Manyoka (Bitter Manioc Linamarin) ne Apricot Kernel (Amygdalin / Laetrile) Kudia: Disama dia Cyanide dia mu bitupa bia munda¶

Kudia manioko mubi (Manihot esculenta, manioc/yuca), kutafuna bimuma bia abricot, bipese bia peach/cherry/plum bitshibule, anyi amande bitter, anyi kumina manga makuabu "Vitamine B17" (amygdalin anyi laetrile) bintu bia pa mutu bidi mua kunyanga muoyo dipanga dia Hydrogène Cyanide (HCN) poison. Bikila nimero ya njiwu ya muaba unudi (911 mu États-Unis ne Canada, 112 mu Union européenne mujima, 999 mu Royaume-Uni) anyi yukila netu tshilaminu tshia nomba ya njiwu ya pa buloba bujima diakamue, ne wambila muena mudimu ne: mubedi udi dijinga ne Hydroxocobalamin (Cyanokit) anyi tshiamu tshia cyanide antidote (Sodium Thiosulfate / Sodium Nitrite). Paudi muindile baminganga, enza bua dilama diebe dia lukasa dikale dipetangana ne dietu bulombodi bua diambuluisha dia kumpala dia dipuekesha dia cyanide ne gaz industriel, kushilanganisha mashi a tshitoke tshia cyanide ne methemoglobinemia wa tshikolakola, ne udilongolole bua nsombelu wa tshimpumpu udi mutantshi mule anyi CPR.

Bishilangane na gaz wa cyanure wa hydrogène udibu bapuekesha (udi ukebesha dikuluka munda mua 10 to 60 seconds), kumina cyanogenic glycosides, nangananga linamarin (mu bitter cassava, lima beans, ne flaxseed) anyi amygdalin / prunasin (mu bitter abricots kernels bitter, bitter almonds, bimuma bia Rosaceae, ne bimuma bia bamboo), bidi ne ** udi ushima30-minute to 4-hour dididishi dia tshikondo tshia tshianana didi kadiyi ne bimanyinu**. Mu tshikondo etshi tshia ditalala, beta-glucosidase ne hydroxynitrile lyase ya mu mitshi ne ya mu mala idi yenza mudimu ne glycosides idibu bamine munda mua mala makese ne mu tshifu tshinene, ipatula dikola dia hydrogène cyanide (HCN) mu tshiibi tshia mashi. Cyanide muangatshila udi ulamakaja ne dinanga dikole kudi ferric (Fe3+) tshiamu tshia mitaku tshia mitokondrie cytochrome c oxidase (Complex IV), udi wimanyika tshishiki dipuya dia mu mashi nansha mudi mijilu ne mijilu ya mubedi bishala biuwule tente ne oxygène (arterialization of venous blood). Kakuyi difila dia lukasa dia 100% ya oxygène wa pa mutu, diondopangana dia mu tshifu, ne difila dia Hydroxocobalamin (5 grams IV) anyi Sodium Thiosulfate (12.5 grams IV) + Sodium Nitrite (300 mg IV), bantu badi bapeta disama edi badi bakola lukasa bua disama dia tshiadi, disama dia nsukadi, ne disama dia tshiadi tshikole (Kussmaul breathing) ku refractory high-anion-gap lactic acidosis (serum lactate > 8 to 10 mmol/L), bipupu bia tshimpitshimpi, dikanga dia mutshima, ne lufu.

