Colchicine (Crocus ya automne) vs. Ail ya zamba Koluka bilei Empoisonnement mpe Triage ya Hemlock ya mayi (Cicutoxine) vs. Poison Hemlock (Coniine).¶

Kosala libunga na molona ya zamba oyo ebomaka ete ezali vert ya printemps to ndunda ya misisa oyo ekoki koliama ezali moko ya makambo ya mbalakaka ya monganga oyo esalemaka nokinoki na kominanola na libándá mpe kolamba na ndako. Soki moto azali na mpasi ya kozoka, kozika monoko, kizunguzungu, motema kobeta malɛmbɛmalɛmbɛ, kolɛmba misisa, to kokangama nsima ya kolya ail ya zamba oyo balukaki bilei (ramps), carottes ya zamba, to persnips ya zamba, 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. Ntango ozali kozela basali ya lisalisi ya liboso, talelá makambo na biso ya monene protocole ya kolya nguba ya zamba mpe banzete ya ngɛngɛ, bomibongisa mpo na status epilepticus ba crises oyo eumelaka mingi soki Mai Hemlock eliama, mpe zala prêt ya ko initier kozongisama ya motema mpe ya mimpululu (CPR) . soki Poison Hemlock to Autumn Crocus esalaka ete mpema to motema ekangama.

Na Mpoto mobimba, na Amerika ya Nɔrdi mpe na Azia oyo ezali na molunge makasi, mitambo mibale oyo eyebani mingi oyo ezali lokola banzete ya zamba ezali kobimisa ngɛngɛ mingi oyo ebomaka banzete ya zamba: 1. Motambo ya "Ail ya zamba" ya nkasa ya monene: Bato oyo balukaka bilei bazali kosangisa biloko oyo ekoki koliama Ail ya zamba / Ramsons (Allium ursinum) to Amérique du Nord Ramps (Allium tricoccum) na ba zamba ya printemps humides kobuka na mbalakaka nkasa ya vert oyo ezali kobima ya Autumn Crocus / Meadow Saffron (Colchicum autumnale) to Hellebore ya lokuta (Veratrum album / . Veratrum viride), oyo ekolaka pembenipembeni na mabele moko mpenza. Alors que Veratrum e déclenchaka kosanza noki, bradycardie makasi, na hypothénormose na kati 30 to 120 minutes oyo ezo répondre na ndenge ya somo na atropine, Colchicum autumnale ezali na poison mitotique ya fuseau colchicine, oyo ezo imiter gastroenterite sans danger pona 24 hours liboso ya kobimisa bozangi ya binama mingi oyo ebomaka, choc cardiogène, mpe aplasie ya moelle osseuse oyo ezali na antidote moko te oyo epalangani mingi na mombongo. 2. Motambo ya Umbellifer "Carottes sauvage / Persnip": Bato oyo balukaka bilei oyo bazali kobuka bato ya libota ya carottes/persil (Apiaceae) libunga Hemlock ya mayi ( .Cicuta maculata, . Cicuta virosa, to Oenanthe crocata) to Hemlock ya ngɛngɛ (Conium maculatum) mpo na carottes ya zamba (dantelle ya Queen Anne), persnip ya zamba, angelica, to céleri ya zamba. Atako bango mibale bamemaka nkombo "hemlock," ba toxines na bango ezali ba opposés cliniques: Hemlock ya mayi ezali na cicutoxine (to oenanthotoxine), antagoniste central ya GABA-A ya mobulu oyo e déclenchaka épilepticus status réfractaire na kati ya 15 à 60 minutes, alors que Poison Hemlock ezali na alcaloïde nicotinique coniine, oyo epesaka paralyse respiratoire flaccide oyo ezali lokola curare oyo ezali komata ntango moto oyo azwi mpasi atikalaka kolamuka mobimba tii ntango hypoxie ekokɔta.

+-------------------------------------------------------------------------+
|        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) |
+-------------------------------------------------------------------------+

