAO "Méthode de mouillage"):
• Grater to pound misisa ya manioko oyo elongolami na nsuki na kati ya mash to farine ya malamu (kobuka ba murs ya ba cellules bongo linamarase ba contacts na ba contacts linamarin).
• Soak / ferment mash na mayi pona 3 to 5 days (to soki ozali kosalela farini ya manioko oyo esi ekauki mpe ezali naino na elɛngi ya bololo, sangisa farini yango na mai na pɔtɔpɔtɔ ya moke oyo ezali na mai mpe panza yango na mwa moke na elili mpo na 5 hours na 30 degrees Celsius bongo résidu linamarase e hydrolyser linamarine na cyanohydrine ya acétone volatile).
• Lamba to tumba malamu na nzungu ya polele donc nionso acétone cyanohydrine na HCN gaz evaporer na mopepe, pe bwaka mayi oyo ezali kosopana/kotɔka.
• Makebisi ya mibeko na ba Noix ya Abricot bololo:
• Arité européenne de sécurité alimentaire (EFSA) mpe Agence ya normes alimentaires ya Royaume-Uni (FSA) basalaki Dose ya Référence aiguë (ARfD) ya 20 micrograms/kg ya cyanure, kosukisa ete kolya koleka 1 to 3 ya mikemike ya noix ya abricot ya bololo epai ya mikóló (to ndambo ya mwa noix moko ya moke na bana mike) eleki limite ya sécurité. Ezala UE (Regulation 2017/1237) mpe Royaume-Uni epekisi koteka ba graines ya abricot bololo brut na ba consommateurs oyo eleki 20 mg/kg ya acide hydrocyanique, mpe Australie/Nouvelle-Zélande epekisi koteka na détail ba graines ya abricot brut lokola bilei mobimba.
• Na Etats-Unis mpe na Canada, FDA ya Etats-Unis epekisi laetrile (amygdalin) lokola eloko oyo endimami te, ya bokosi, mpe ya poison mingi, mpe Health Canada ekitisaka cyanure totale extractable na ba graines ya abricot oyo etekamaka na 20 ppm nzokande azali kokebisa mikóló ete bálya ata moke te mbuma ya bololo.

Protocoles ya accès ya urgence régionale mpe ya antidote¶

• Etats-Unis mpe Canada: Benga 911 mbala moko mpe benga 1-800-222-1222 (Lisalisi ya poison ya Etats-Unis) to 1-844-POISON-X (1-844-764-7669 na Canada). Lisungi ya bomoi ya liboso (ALS) ba ambulance mpe ba départements ya urgence ya lopitalo na Amérique du Nord mobimba stock Hydroxocobalamin (Cyanokit, . 5 g ba fiole) mpe Nithiodote ( .Sodium Nitrite + Sodium Thiosulfate).
• Royaume-Uni mpe Union européenne: Benga na 999 (Royaume-Uni) to 112 (UE). Ba cliniciens ba consulter NPIS / TOXBASE (Royaume-Uni) to ba centres nationales ya poison ya UE (CAPTV, . Giftnotruf). Na Royaume-Uni mpe na UE, ba départements ya urgence ba stockaka Hydroxocobalamin (Cyanokit) mpe Thiosulfate de sodium na armoire ya antidote ya réanimation immédiate (Category A Antidotes required immediately at every acute hospital).
• Australie mpe Nouvelle-Zélande: Benga 000 (Australie) to 111 (Nouvelle-Zélande), mpe tuna na Centre d’information des poisons (13 11 26 na Australie; 0800 764 766 na Nouvelle-Zélande) mpo na mbala moko Cyanokit mpe Sodium Thiosulfate bokambi.
• Afrika ya nse ya Sahara, Amerika ya Sudi, mpe Asie ya Sudi-Ɛsti: Na bitúká oyo bato mingi balyaka manioko (Democratic Republic of the Congo, Mozambique, Tanzania, Nigeria, Brazil, Indonesia, Philippines), epai wapi Cyanokit ekoki kozala na stock te na ba cliniques rurales, kopesa mbala moko 100% Oxygène + Charbon activé + Thiosulfate de sodium intraveineux (25%, . 50 mL IV) + Bicarbonate de sodium intraveineux (mpo na ko corriger acidose lactique makasi) ebikisaka bomoi mpe ebombami mingi.