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

Enza nunku mpindieu¶

1. Bikila bena mudimu ba tshimpitshimpi ne bena mudimu ba malu a lufu diakamue, nansha mudi muntu udiumvua bimpe. Ela 911 (US ne Canada), 112 (European Union), 999 (Royaume-Uni), 000 (Australie), anyi 111 (Nouvelle-Zélande). Ambila mutumibue bintu menemene bivuaye mumine (bitter apricot kernels, laetrile / amygdalin tablets, bitter cassava / manioc, anyi bitter almonds), bungi bua ntete anyi grame ivuabu batafune, ne dîba dia kudia bua lupitadi ludi lupeta luondapu lufike ku dilongolola Hydroxocobalamin (Cyanokit) ne Sodium Thiosulfate ku nzubu wa dikisha kumpala kua mubedi kukuluka.
2. Kuena ne bua kuenzeja muntu bua kuela nsukadi nansha kakese, ne kuena ne bua kuenza mudimu wa dilengeja dia mukana ne mukana kuyi ne tshilamba tshia kujika natshi mêsu to. Bikala mubedi uvua mumine glycosides cyanogènes anyi mishipa ya cyanide muele nsukadi, aside wa mu tshifu udi ukudimuna cyanide mu tshintu tshidi tshinyanguka cyanide d’hydrogène (HCN) gaz (which smells weakly like bitter almonds to the 40% to 60% of people genetically able to detect the odor). Shi mubedi ulekela kupuyakana, enza mudimu ne bag-valve-mask (BVM) anyi tshilamba tshia CPR tshia mu tshibombi tshimue tshidi ne oxygène wa bungi pamutu pa kuelangana buludiludi mukana ne mukana.
3. Ufila oxygène wa bungi 100% diakamue padi baminganga bafika. Nansha mudi pulse oximetry (SpO2) neabale 98% to 100% bualu selile idi ne buanga kayena mua kupatula oxygène mu mashi to, padibu bafila 100% normobaric oxygène udi uvudija bukole bua oxygène wa mu plasma, udi uluangana ne cyanide mu miaba idi cytochrome c oxidase ulamakaja, ne udi ukolesha dienza dia mudimu pamue dia sodium thiosulfate ne hydroxocobalamin.
4. Kulekela Vitamine C (Ascorbic Acid) bintu bia pa mutu. Shi muntu uvua muangate ntete ya abricot anyi ya ku mishiku laetrile, tangila ni bavua kabidi banua Vitamine C wa bungi. Vitamine C (> 1 to 3 grams) udi wenza bua amygdaline alue cyanide wa hydrogène mu tshifu ne udi ujimija bintu bidi mu tshifu bidi bikengedibua kudi enzyme wa rhodanese wa mu tshifu.
5. Lama tshibombi, tshibombi tshia ntete, anyi muji wa manioko udi mushale. Lua ne tshibombi tshia ntete ya abricot, B17 mulondo wa bintu bia kukumbaja nabi, anyi tshimuma tshia manioko tshibi ku tshibambalu tshia malu a mpukapuka. Bala anyi ela bungi bulelela bua ntete idibu badia: kutafuna anu 5 to 10 bitter apricot kernels mu muana mutekete anyi 20 to 60 bitter apricot kernels (0.5 to 3.5 mg/kg wa cyanide udi mufuanangane) mu muntu mukulumpe udi mua kufila disama dia cyanide didi mua kunyanga muoyo anyi lufu.

Mutshi wa dipangadika: Disungula dia glycoside cyanogenic ya mu mala ne disungula dia antidote¶

flowchart TD
    A["Kudia manioko a bululu, ntete ya abricot ya bululu, bimuma bia muitu, anyi laetrile (Amygdalin)"] --> B{"Ntshinyi tshivuabu badie ne mushindu kayi?"}
    B -->|"1-3 ntete ya cerise/prune/peche mijima kayiyi mitshibule anyi ntete mikese ya pomme"| C["Njiwu mikese: Tshilamba tshia ntete tshidi katshiyi tshinyanguke tshidi tshipangisha dipatuka dia Amygdalin; Tangila kumbelu pa kumbusha padibu batafuna"]
    B -->|"Ntete ya abricot mikole, amande mibi, ma tablette a laetrile, anyi manioko mibi"| D["NYIKA MUNENE BIA POISONE WA HCN WA MU MUTU (Ditantamana dia minite 30 too ne ku mêba 4)"]
    D --> E["Bikila 911/112/999; Ela 100% ya oxygène wa bungi; Pesha makala a kapia (1 g/kg too ne ku 50-100 g) pikala < 1-2 mêba ne kujuka"]
    E --> F["Order Stat Venous Blood Gas (VBG), Arterial Blood Gas (ABG), Serum Lactate, and Basic Metabolic Panel"]
    F --> G{"Tangila bukole bua disama ne serum lactate"}
    G -->|"Asymptomatic & Lactate < 3.0 mmol/L"| H["Tangila mu ED/ICU munkatshi mua mêba 6 too ne ku 12 (Dinyanguka dia mala didi dienda dijika); Enza kabidi Lactate q1-2h"]
    G -->|"Nsombelu wa lungenyi mushintuluke, disama dia tshiadi, disama dia mashi, dipanga dia tshiadi, anyi lactate >= 8-10 mmol/L"| I["DIFILA DIA MUSHINDU WA KUENZA BIDIMU (KUINDI bua bungi bua cyanide mu laboratware to)"]
    I --> J{"Ntshintu kayi tshia Cyanide tshidi tshipeta diakamue?"}
    J -->|"Hydroxocobalamin (Cyanokit) udiku (disungula dia kumpala)"| K["Ela Hydroxocobalamin 5 g IV (70 mg/kg kudi bana) mu minite 15 + Ela Sodium Thiosulfate 12.5 g IV bua kutungunuka ne kupatuka mu bitupa bia munda"]
    J -->|"Anu tshiamu tshia Nitrite + Thiosulfate ke tshidiku"| L["Pesha Sodium Nitrite 300 mg IV (10 mL ya 3%) mu 2-4 min (Tangila Hemoglobine kumpala) -> Londa ne Sodium Thiosulfate 12.5 g IV"]

Pathophysiology: Mushindu kayi udi glycosides ya mitshi ishintuluka kulua Hydrogène Cyanide (HCN) munda mua tshifu tshia muntu¶

Kupita 2,500 mishindu ya mitshi idi yenza cyanogenic glycosides bu tshintu tshia kudikuba natshi kudi nyama idi idia bisonsa. Mu dibeji dia mutshi, mu miji, anyi mu ntete, glycoside cyanogenic udi mulamibue bimpe munda mua vacuoles ya selile, mutapuluke ku mubidi ne enzymes yende ya hydrolytique (beta-glucosidase ne hydroxynitrile lyase), idi mu tshimanu tshia selile ya mutshi anyi mu cytoplasme.