Sala boye sikoyo¶

1. Benga ba services ya urgence mpe Contrôle ya Poison mbala moko. Benga na 911 (Etats-Unis mpe Canada), 112 (Union européenne), 999 (Royaume-Uni), 000 (Australie), to 111 (Nouvelle-Zélande). Kozela te bilembo ebanda soki moto amoni ete awuti komela Autumn Crocus, Water Hemlock, Poison Hemlock, to False Hellebore: colchicine ezali na bokosi 2 to 12 hour phase silencieuse oyo na boumeli na yango décontamination ya intestin ya lopitalo na ebandeli ezali chance seule ya kopekisa absorption cellulaire fatale.
2. Kosangisa mpe kokanga fɔtɔ́ ya molona oyo ebebi te, bakisa mpe bulbe/mosisa, moboko ya lititi, mpe nkasa. Tia échantillon oyo elambi te ya nkasa, matiti, ba tubers, to bulbes (bakisa supu, pesto, to salade nyonso oyo etikali) na saki ya papier to na récipient mpe mema yango elongo na mobeli na salle d’urgence. Ba toxicologistes ya urgence mpe ba botanistes ya centre ya poison oyo babengami basalelaka ba chambre ya misisa, ba taches ya tige, venation ya nkasa, mpe nsolo ya ail mpo na koyeba toxine ya sikisiki na boumeli ya miniti.
3. Kosala ata moke te kosanza na ndako. Kopesa te sirop ya ipecac, mayi ya mungwa, to kokanga misapi te. Soki molona yango ezalaki Water Hemlock (Cicuta), ba crises généralisées violentes ekoki ko frapper na kati 15 minutes ya kolya, kosala aspiration pulmonaire oyo ebomaka soki moto yango azali kosanza.
4. Tia mobeli alali na mopanzi na ye mpe komibongisa soit ba crises to pema ya kozanga kopema.
5. Soki moto yango aliaki misisa/tubered chambered pembeni ya creek to marsh (Water Hemlock), longola biloko ya makasi mpe cushion motó na ye mpo na komibongisa mpo na ba convulsions tonic-cloniques ya mbalakaka.
6. Soki moto yango alei lititi ya mabulu oyo ezali na ba taches violets to nkasa oyo ezali lokola fougère (Poison Hemlock), tala ntolo na ye komata malamu: soki makolo na ye ayoki kilo mpe pema na ye ekomi mozindo to etelemi, banda kopema ya kobikisa / ventilation ya sac-valve-mask (to CPR mobimba soki pulseless) mbala moko.
7. Soki mutu ayoki kizunguzungu na pulse ya malembe na se 45 beats per minute sima ya kolia nkasa ya vert ya large (False Hellebore), lalisa yango plat pe tombola makolo 30 centimeters (12 inches) mpo na kosunga makila ezongi na motema kino ba paramédicaux bakopesa atropine na misisa.
8. Kebisa bato nyonso mosusu oyo bakabolaki bilei mbala moko. Pesto ya ail ya zamba, supu ya rampe, mpe salade ya bilei ekabolamaka mingi epai ya bato ya libota, bapaya oyo balyaka na mpokwa, to baninga ya kaa. Moto nyonso oyo amɛlaki ata nkasa moko to mbɛki ya bouillon ya kolamba (colchicine mpe alcaloïdes ya veratrum ezali completement chaleur-stable mpe ekɔtaka na mai ya supu) asengeli kokende mbala moko na lopitalo ata soki ayoki malamu.

Nzete ya mokano : Identification botanique mpe triage clinique ya toxidrome¶

flowchart TD
    A["Maladi ya Aiguë to Komela Nsima ya Koluka bilei ya Milona ya Zamba"] --> B{"Lolenge nini ya molona ebukamaki?"}
    B -->|"Nkasa ya Vert Lisse ya large (Erreur na Ail ya zamba / Rampes)"| C{"Tala Début ya Symptôme & Rate Cardiaque"}
    B -->|"Nkasa oyo ezali lokola fougère to Bafololo ya Parapluie ya Pembe / Misisa (Ekanisami ete ezali Carottes ya zamba / Parsnip)"| D{"Tala Signe Neurologique Dominant"}
    C -->|"Ebandeli ya mbangu (30-120 min) + Bradycardie makasi (HR < 45) + Hypotension"| E["LOKUTA HELLEBORE (Album ya Veratrum / viride) - Réflexe ya Bezold-Jarisch"]
    C -->|"Début retardé (2-24 hrs) + Diarrhee profuse oyo ekokani na Choléra + Tachycardie"| F["CROCUS YA OTUMNE (Colchicum autumnale) - Empoisonnement mitotique ya colchicine"]
    E --> G["Pesa Charbon Activé (< 1-2h); IV 0,9% Saline + IV Atropine (0,5-1,0 mg q3-5m) -> Dopamine/Phenyléphrine soki esengeli"]
    F --> H["Charbon activé à dose multiple agressif (MDAC q4-6h) + Réanimation ya volume ya ICU ya liboso + G-CSF mpo na Pancytopénie"]
    D -->|"Epilepticus Status Généralisé ya Mobulu na kati ya 15-60 Minutes"| I["HEMLOCK YA MAYI (Cicuta maculata / virosa / Oenanthe crocata) - Cicutoxine"]
    D -->|"Ascending Muscle Flaccid & Paralyse Respiratoire na Esprit ya Polele"| J["HEMLOCK YA POISON (Conium maculatum) - Blocage nicotinique ya coniine"]
    I --> K["Batela nzela ya mpepo; Benzodiazépines IV ya dose ya likolo -> Phenobarbital to Propofol + Refroidissement actif + Bicarbonate pona Rhabdomyolyse"]
    J --> L["Intubation Endotrachéale Immédiate & Ventilation Mécanique pendant 24-72 Heures (Eviter Succinylcholine) + Charbon Activé"]