Mituna oyo batunaka mingi¶

Mpo na nini kozwa ngɛngɛ ya cyanure oyo euti na mbuma ya abricot to manioko ya bololo esɛngaka ngonga 1 to 4 mpo ebanda?¶

Na bokeseni na gaze ya cyanure d’hydrogène oyo epemami (oyo ekɔtaka na mimpululu mpe na makila na boumeli ya mwa basegɔnde), mbuma ya abricot mpe manioko ya bololo ezali na biloko oyo ekangami na sukali ya banzete oyo babengaka glycosides cyanogènes (amygdaline mpe linamarine). Ba composés yango ezali na likama te tii ntango ba enzymes ya banzete (oyo esalaka na kotafuna) mpe mikrobe ya misɔpɔ ya moto ekokata mokemoke bamolekile ya sukali oyo ezali na kati ya intestin grêle alcalin mpe colon, mpe ekobimisa gaze ya cyanure d’hydrogène ya ofele na makila miniti 30 kino ngonga 4 nsima ya kolya.

Pourquoi komela "Vitamine B17" (Laetrile) na monoko ebomaka mingi koleka ba injections intraveineuses?¶

Makila mpe binama ya moto ezali na enzyme bêta-glucosidase te oyo esengeli mpo na kobuka amygdaline na cyanure, yango wana ntango ba injectaka laetrile na misisa, koleka 90% na yango ebimaka kozanga kobongwana na makila. Kasi, ntango bamɛli yango na monɔkɔ, bamiliare ya mikrobe ya bozalisi oyo efandaka na kati ya misɔpɔ mike mpe ya libumu monene ya moto ebimisaka ebele ya ba enzymes bêta-glucosidase oyo ekabolaka laetrile ya monɔkɔ mbala moko na cyanure d’hydrogène oyo ebomaka, mpe yango esalaka ete ba tablettes ya monɔkɔ ezala na ngɛngɛ soki mbala 40 koleka oyo ekɔtisami na misisa.

Nini esalemaka soki mwana ameli na mbalakaka libulu mobimba ya cerise to libanga ya pêche kozanga ete atafuna yango?¶

Soki libulu ya cerise, libulu ya prune, libanga ya pêche, to mboto ya pome emeli mobimba mobimba na libenga na yango ya libanda ya nzete ya makasi oyo ebukani te, amygdaline ekangamaka malamu na kati ya kazaka ya mboto mpe libulu yango elekaka na bozangi likama na kati ya biloko ya kolya na boumeli ya mokolo moko to misato. Empoisonnement ya cyanure esalemaka kaka soki ba tafunaka mboto to mabulu, banyati yango, banika yango, basangisi yango to bapasuka liboso ya komela yango.

Ndenge nini minganga ya urgence ba diagnostiquer poison ya cyanure na 5 minutes soki ba test ya cyanure na makila ezuaka mikolo?¶

Minganga balukaka bilembo mibale oyo ekoki kozala na ntembe te pembeni ya mbeto oyo emonisi ete oxygène cellulaire ekangami: ya liboso, makila ya misisa ya périphérique oyo ezwami na lobɔkɔ emonanaka lokola “rouge-cerise” (kaka lokola makila ya misisa) oyo ezali na saturation ya oxygène veineux koleka 85% tii 90% mpo mitochondrie oyo ezali na ngɛngɛ ekoki kobimisa oxygène na makila te; mpe ya mibale, nivo ya lactate na makila emati koleka 8 kino 10 mmol/L mpo na métabolisme anaérobie ya mbalakaka.