1. Dikosolola dia Amygdalin ne Linamarin mu bitupa bibidi¶

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

• Bua tshinyi ku mishiku Laetrile / Amygdalin udi ne bubi misangu 40 kupita mudibu bafila mu mishipa Laetrile: Bafidi ba "Vitamine B17" ba dishima bavua bamba ne: laetrile uvua muimpe bualu diela dia nyama mu mijilu divua difikisha ku disama dikese dia lukasa. Padibu bamuela mu mishipa, amygdaline udi kayi ne disama udi upitshila mu tshitupa tshia dijimija dia biakudia ne udi upatuka > 90% ki mbishintuluke mu mashi bualu mashi a muntu ne bitupa bia mubidi kabiena ne enzyme ya beta-glucosidase to. Padibu bamuangata ku mukana, nansha nanku, bactérie ya mu tshifu tshia muntu ne ya mu mala makese idi ne mudimu wa bungi wa beta-glucosidase. Nansha muntu yeye mulamba ntete ya abricot bua kunyangakaja ntete ya mutshi au emulsin enzyme, anyi udi umina manga adibu balengeje laetrile manga, bactérie yabu ya mu mala idi itapulula glycoside 1 to 4 hours pashishe mu ileum wa kuinshi ne mu tshifu, kuwuja mushipa wa tshiibi ne cyanide d'hydrogène (HCN).
• Bua tshinyi manyoka a bululu adi anyanga mêku mu tshikondo tshia mashika ne dipanga dia biakudia: Mishindu ya manioko idi miteka mu manioko "mutoke" (< 50 milligrams wa HCN udi mufuanangane ne kilo wa miji mipiamipia, udi nangananga mu tshitupa tshia pambelu) ne "bitter" cassava (100 to > 500 milligrams wa HCN ku kilo mutangalake mu mubidi mujima udi ne amidon). Mu tshikondo tshia mashika makole, mitshi ya manioko idi ivudija bungi bua linamarin misangu isatu anyi itanu. Dilongolola dia bilele bia kale didi dilomba dikosa, dikosa/ditshibula, diela/difuka mu mayi munkatshi mua matuku 3 to ne 5 (kulekela linamarase bua kukudimuna linamarin mu acetone cyanohydrin), ne pashishe kuuma mu munya anyi kuosha ku kapia kakole bua kuenza bua acetone cyanohydrin ikale mupuya ne HCN gaz. Bikala dîku didi ne nzala dilamba miji ya manyoka mikole kayiyi miela mâyi anu bua 20 minutes, anyi udia manioko miela tshitupa munda mua 24 hours, luya ludi lunyangakaja linamarase enzyme kumpala kua linamarin kunyanguka, kushiya linamarin ne acetone cyanohydrin mu biakudia. Padibu bamumina, acetone cyanohydrin udi ubola nkayende ulua tshintu tshia lufu HCN munda mua duodenum wa alkaline, padi bactérie ya mu mala inyangakaja linamarin udi mushale mu tshitupa tshidi tshilonda 2 to 6 hours.

Difuanyikija dia bintu bia kudia bia cyanogenic glycoside ne buanga bua mu lupitadi¶

Dimanya dia ku luseke lua bulalu: Mushindu kayi wa kujadika disama dia Cyanide kumpala kua laboratware ya tshikebelu kupingana¶

Diteta dia bungi dia cyanide mu mashi didi diangata mêba anyi matuku mu laboratware ya tshikebelu ne kadiena mua kuikalaku mu tshikondo tshiakanyine bua kulombola diambuluisha dia lukasa to. Baminganga badi bajadika disama dia cyanide mu bitupa bia munda bia mubidi ku luseke lua bulalu mu 5 minutes ku diambuluisha dia bimanyinu bisatu bia diakamue bia dimanya dia masama:

1. "Dibueja" dia mashi a mu mishipa (Mashi a mu mishipa a Cherry-Red ne Narrow A-V O2 Gap)¶