Comparaison botanique et clinique ya ba 4 syndromes ya koluka bilei oyo ebomaka¶

Eteni 1: Bato oyo bazali komonana lokola ail ya zamba: Crocus ya automne (Colchicine) vs. Hellebore ya lokuta (Veratrum) .¶

Na eleko nyonso ya prɛnta na Mpoto, na Royaume-Uni, mpe na Amerika ya Nɔrdi, bankóto ya bato balukaka bilei na bazamba oyo ezali na mai mingi mpe nkasa ekiti mpo na Ail ya zamba (Allium ursinum) to Ba rampes (Allium tricoccum) mpo na kosala pesto ya ail ya zamba, supu, to ba verts sauté. Po ail ya zamba ekolaka na ba tapis dense kaka na ba patches ya Autumn Crocus (Colchicum autumnale) mpe Hellebore ya lokuta (Veratrum album na Mpoto; Veratrum viride na Amerika ya Nɔrdi), mbala mingi nkasa moko ya nkasa oyo bakangi ezalaka na mitindo nyonso misato ya banyama. En plus, mbala moko misapi ya forager ezipami na jus ya ail ya zamba oyo enyatami, maboko na bango ezo nsolo lokola ail, ekosaka "test ya sniff" tango ba inspecter ba feuilles oyo elandi.

Syndrome 1A: Crocus ya automne (Colchicum autumnale) mpe Lily ya Nkembo (Gloriosa superba): Empoisonnement na colchicine¶

Biteni nyonso ya Colchicum autumnale (nkasa, corm/bulbe, mboto, mpe bafololo ya ɔtɔne) mpe ba tubercules ya Gloriosa superba ya tropical ezali na ba concentrations ya likolo (0.1% to 0.6%) ya alcaloïde colchicine. Komela mingi koleka 0.5 mg/kg ya colchicine (roughly 2 to 5 fresh leaves of Autumn Crocus mpo na mokóló, to 1 leaf mpo na mwana) mbala mingi ebomaka, mpe ba dose eleki 0.8 mg/kg cause presque 100% liwa na choc cardiogène mpe na insuffisance multi-organes.

Physiologie pathophisiologie na ba 3 étapes cliniques ya toxicité ya Colchicine¶

Colchicine ekangamaka na ndenge ya irreversible na ba dimères alpha- mpe bêta-tubuline intracellulaire, kopekisa yango e polymériser na microtubules. Soki ba microtubules oyo ezali kosala ezali te, ba cellules ekoki kosala brosse mitotique te mpo na kokabwana (kokanga ba cellules nionso oyo ekabwanaka noki na métaphase), mpe ba cellules oyo ekabwanaka te (lokola ba myocytes cardiaques mpe ba nerfs périphériques) ebungisaka transport ya vésicules intracellulaire mpe contractilité.

+-------------------------------------------------------------------------+
|            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)         |
+-------------------------------------------------------------------------+

Gestion lopitalo ya étape par étape ya Empoisonnement ya Colchicine¶

1. Kolongolama ya misɔpɔ mbala moko mpe mbala na mbala (Even if Presenting Late): Lokola colchicine ezuaka recirculation enterohépatique ya monene (e secréter na bile mpe e réabsorbé na intestin grêle) mpe e ralentir motilité gastro-intestinal, pesa aspiration gastrique/lavage ya liboso (soki na kati 1 to 2 hours ya kolia nkasa) mpe kobanda Makala activé à dose ebele (MDAC: 1 . 50 grams na ebandeli, bongo 25 grams nyonso 4 to 6 hours mpo na 24 to 48 hours). Charbon activé ekangisaka colchicine makasi na lumen ya intestin mpe ezali mesure seule oyo eleki malamu mpo na kokitisa létalité systémique.
2. Hémodynamique agressif mpe Réanimation ya ICU: Infuser ba volumes massifs ya ba cristalloïdes équilibrés na tango ya Stage 1 mpo na ko remplacer 5 to 10 liters ya kobungisa mai ya GI oyo ekokani na choléra. Sala échocardiographie pembeni ya mbeto ya liboso : lokola choc hypovolémique ya Stage 1 e transition na Stage 2 choc cardiogénique direct (typically at 24 to 72 hours), kobongola na ba fluides ya volume mingi na ba inotropes (norépinephrine + dobutamine to épinephrine) mpe kotalela na ebandeli Oxygénation ya membrane extracorporelle veno-artériale (V-A ECMO) liboso ete asystole réfractaire esalema.
3. Facteur oyo elamusaka colonie ya ba granulocytes (G-CSF / . Filgrastim): Bolandela motango mobimba ya makila mbala mibale na mokolo. Moment oyo globule blanc (WBC) motángo ebandi kokita na yango ya mbangumbangu (typically Day 3 to 4), kobanda na nse ya loposo Filgrastim ( .G-CSF, . 5 micrograms/kg/day) mpe kotia mobeli na isolement neutropénique protectrice na ba antibiotiques intraveineuses ya spectre large mpe transfusions ya ba plaquettes mpo na kobika na aplasie nadir ya moelle osseuse.
4. Pourquoi Dialyse Fails & Fab Fragments: Po colchicine ekota noki na ba cellules pe eza na volume ya distribution munene (2 to 12 L/kg), hémodialyse mpe hémoperfusion elongolaka te colchicine (atako CRRT esalelamaka mpo na insuffisance rénale aiguë mpe acidose). Expérimental ba fragments ya anticorps Fab ovine spécifique ya colchicine ezo reverser na ndenge ya somo toxicité na ba études cliniques, atako stock commercial ezali très limité na mokili mobimba; consulter Poison Control mbala moko pona kotala soki ba recherches ezali.