Mpo na nini minganga bapesaka NIOSO Hydroxocobalamine (Cyanokit) mpe Sodium Thiosulfate mpo na empoisonnement ya noix ya abricot?¶

Dose moko ya 5 gramme ya Hydroxocobalamine (Cyanokit) ekɔtisaka mbala moko cyanure oyo ezali kotambola sikoyo na makila mpe na binama na yango mpo ekóma Vitamine B12 oyo ezali na likama te, mpe ebikisaka motema mpe bɔɔngɔ na boumeli ya mwa miniti. Kasi, lokola mbuma ya abricot oyo enyatami to manioko ya bololo ezali kokoba kofanda na misɔpɔ mpe kobimisa cyanure ya sika na boumeli ya ngonga mosusu 4 to 12, kobakisa Thiosulfate de Sodium na misisa (na nzela ya nsinga ya IV oyo ekabwani to oyo epɛtolami) epesaka enzyme rhodanese ya foie soufre ntango nyonso mpo na kosilisa kozwa cyanure ya misɔpɔ oyo ezali kokoba.

"Konzo" ezali nini mpe ndenge nini ezali na boyokani na manioko ya bololo?¶

Konzo ezali paralysie ya makolo mibale ya likolo-moteur-neuron oyo ebebisaka, oyo ekoki kobongwana te (paraparèse spastique) oyo ebɛtaka bana mpe basi oyo bazali na mbula ya kobota na bamboka ya Afrika ya Sudi ya Sahara na ntango ya kokauka mpe nzala. Esalemaka ntango mabota batindaka bango na makasi bálya manioko ya bololo oyo batyá mai na ndenge oyo ebongi te pɔsɔ na pɔsɔ ntango bazali na bozangi makasi ya proteini na bilei (kozanga ba acides aminés méthionine mpe cystéine oyo ezali na soufre oyo foie esengeli mpo na kosilisa ngɛngɛ ya cyanure na thiocyanate).

Mpo na kosilisa malamu makambo ya mbalakaka ya ngɛngɛ, ya nzela ya mpema, mpe ya motema, kanisá kosilisa kelasi ya lisalisi ya liboso mpe ya CPR oyo esalemaka na mabɔkɔ epai ya Croix-Rouge, Ambulance ya St John, to ebongiseli ya formation ya mboka oyo ezwami na mokanda ya kondimama.

Ba guides oyo etali yango¶

• Cyanure, Sulfure d’hydrogène, mpe Gaz industriel mpo na kopema lisalisi ya liboso
• Méthémoglobinémie (Makila ya Chocolat-Marron), Spray ya Benzocaïne, mpe Empoisonnement na Nitrate
• Koluka bilei ya nguba ya zamba (Amatoxine) mpe kolya banzete oyo ezali na ngɛngɛ
• Status Epilepticus, Ba crises ya ntango molai, mpe bankisi ya kobikisa
• Empoisonnement Général Soins ya liboso mpe Décontamination

Maziba mpe bokambi ya Leta¶

• Organisation mondiale de la santé (OMS) & Organisation alimentaire et agriculture (FAO): Mokanda ya mokuse ya évaluation chimique internationale 61: Cyanure d’hydrogène na ba cyanures: Makambo ya bokolongono ya bato; Glycosides cyanogènes na ba tiges ya Manix mpe ya Bambou (Genève).
• Panel ya Autorité européenne ya sécurité alimentaire (EFSA) oyo etali ba contaminants na chaîne alimentaire: Makama ya makasi ya santé oyo etali bozali ya ba glycosides cyanogènes na ba noix ya abricot brut pe biloko oyo ezuami na ba noix ya abricot brut (EFSA Journal).
• BISO. Centres ya contrôle mpe prévention ya maladie (CDC) / ATSDR: Mabongisi ya boyangeli ya monganga mpo na Cyanure d’hydrogène, Cyanure de sodium, mpe ba composés cyanogènes (Etats-Unis).
• Service national d’information ya poisons ya Royaume-Uni (NPIS) / TOXBASE & Royal College of Emergency Medicine: Mabongisi ya antidote: Hydroxocobalamine (Cyanokit), Thiosulfate de sodium, mpe nitrite de sodium na empoisonnement aigu ya cyanure mpe glycoside cyanogène (Royaume-Uni).
• Baud F. J., Barriot P., Toffis V., mpe basusu. / Hall AH, Rumack BH: Bomati ya ba concentrations ya cyanure na makila mpe lactate ya plasma na empoisonnement aigu ya cyanure; Laetrile (Amygdaline) mpe Toxicité ya noix ya Abricot (New England Journal of Medicine / Annals of Urgency Medicine).