• Mushindu: Bualu bua cyanide udi ukanga mitochondrial cytochrome c oxidase (Complex IV) mu oxydation wende (Fe3+) mu tshitupa, bitupa bia mubidi bidi pambelu kabiena mua kupatula oxygène mu oxyhemoglobine udi upitshila to.
• Tshimanyinu tshia ku luseke lua bulalu: Padi munganga anyi munganga wa mashi wangata tshilejilu tshia mashi a mu mishipa, mashi a mu mishipa adi amueneka mutoke bu "tshikunze" (kaayi mua kushintuluka ne mashi a mu mishipa) pamutu pa kuikala mukunze mufiike.
• Dijadika dia gaz wa mashi: Fuanyikija Gas wa mashi a mu mishipa (ABG) ne munkatshi/ku mpenga Gas wa mashi a mu mishipa (VBG):
• Padi mashi PaO2 ne pulse oximetry (SpO2) kushala anu bu muntu (97% to 100%) ku ntuadijilu, dikumbaja dia oxygène mu mishipa (ScvO2 anyi SvO2) udi upita 85% to 90% ne mu mishipa PvO2 udi upita 50 to 60 mmHg.
• Dishilangana dia oxygène wa mu mishipa (A-V O2 gradient) udi ukepela ku muinshi mua 1 to 2 vol%, bileja dipanga dia oxygène mu selile (shared only by cyanide, hydrogen sulfide, sodium azide, and high-oxygen resuscitation).
• Dijadikibua dia fundoscopie: Ophthalmoscopie wa buludiludi wa retina udi uleja mishipa ya retina idi ne dikala dikunze dia muomumue ne mishipa ya retina.

2. Serum Lactate >= 8 to 10 mmol/L (The Gold-Standard Surrogate Marker)¶

• Bualu aérobie ATP dienza dia bintu didi dikanga (producing only 2 ATP molecules per glucose via anaerobic glycolysis instead of 36 ATP), selile idi ikudimuna pyruvate lukasa mu acide lactique.
• Malongesha a mu lupitadi (Baud et al., New England Journal of Medicine) adi ajadika ne mu muntu udi kayi ne disama dia luya lua muishi, tshitupa tshia lactate mu plasma tshia >= 8 mmol/L (72 mg/dL) (anyi >= 10 mmol/L mu dipuekesha dia muishi) udi ne > 90% bujalame ne bujalame bua disama dikole dia cyanide (blood cyanide > 40 micromoles/L anyi > 1.0 mg/L) ne udi umvuangana ne bujitu bua cyanide munda mua selile.

3. Biphasic Hemodynamic ne Respiratory Curve¶

• Tshitupa 1 (Dikolesha dia tshimuma tshia kumpala, 30 to 90 minutes): Cyanide udi usaka buludiludi mubidi wa carotid chemoreceptors, wenza bua tshimpitshimpi "cyanide gasp" ulonda kudi hyperventilation / tachypnea (Kussmaul breathing), sinus tachycardia, tension, mutu usama, vertigo, dipanga dia lungenyi, ne disama dia tshiadi.
• Tshitupa 2 (Dijimija dia hypoxic dia ndekelu, 1 to 4 hours): Bu mudi munda mua selile ATP dikuluka mu tshitupa tshia buongo ne tshia mutshima, mubedi udi ushintuluka mu tshimpitshimpi ku apnée / bradypnée, bradycardie sinus profonde ou AV block, hypotension artérielle severe, généralisé tonic-clonic seizures, decerebrate posturing, and pulseless electrical activity (PEA) anyi asystole.

Mukenji wa lupitadi wa diondopangana ne diumusha dia masama¶

Bualu dinyanguka dia munda dia amygdalin ne linamarin didi ditungunuka munkatshi mua mêba munda mua tshitupa tshia munda mua tshifu (bishilangane ne dipuekesha dia musangu umue dia HCN gaz), bua kuondopa disama dia cyanogenic glycoside didi dilomba disungila dia lukasa dia manga a mu mishipa NE dilengeja dia tshifu tshia mu tshifu + difila dia sulfure-donor mutantshi mule.

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

Tshitupa 1: Dilengeja dia tshifu (Activated Charcoal ne Gastric Lavage)¶

• Nansha mudi makala a kapia ne bukole bukese bua grame ku grame bua potassium cyanide mukezuke (1 gram of charcoal adsorbs -35 mg of KCN), dose ya bantu bakole (50 to 100 grams wa makala a kapia) udi mua kuangata bipepele bungi bua miligrame ya lufu ya amygdaline, linamarin, ne liberated HCN mu tshifu ne kulengeja bikole mushindu wa kuikala ne muoyo mu mateta ne mu luondapu.
• Shi mubedi udi mu 1 to 2 hours wa kudia ntete ya abricot mubi mitshibule, ma tablette a laetrile, anyi manioko mubi, kulama njila wa luya (intubate pikalaye mubuikila) ne kuenza aspiration/lavage wa mu tshifu bua kumbusha bitupa bia ntete bidi bishale, pashishe diakamue Activated Charcoal (1 gram/kg, too ne 50 to 100 grams).