Syndrome 1B: Hellebore ya lokuta (Veratrum album, . Veratrum viride, . Veratrum californicum): Syndrome ya Bradycardie ya Bezold-Jarisch¶

Na bokeseni na retard letalité ya Autumn Crocus, kolia nkasa ya False Hellebore (to komela liqueur gentian ya ndako oyo esalemi na libunga na misisa ya Veratrum album) e déclenchaka ba symptômes dramatiques na kati ya 30 minutes to 3 hours **.

• Mecanisme: Lolenge ya Veratrum ezali na ba alcaloïdes stéroïdes veratrum (veratridine, . protoveratrine A and B, . germerine, mpe jervine). Ba toxines wana oyo epɔlaka na lipide ekangamaka na sodium oyo efungwami voltage-gated (Na+) ba canaux na nerf vague, ba barorécepteurs ya sinus carotide, mpe ba mécanorécepteurs ventriculaire gauche, kopekisa inactivation ya canal de sodium. Kosala masasi mbala na mbala mbala na mbala ya ba fibres vagales sensorielles cardiaques e activaka reflexe Bezold-Jarisch : troche ya cerveau e percevoir que motema ezali dangereusement sur-étirré mpe ezo répondre na ko dégager ton vagal parasympathique massif tout en kangaka ton vasculaire sympathique.
• Présentation clinique: Na kati ya 30 to 120 minutes, mobɛli akómaka kozika makasi na nsima ya mikuwa, kosanza makasi, kolɛmba nzoto mpe kolɛnga zingazinga ya monɔkɔ mpe nsɔngɛ ya misapi (paresthesia), kotungisama ya komona ( .xanthopsia), bradycardie ya sinus ya mozindo (heart rate 30 to 45 beats per minute), atrioventriculaire ( .AV) kokangama ya motema, mpe hypotansion artérielle makasi (systolic BP < 60 to 70 mmHg).
• Traitement oyo etalisami:
• Makala activé ya dose moko (50 grams na monoko soki na kati 1 to 2 hours mpe nzela ya mopɛpɛ ezali na likama te) + antiémétiques (ondansetron).
• Boluses ya fluide intraveineux noki: Kopesa 1 to 2 liters ya 0.9% saline normale.
• Atropine oyo epesamaka na misisa (The Specific Physiologic Antagonist): Kopesa Atropine 0.5 to 1.0 mg IV push chaque 3 to 5 minutes (up to 3 mg total na mikóló; 0.02 mg/kg na bana). Atropine ekangaka ba récepteurs vagales muscariniques na ba ganglions sinoatrials mpe atrioventriculaires, mbala moko ezo reverser bradycardie na blocage cardiaque.
• Vasopresseurs mpo na Hypotension persistante: Lokola réflexe Bezold-Jarisch esalaka mpe retrait sympathique central (vasodilation périphérique) pembeni ya bradycardie, tansion ekoki kotikala mwa moke ata sima ya atropine kozongisa rythme cardiaque normal; bakisa infusion ya phenyléphrine, dopamine, to norépinephrine ya dose moke mpo na 12 to 24 hours tii ntango akobika mobimba (virtually 100% of Veratrum patients recover fully within 24 to 48 hours with supportive care).