Tshitupa 2: Tshintu tshia kumpala tshia kuela mu mashi: Hydroxocobalamin (Cyanokit)¶

Hydroxocobalamin (Cyanokit) i buanga bua kumpala budi bantu bonso basue bua kujikija disama dia cyanide mu Amerike wa ku Nord, ku Mputu, mu Grande-Bretagne ne mu Australie bualu budi bulamakaja buludiludi cyanide udi munda mua selile ne mu mishipa bua kuenza cyanocobalamin (Vitamin B12) kakuyi kunyanga hémoglobine udi ne oxygène anyi kuenza tshipupu tshia vasoplegic tshidi tshifumina ku nitrites.

• Mushindu wa bantu bakole: Kupingaja 5 grame (one 5 g vial anyi two 2.5 g vials) wa Hydroxocobalamin mu 200 milliliters wa 0.9% sodium chloride ne kuela mu mushipa pa mutu pa 15 minutes (-15 mL/minute).
• Dose wa bana: Infuse 70 milligrams per kilogram (70 mg/kg, too ne ku tshipiminu tshinene tshia ntuadijilu tshia 5 grams) mu mishipa pa mutu pa 15 minutes.
• Difila dia misangu ne misangu bua dinyanguka dia mala: Mu ntete ya abricot, laetrile, anyi manioko mubi, babedi batu misangu ya bungi bapeta divulangana dia cyanide 2 to 6 hours panyima pa wa kumpala 5 g Hydroxocobalamin dose bu mudi bactérie ya mu mala itungunuka ne kutapulula glycosides idi kayiyi miangatshibue mu mala. Shi lactic acidose (> 4 mmol/L), hypotension, anyi koma udi upingana anyi utungunuka, ela seconde 5 gram (70 mg/kg bana) dose wa Hydroxocobalamin kupita 15 minutes to 2 hours.
• Bipeta bibi bidibu batekemene (Chromaturie udi kayi ne njiwu ne dinyanguka dia laboratware): Hydroxocobalamin i tshintu tshikunze tshikole tshia burgundy. Diakamue bidi bivuija dikoba dia mubedi, binsonji, tuishi, plasma, ne mashi a mubidi mukunzubile (chromaturia) bua 2 to 7 days (ne too ne ku 28 days mu mashi). Dimuija laboratware ne: hydroxocobalamin udi unyangakaja mateta a colorimetric bua creatinine, bilirubin, transaminases, magnesium, ne carboxyhemoglobin/methemoglobin co-oximetry, koka mashi a ntuadijilu diakamue kumpala kua kutuadija difila dia mashi makunze.

Tshitupa 3: Difila dia Sodium Thiosulfate (12.5 Grams)¶

Bualu enzyme wa mubidi udi umbusha cyanide, mitochondrial rhodanese (thiosulfate sulfurtransferase) mu tshifu ne mu mifuba, udi ujika lukasa ne bafidi ba sufre ba munda mu tshikondo tshia dikuata dia glycoside wa mu mala mutantshi mule, difila dia Thiosulfate de sodium mu mushipa didi difila sufre wa sulfane udi kayi mua kujika bua kukudimuna cyanide mu thiocyanate (thiocyanate) udi kayi ne njiwuSCN-), udi upatuka kudi mifuba: **Dose wa bantu bakol **12.5 grams (50 milliliters wa a 25% Sodium Thiosulfate soluti) infused intranously over klzzwxh:0063 * Dose wa bana: **250 milligrams per kilogram (1.0 mL/kg wa 25% diandamuna, anyi 412.5 mg/kg [1.65 mL/kg] bilondeshela dilengeja dia mayi,oo ne 12.5 grams) mu mishipa pa mutu pa 10 to 30 minutes.

Tshitupa 4: Mushindu mukuabu wa kujikija disama (padi hydroxocobalamin kayiku): Nitrite wa sodium + Thiosulfate wa sodium (Nithiodote) anyi Dicobalt Edetate (Kelocyanor)¶