Eteni 2: Libota ya Carottes (Apiaceae) Bato oyo bazali komonana lokola: Hemlock ya mai (Cicutoxin) vs. Hemlock ya ngɛngɛ (Coniine) .¶

Libota ya botanique Apiaceae (Umbelliferae) ezali na bilei ya elengi oyo bato basalaka na bilei (carottes, pastinages, céleri, persil, fenugrec, aneth, coriandre) pembeni ya banzete mibale oyo ebomaka mingi neurotoxiques na Hémisphère du Nord: Water Hemlock (Cicuta lolenge ya banyama mpe Oenanthe crocata) mpe Hemlock ya ngɛngɛ (Conium maculatum). Bango mibale bazali na bituluku ya bafololo ya mpɛmbɛ oyo ezali lokola parapluie (compound umbels), matiti ya matonga oyo ezali na mabulu, mpe nkasa ya kosangisa oyo ekabolami malamu.

+-------------------------------------------------------------------------+
|     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   |
+-------------------------------------------------------------------------+

Syndrome 2A: Hemlock ya mai (Cicuta maculata, . Cicuta virosa) mpe Hemlock Water Dropwort (Oenanthe crocata): Ezalela ya cicutoxine Epilepticus¶

Water Hemlock etalelami mingi lokola nzete ya mboka oyo ezali na ngɛngɛ makasi na Amerika ya Nɔrdi mpe na nɔrdi ya Mpoto. Misisa ya tuberous oyo ezali na elɛngi ya sukali, oyo ezali na nsolo kitoko ya parsnip mpe ba chambre ya lititi ya nse ezali na mai ya monene, ya jaune, ya mafuta oyo ezali na cicutoxine (to oenanthotoxine na Oenanthe crocata, oyo emonanaka mingi na Royaume-Uni mobimba mpe na Europe occidentale), aliphatique insaturée C17 masanga ya polyacétylénique. Koswa moko (2 to 3 centimeters) ya misisa ya Water Hemlock, to ata mwana oyo azali kosalela lititi oyo ezali na mabulu lokola peashooter to whistle, akoki kopesa dose oyo ebomaka.

• Mecanisme: Cicutoxine ekatisaka barrière ya makila-cerveau noki mpe ekangamaka sans concurrence na site ya picrotoxine na ba complexes récepteur-ionophore ya système nerveux central GABA-A, ekangaka mobimba conductance ya canal chlorure. Soki GABA epekisami te, ba neurones corticales mpe ya tronc cerveau e dépolariser continuellement.
• Présentation clinique (15 to 60 minutes): Na kati ya 15 minutes ya komela mosisa, moto oyo azwi mpasi ayokaka mpasi na motema, abimisaka mai mingi, ayokaka mpasi na libumu, akómaka kizunguzungu, mpe miso na ye epanzani (mydriasis), elandi na mbalakaka na ba crises tonic-cloniques généralisées généralisées, oyo ezongaka mbala na mbala (status epilepticus). Ba convulsions ezalaka makasi mingi na boye ete mbala mingi ba malades ba souffrir na ba lacerations ya monoko, ba opisthotonos, ba fractures ya compression vertébrale, hyperthermie ya makasi (> 41 degrees Celsius), rabdomyolyse ya monene ( .creatine kinase > 50,000 U/L), esika makasi ya ba anions mingi acidose lactique (pH < 6.9), insuffisance rénale myoglobinurique, mpe arrêt cardiaque hypoxique.
• Bokambami ya lopitalo ya mbalakaka:
• Contrôle ya ba crises ya voie respiratoire na GABA-Agoniste ya mbala moko: Kolekisa tango te na phenytoïne (ineffective against GABA-A blockade). Kopesa dose ya likolo na misisa benzodiazépines (lorazepam 4 mg IV to mpe diazepam 10 mg IV), komata mbala moko kino na phenobarbital intraveineux ( .15 to 20 mg/kg) to intubation ya séquence rapide na infusion continue ya propofol to midazolam.
• Blocage neuromusculaire mpe refroidissement actif mpo na Rhabdomyolyse: Soki rigidité musculaire mpe hyperthermie ewumeli malgré sédation profonde ya agoniste GABA, pesa bloquant neuromusculaire non dépolarisant (rocuronium to mpe vecuronium; koboya succinylcholine mpo na risque ya hypercalémie) na se ya bolandi ya EEG oyo ezali kolandana mpo na kopekisa mbala moko bokeli ya molunge ya misisa ya mikuwa mpe kobimisama ya myoglobine.
• Bicarbonate de sodium agressif et diurése fluide: Ko infuser ba cristalloïdes intraveineux isotropes na bicarbonate de sodium intraveineux pona ko corriger acidose métabolique makasi pe ko alcaliner makila (target urine pH > 6.5), kopekisa mbula ya myoglobine oyo ekɔtisami na ba tubules rénaux. Salá hémodialyse liboso soki hypercalémie réfractaire, acidose, to insuffisance rénale anurique ekómi.

Syndrome 2B: Hemlock oyo ezali na ngɛngɛ (Conium maculatum): Coniine Paralysie respiratoire ascendante¶

Ezali na ngɛngɛ Hemlock (Conium maculatum), oyo eyebani mingi na lisolo ya kala lokola ngɛngɛ ya kobomama ya filozofe Socrate na 399 BCE, ezali na ba alcaloïdes pipéridine mwambe oyo ekoki kopɔla, mingimingi coniine mpe gamma-coniceine. Lokola nkasa na yango ya dantelé, oyo ezali lokola fougère emonanaka pene na ndenge moko na nkasa ya persil ya nkasa ya patatalu, ya chervil, to ya carottes ya zamba (mpe misisa na yango ya mpɛmbɛ ya tapo ekokani na parsnip), mbala mingi bato oyo batambolaka na bangomba mpe bato oyo basalaka bilanga na bandako bamɛlaka yango na libunga.

• Mecanisme (Biphasic Nicotinique Blockade): Coniine ezali na structure chimique mpe action pharmacologique ekokani mingi na nicotine mpe curare. Esalaka na ba phases mibale ekeseni na ba ganglion autonome mpe na jonction neuromusculaire ya muscle squelettique (nicotinic acetylcholine receptors [nAChR]):
• Eteni 1 (Simulation ya liboso ya nicotine, 15 to 60 minutes): Kozika na monoko mpe na zolo, kobimisa mai mingi, kozoka, kosanza, kolɛmba ya libumu, tachycardie, hypertension, ba pupilles dilatées, mpe ba fasciculations/tremures ya misisa ya mabe.
• Phase 2 (Blocage neuromusculaire dépolarisant/non dépolarisant, 1 to 4 hours): Bokangami ya ba récepteurs oyo ewumeli e désensibiliser mpe e bloquer ba récepteurs acétylcholine nicotiniques na plaque final motrice, ebimisaka classique paralyse flaccide ascendante-like curare.
• "Elembo ya Socrate" (Paralysie ascendante na conscience claire): Paralysie ebandi na makolo mpe na makolo (esalaka ataxie ya kobɛta libaku mpe kozanga makoki ya kotelema), ematamaka ntango nyonso na makolo, na tronc, mpe na maboko, mpe na nsuka e paralyser misuni ya intercostal mpe diaphragme, nzokande ezali ko épargner système nerveux central. Kino hypoxie cérébrale makasi ekobanda na arrêt respiratoire, mobeli atikalaka na kolamuka mobimba, lucide, mpe na somo, akoki koningana to kopema te. Coniine ekoki mpe kosala rhabdomyolyse directe mpe nécrose tubulaire aiguë.
• Bokambami ya lopitalo ya mbalakaka:
• Intubation endotrachée ya liboso mpe ventilation mécanique (The Definitive Cure): Antidote chimique ezali te mpo na coniine (mpe esengeli TE kopesa ba anticholinesterases lokola néostigmine to physostigmine, mpo ekoki kobebisa blocage nicotinique dépolarisant mpe ko déclencher crise cholinergique). Au lieu ya kosala bongo, ventilation mécanique ezali 100% ya kobikisa bomoi. Kokɔtisa mobɛli intubation liboso ntango kaka makoki ya kopema na makasi to nguya ya kopema mabe elɛmbi (avoid succinylcholine), kopesa nkisi oyo ebongi mpo na kosilisa mpasi ( .propofol/ .midazolam yango wana mobɛli oyo azali paralize oyo azali na makanisi malamu azali kolamuka te na ventilateur), apesa makala activé na nzela ya tube nasogastrique, mpe apesa ventilateur mpo na 24 to 72 hours **. Soki foie mpe mimpululu esali métabolisme mpe ebimisaka coniine, makasi ya misisa ya misisa ezongaka mobimba kozanga ba séquelles neurologiques ya libela.