Mu bitupa bia bungi bidi mu njila wa dikola mudi tshipupu tshia manyoka tshikole tshitangalake, anyi mu nzubu mikese ya luondapu ya mu misoko idi kayiyi ne Cyanokit, baminganga badi benza mudimu ne mishindu ibidi ya Nitrite + Thiosulfate: 1. Amyl Nitrite (Inhaled bridge before IV access): Crush an ampoule of amyl nitrite (0.3 mL) mu gaze ne umukuate muinshi mua diulu dia mubedi (anyi pa mutu pa tshibuelelu tshia tshibombi tshia valve-mask) bua 15 to 30 seconds wa minite yonso padibu bajadika IV access. 2. Nitrite wa sodium mu mishipa (3% diandamuna): * Mushindu: Udi wenza oxide 10% to 20% wa hémoglobine wa tshiamu udi wenda mu mashi (Fe2+) mu ferric methemoglobin (Fe3+). Bualu bua cyanide udi ne dinanga dia bungi bua Fe3+, methemoglobin udi ukoka cyanide ku mitochondrial cytochrome c oxidase bua kuenza cyanmethemoglobin. * Dose wa bantu bakole: 300 milligrams (10 milliliters wa 3% Sodium Nitrite) mubueja mu mushipa pa mutu pa 2 to 4 minutes (tangila tension bimpe, bualu nitrites idi ifila divulangana dia mashi ne dipueka dia tension). * Dose wa bana (Must Adjust for Hemoglobin to Prevent Fatal Methemoglobinemia): 6 to 10 mg/kg (0.2 to 0.33 mL/kg wa 3% diandamuna, tshitamba bunene 300 mg), bikepesha bikole pikala muana kayi ne mashi (hemoglobin < 10 g/dL). Tangila bungi bua methemoglobine ku 30 minutes ne kulama methemoglobine mujima kuinshi eku 20% to 30%. 3. Intravenous Sodium Thiosulfate (25% diandamuna): Londa diakamue (after flushing the line) ne 12.5 grams (50 mL wa 25% diandamuna; bana 1.0 to 1.65 mL/kg) bua kukudimuna cyanmethemoglobine bua kashidi mu thiocyanate wa mu mashi. 4. Dicobalt Edetate (Kelocyanor - UK/Commonwealth Legacy Stock): Administered as 300 mg (20 mL) IV pa mutu pa 1 minute ulonda diakamue kudi 50 mL wa 50% Dextrose. Bualu bua cobalt wa tshianana udi ukebesha disama dia mutshima dikole, disama dia mpala/dia mu tshiadi, ne dipueka dia mashi padiku kakuyi cyanide mu mashi, **Dicobalt Edetate udi ne tshia kupeshibua ANYI kudi babedi badi ne disama dia cyanide dikole dia mu lupitadi (coma, apnée, anyi shock) bua kubenga kuikala ne disama dia ampytomatic babedi.

Dilongolola dimpe dia manyoka ne mikalu ya mikenji idi itangila ntete ya abricot¶

• Mushindu wa kumbusha buanga bua bitter Cassava kumbelu (The WHO / FAO "Wetting Method"):
• Kukosa anyi kukuma miji ya manioko mikosolola mu bukula anyi bukula (kutshibula bimanu bia selile bua linamarase bantu linamarin).
• Uteke / uteke tshisuku mu mayi bua 3 to 5 days (anyi shi udi wenza mudimu ne bukula bua manioko budi buume budi butshidi anu ne dipembu dia bululu, udi mua kusangila bukula ne mayi mu tshintu tshitekete tshidi ne mâyi ne kutshitangalaja mu tshitupa tshikese mu mundidimbi bua 5 hours ku 30 degrees Celsius nunku tshidi tshishala linamarase udi ushintulula linamarin mu volatile acetone cyanohydrin).
• Lamba anyi kuosha bimpa mu tshilongo tshiunzulula bua acetone cyanohydrin yonso ne HCN gaz udi uya mu lupepele, ne umbusha mayi adi atokesha.
• Madimuija a mikenji adi atangila ntete ya abricot mubi:
• European Food Safety Authority (EFSA) ne UK Food Standards Agency (FSA) bakateka tshipiminu tshia Acute Reference Dose (ARfD) wa 20 micrograms/kg wa cyanide, kujikija ne kudia bipite pa 1 anyi 3 bia tumuma tukese tua abricot mu bantu bakole (anyi tshitupa tshia tumuma tukese tua abricot mu bana bakese) bidi bipita tshipiminu tshia bukubi. Bubidi bua UE (Regulation 2017/1237) ne UK udi ukandika dipana dia ntete ya abricot mikole kudi bantu badi basumba bintu kupita 20 mg/kg wa aside wa hydrocyanic, ne Australie/Nouvelle-Zélande badi bakandika dipana dia ntete ya abricot bu biakudia bionso.
• Mu États-Unis ne mu Canada, US FDA udi ukandika laetrile (amygdalin) bu tshintu tshidi katshiyi tshianyishibue, tshia dishima, ne tshidi ne buanga bua bungi, ne Health Canada udi ukandika bungi buonso bua cyanide budibu mua kupatula mu ntete ya abricot idibu bapana bua kufika ku 20 ppm eku udimuija bantu bakole bua kubenga kudia ntete mikole nansha kakese.