Protocoles ya urgence régionale mpe ya contrôle ya poison¶

• 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). Na Amerika ya Nɔrdi, Hemlock ya mai (Cicuta maculata mpe Cicuta douglasii), Hemlock ya ngɛngɛ (Conium maculatum), mpe Hellebore ya lokuta / Lis ya maïs (Veratrum viride mpe Veratrum californicum) epalangani mingi na bisika oyo mai ezali mingi, na matiti ya ngomba, mpe na pembenipembeni ya banzela; ba Centres de Poison régionaux ebatelaka ba réseaux ya revue numérique ya bilili 24/7 na ba toxicologues mpe ba botanistes oyo ba consulter mpo na koyeba ba échantillons ya ba plantes oyo ezuami na ba photos oyo etindami na ba salles d’urgence.
• Royaume-Uni mpe Union européenne: Benga na 999 (Royaume-Uni) to 112 (UE). Na Allemagne mobimba, Autriche, Suisse, France, Italie, Slovénie, mpe Royaume-Uni, mobulungano ya koluka bilei ya prɛnta kati na Bärlauch / Ramsons (Allium ursinum) mpe Herbstzeitlose ( .Colchicum autumnale) to Weißer Germer (Veratrum album) esalaka ete ebele ya bato bákɔta na ICU mpe bákufa na sanza ya minei mpe ya mitano nyonso. Na Royaume-Uni mpe na libongo ya Mpoto ya wɛsti, Hemlock Water Dropwort (Oenanthe crocata, "Misapi ya Moto akufi") ba tubercules oyo esukolami pembeni ya bibale mpe mabongo esalaka ete statut ya oenanthotoxine ya mbangu epilepticus ekokani na Cicuta. Ba cliniciens basengeli kotala NPIS / TOXBASE (Royaume-Uni) to ba centres nationales ya poison ya UE (Giftnotruf / . Tox Info Suisse / . CAPTV) mbala moko.
• 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). Akɔtisaki Hemlock ya ngɛngɛ (Conium maculatum) mpe biloko ya kokembisa Gloriosa Lily (Gloriosa superba, oyo ezali na colchicine mingi) ezali bantina ya ntina ya poison ya banzete na mikili nyonso mibale.
• Asia mpe bitúká ya mikili ya molunge: Na Inde mobimba, Sri Lanka, mpe Sudi-Ɛsti ya Azia, ba tubers ya Flame Lily / Glory Lily (Gloriosa superba) ezali ntina monene ya empoisonnement makasi ya colchicine (ezala na mbalakaka mpe na mokano), oyo ekambami na protocole identique ya Charbon activé Multi-Dose, hémodynamique ya ICU, mpe G-CSF oyo esalelamaka mpo na Colchicum autumnale.

Mituna oyo batunaka mingi¶

Ndenge nini bato babulunganisaka Crocus ya Automne to False Hellebore oyo ebomaka na Ail ya Zamba oyo ekoki koliama?¶

Na ebandeli ya prɛnta liboso ete bafololo ebima, Ail ya Zamba oyo ekoki koliama (Allium ursinum) mpe Rampe (Allium tricoccum) etindaka nkasa ya minene, ya vert, oyo ezali lokola lance na mabele ya zamba oyo ezali na mai pembenipembeni ya nkasa ya vert oyo ezali kobima ya Autumn Crocus (Colchicum autumnale) mpe False Hellebore (Veratrum album to viride). Ntango moto oyo azali koluka bilei azwi mwa nkasa ya ail ya zamba na mbala moko, babukaka na pɛtɛɛ nyonso nkasa ya Crocus ya Automne to ya Hellebore ya lokuta oyo ezali kokola na katikati ya esika yango, mpe lokola mabɔkɔ na bango esi elati mafuta ya ail, emonani ete nkasa ya ngɛngɛ oyo ezali na nsolo te mpe ezali koyoka nsolo lokola ail.

Ndenge nini monganga akoki koyeba soki moto moko ya maladi oyo azalaki koluka bilei ya ail ya zamba alyaki Crocus ya Automne to Hellebore ya lokuta?¶

Ntango mpe rythme cardiaque ekabolaka mbala moko mibale: False Hellebore (Veratrum) ebetaka noki na kati ya 30 minutes to 3 heures, epesaka kosanza makasi elongo na rythme cardiaque ya likama ya malembe (bradycardie sinus makasi na se ya 45 bpm) mpe tansion ya nse oyo ezongaka sima noki na atropine intraveineuse. Crocus ya Automne (colchicine) ezali na retard ya bokosi ya ngonga 2 kino 24 liboso ya kobimisa diarrhee ya makila lokola choléra mpe rythme cardiaque ya mbangu (tachycardie), kokende liboso na Mikolo 2 kino 7 kino na choc cardiogène oyo ebomaka mpe insuffisance ya moelle osseuse.

Bokeseni nini ezali kati na Hemlock ya Mai (Cicuta) mpe Hemlock ya Poison (Conium)?¶

Atako bango mibale bazali bato ya libota ya carottes oyo ezali na bafololo ya parapluie ya mpɛmbɛ mpe matiti ya mabulu, babundisaka système nerveux na ndenge ekeseni. Water Hemlock (lolenge ya Cicuta) ekolaka na ba marécages ya mayi, ezali na misisa ya chambre oyo esopanaka mafuta ya jaune, mpe ezali na cicutoxine, oyo ekangaka ba récepteurs GABA-A ya cerveau mpo na kosala ba crises ya épileptique explosif, ya statut continu na kati ya miniti 15 to 60. Poison Hemlock (Conium maculatum) ekolaka na mabele ya kokauka, ezali na matiti ya tache ya violet, mpe ezali na coniine, oyo ekangaka ba récepteurs muscles périphériques mpo na kosala paralysie respiratoire flaccide ascendante ntango mobɛli azali kolala mpɔngi.