Mikenji ya tshimpitshimpi ya mu tshijengu ne ya dipeta dia manga¶

• Etats-Unis ne Canada: Bikila 911 diakamue ne ubikile 1-800-222-1222 (US Poison Help) anyi 1-844-POISON-X (1-844-764-7669 mu Canada). Dikuatshisha dia muoyo dia pa mutu (ALS) ambulanse ne bibambalu bia lupitadi bia lukasa lukasa mu Amerike wa ku Nord bidi ne bintu Hydroxocobalamin (Cyanokit, 5 g milondo) ne Nithiodote (Sodium Nitrite + Sodium Thiosulfate).
• Bukalenge buobumue ne Buobumue bua ku Mputu: Bikila 999 (UK) anyi 112 (EU). Baminganga badi baya kutangila NPIS / TOXBASE (UK) anyi nzubu ya diondopangana ya ditunga dia UE (CAPTV, Giftnotruf). Mu UK ne mu EU, bibambalu bia malu a tshimpitshimpi bidi ne Hydroxocobalamin (Cyanokit) ne Sodium Thiosulfate mu tshilaminu tshia manga tshia lukasa (Category A Antidotes required immediately at every acute hospital).
• Australie ne Nouvelle-Zélande: Bikila 000 (Australie) anyi 111 (Nouvelle-Zélande), ne yukila ne Centre d’information des poisons (13 11 26 mu Australie; 0800 764 766 mu Nouvelle-Zélande) bua diakamue Cyanokit ne Sodium Thiosulfate buludiki.
• Afrike wa kuinshi kua Sahara, Amerike wa ku Sud, ne Asie wa ku Sud-Est: Mu bitupa bia manioko (Democratic Republic of the Congo, Mozambique, Tanzania, Nigeria, Brazil, Indonesia, Philippines), mudi Cyanokit kabena mua kuikala mu nzubu ya luondapu ya mu misoko to, difila dia lukasa dia 100% Oxygène + Activated Charcoal + Intravenous Sodium Thiosulfate (25%, 50 mL IV) + Intravenous Sodium Bicarbonate (bua kulongolola disama dikole dia lactic acidose) udi usungila muoyo ne udi ne bintu bia bungi.

Nkonko itubu bela misangu ya bungi¶

Bua tshinyi disama dia cyanide didi difumina ku ntete ya abricot anyi dia manioko mubi didi diangata mêba 1 anyi 4 bua kutuadija?¶

Bishilangane na luya lua hydrogène cyanure (ludi lubuela mu mikolo ne mu mashi mu tusekonde tukese), ntete ya abricot ne manioko adi ne sukadi wa mitshi udibu babikila ne: cyanogenic glycosides (amygdalin ne linamarin). Bintu ebi kabiena ne njiwu too ne padi enzyme ya mu mitshi (idibu benza mudimu ku ditafuna) ne bactérie ya mu mala a muntu ikosa bitekete bitekete molecule ya sukadi idi munda mua mala makese ne mu tshifu tshinene, ipatula kapepe ka cyanure wa hydrogène mu mashi minite 30 too ne ku mêba 4 kunyima kua didia.

Bua tshinyi kunua "Vitamine B17" (Laetrile) ku mishiku kudi kushipa bantu bikole kupita kunua tuishi tua mu mishipa?¶

Mashi a muntu ne bitupa bia mubidi kabiena ne tshiamu tshia beta-glucosidase tshidi tshikengela bua kutshibula amygdaline bua kulua cyanide to, nunku padibu bela laetrile mu mushipa, 90% yawu idi ipatuka kayi mushintuluke mu mashi. Padibu bamina ku mishiku, nansha nanku, miliyare ya bactérie ya mu tshifukilu idi munda mua mala makese a muntu ne mu tshifu tshikole idi ipatula enzyme ya bungi ya beta-glucosidase idi itapulula laetrile wa ku mishiku buludiludi mu cyanide wa hydrogène udi ushipa bantu, bienza bua manga a ku mishiku ikale ne buôwa misangu mitue ku 40 kupita adibu bafila mu mishipa.

Ntshinyi tshidi tshienzeka padi muana umina dibue dia cerise anyi dibue dia peche ku mpukapuka kayi muditafune?¶

Shi tshina tshia cerise, tshina tshia prune, dibue dia peche, anyi ntete ya pome mimina mujima ne tshitupa tshia pambelu tshia mutshi tshikole katshiyi tshitshibuka, amygdaline udi ushala mukanga bimpe munda mua tshilamba tshia ntete ne tshina tshidi tshipatuka mu tshina tshia ntete kakuyi bualu bubi mu matuku 1 anyi 3. Disama dia cyanide didi dienzeka anu padibu batafuna ntete anyi miaba idibu batapa, batshibula, batshibula, batshisambakaja anyi batshibula kumpala kua kuyimina.