Pourquoi Charbon Activé Multi-Dose ya ebandeli ezali critique mingi soki mutu alei Crocus ya Automne?¶

Soki colchicine ekɔti na baselile ya misisa ya motema mpe ya moelle osseuse mpe ekangami na tubuline intracellulaire, hémodialyse ekoki kolongola yango te mpe antidote standard ezali mingi te. Kasi, foie ebimisaka colchicine ntango nyonso na bile mpe ekɔtaka lisusu na misɔpɔ mike; kopesa ba doses mbala na mbala ya Charbon Activé chaque 4 à 6 heures ekanga colchicine na lumen ya intestin, ekata recyclage biliaire, mpe ekoki kopekisa arrêt cardiaque ya Stage 2 oyo ebomaka.

Moto akoki kobika na Poison Hemlock (Conium maculatum) soki pema na ye etelemi?¶

Oui, na soins d’urgence ya mikolo oyo, kobika na Poison Hemlock ezali pene na 100% soki pema ya kobikisa mpe ventilation mécanique ya lopitalo ebandi avant que ba dégâts hypoxiques ya cerveau esalema. Lokola coniine ebebisaka libela bɔɔngɔ to misisa te, kotya mobɛli na masini ya kopema mpema oyo ezali na nkisi ya kolɛmbisa nzoto na boumeli ya ngonga 24 to 72 epesaka nzoto nzela ya kosala métabolisme mpe kobimisa ngɛngɛ yango tii ntango makasi ya misisa mobimba ekozonga.

Ko lamba to kolamba ba verts ya zamba ebebisaka ba toxines oyo ezali na Autumn Crocus to Hemlock?¶

Te, kolamba, kolamba, kotumba to kokaukisa ebebisaka te colchicine, alcaloïdes veratrum, to cicutoxine. Kutu, kotɔkisa nkasa ya Autumn Crocus to False Hellebore na mai ya supu to ya pâtes ebimisaka biloko ya ngɛngɛ oyo epɔlaka na mai mbala moko na mai ya kolamba, mpe epesaka ngɛngɛ na moto nyonso oyo azali kolya bouillon yango.

Mpo na kotikala na bokengi na ntango ya kominanola libanda mpe ya mbalakaka ya esobe, kanisá kosala cours ya secours ya liboso mpe CPR ya maboko uta na Croix-Rouge, Ambulance ya St John, to mopesi ya nkisi ya esobe oyo azali na mokanda ya kondimama.

Ba guides oyo etali yango¶

• 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
• CPR: Kozongisa bomoi na motema mpe mimpululu na litambe na litambe
• Empoisonnement alimentaire, Gastroentérite aiguë, mpe Déshydratation
• Empoisonnement Général Soins ya liboso mpe Décontamination

Maziba mpe bokambi ya Leta¶

• Ebongiseli ya États-Unis. Centres ya contrôle mpe prévention ya bokono (CDC): Rapport ya poso na poso ya bokono mpe liwa (MMWR): Ba poisons ya Hemlock ya mayi (Cicuta maculata), Hemlock ya poison (Conium maculatum), mpe ya Hellebore ya lokuta (Veratrum viride) oyo esangisi na koluka bilei (Etats-Unis).
• Institut fédéral allemand ya évaluation ya ba risques (BfR) & Centre suisse d’information toxicologique (Tox Info Suisse): Kebisi ya ba consommateurs mpe guidance clinique na oyo etali ko confuser ail sauvage (Allium ursinum) na Crocus ya automne (Colchicum autumnale) na Hellebore ya pembe (album ya Veratrum) (Union européenne na Suisse).
• Service national d’information ya poisons ya Royaume-Uni (NPIS) / TOXBASE: Gestion clinique ya Colchicum autumnale (Colchicine), Oenanthe crocata (Hemlock Water Dropwort), mpe Conium maculatum Ingestion (Royaume-Uni).
• Finkelstein Y, Aks SE, Hutson JR, Juurlink DN, et al.: Empoisonnement ya colchicine: côté ya molili ya kisi ya kala (Toxicologie clinique).
• Schep LJ, Slaughter RJ, Becket G, Beasley DM: Empoisonnement oyo euti na hémlock ya mayi (espèce ya Cicuta) na hémlock ya poison (Conium maculatum) (Toxicologie clinique / Centre national ya poisons ya Nouvelle-Zélande).