Mmunyi mudi baminganga ba lupitadi lua lukasa mua kumanya disama dia cyanide mu minite 5 pikala mateta a cyanide mu mashi angata matuku a bungi?¶

Baminganga badi bakeba bimanyinu bibidi bia ku bulalu bia dipangisha dia mudimu wa oxygène wa mu selile: tshia kumpala, mashi a mu mishipa adibu bangata ku diboko adi amueneka bu "tshikunze" (anu bu mashi a mu mishipa) ne oxygène wa mu mishipa udi pa mutu pa 85% too ne ku 90% bualu mitokondrie idi ne buanga kayena mua kupatula oxygène mu mashi to; ne tshibidi, tshipiminu tshia lactate mu mashi tshidi tshivula kupita 8 too ne ku 10 mmol/L bua dishintuluka dia tshimpitshimpi dia anaerobe.

Bua tshinyi baminganga batu bafila Hydroxocobalamin (Cyanokit) ne Sodium Thiosulfate bua disama dia apricot kernel?¶

Dose umua wa 5-gram wa Hydroxocobalamin (Cyanokit) udi ushintulula diakamue cyanide udi wenda mu mashi ne mu bitupa bia mubidi bua kulua Vitamine B12 udi kayi ne njiwu, usungila mutshima ne buongo mu minite mikese. Ino, bu mudi ntete ya abricot mitshibule anyi manioko mikole itungunuka ne kusomba mu mala ne kupatula cyanide mupiamupia munkatshi mua mêba makuabu 4 anyi 12, kusakidila Sodium Thiosulfate mu mushipa (ku diambuluisha dia mulongo wa IV mushilangane anyi mulengeja) kudi kupesha enzyme wa rhodanese wa mu tshifu ne sufre bua kujikija dikuata dia cyanide mu mala.

"Konzo" ntshinyi ne mmunyi mudiye mulamakaja ne manioko a bululu?¶

Konzo i disama dikole, didi kadiyi mua kupingana dia maulu onso abidi (spastic paraparesis) didi dikuata bana ne bakaji badi ne bidimu bia kulela mu misoko ya mu Afrike wa ku Sud kua Sahara mu tshikondo tshia mashika ne nzala. Bidi bienzeka padi bena mu mêku benzejibua bua kudia manioko a bululu adi kaayi makane lumingu luonso padibu bakenga ne dipanga dia proteyine mu biakudia (dipanga dia aside amino udi ne sufre methionine ne cysteine ​​bidi bikengela kudi tshifu bua kumbusha cyanide mu thiocyanate).

Bua kuenza mudimu bimpe ne disama dia poison, dia njila ya luya ne dia muoyo, ela meji bua kujikija dilonga dia diambuluisha dia kumpala ne dia CPR dia kudi Croix-Rouge, dia St John Ambulance, anyi kudi bulongolodi bua dilongesha budibu banyishe.

Malu adi apetangana¶

• Diambuluisha dia kumpala dia cyanide, hydrogène sulfure, ne gaz industriel inhalation
• Methemoglobinemia (Mashi a tshitoke), Benzocaine Spray, ne Nitrate Poisoning
• Dikeba dia nkunde ya muitu (Amatoxin) ne didia dia mitshi idi ne buanga
• Status Epilepticus, Disama dia tshimpitshimpi dia matuku a bungi, ne manga a diambuluisha
• Diambuluisha dia kumpala dia disama dia lufu ne diumusha dia masama

Miaba ne buludiki bua mbulamatadi¶

• Bulongolodi bua makanda a mubidi pa buloba bujima (OMS) & Bulongolodi bua biakudia ne madimi (FAO): Mukanda muipi wa malu a tshimuma tshia pa buloba bujima 61: Hydrogène Cyanure ne Cyanides: Malu adi atangila makanda a mubidi a bantu; Cyanogenic Glycosides in Cassava and Bamboo Shoots (Geneve).
• European Food Safety Authority (EFSA) Panel on Contaminants in the Food Chain: Njiwu mikole ya bukola bua mubidi idi itangila dikala dia cyanogenic glycosides mu ntete ya abricot ne bintu bifumina ku ntete ya abricot (EFSA Journal).
• TUETU. Bibambalu bia diluisha ne dikuba dia masama (CDC) / ATSDR: Mibelu ya dilama dia buanga bua hydrogène cyanide, sodium cyanide, ne cyanogenic compounds (États-Unis).
• UK National Poisons Information Service (NPIS) / TOXBASE & Royal College of Emergency Medicine: Antidote Guidelines: Hydroxocobalamin (Cyanokit), Sodium Thiosulfate, and Sodium Nitrite in Acute Cyanide and Cyanogenic Glycoside Poisoning (United Kingdom).
• Baud FJ, Barriot P, Toffis V, ne bakuabu. / Hall AH, Rumack BH: Divula dia cyanide mu mashi ne plasma lactate mu disama dia cyanide; Laetrile (Amygdalin) ne Apricot Kernel Toxicity (New England Journal of Medicine / Annals of Emergency Medicine).