Chipatso cha Ackee (Hypoglycin Yosakhwima A Jamaican Vomiting Sickness) ndi Lychee (MCPG) Kusala Kuthamanga kwa Hypoglycemic Encephalopathy mu Ana¶

Kusanza mwadzidzidzi m'mawa, kuledzera kwambiri, kukomoka, kapena chikomokere mutatha kudya chipatso cha ackee chosapsa (Blighia sapida) kapena kudya lychee (Litchi chinensis) pamimba yopanda kanthu popanda chakudya chamadzulo ndi vuto lalikulu la kagayidwe kachakudya lomwe limayambitsidwa ndi vuto la non-ketotic hypoglycemia.blood glucose often below 20 mg/dL or 1.1 mmol/L). Imbani nambala yanu yazadzidzi (911 ku United States ndi Canada, 112 kudutsa European Union, 999 ku United Kingdom) kapena funsani athu manambala angozi zapadziko lonse lapansi nthawi yomweyo, ndikuwuza wotumizayo kuti wodwalayo akufunika kuyezetsa magazi mwachangu ndi mtsempha wa 10% Dextrose. Poyembekezera azachipatala, yesani kugwedezeka pogwiritsa ntchito athu Status epilepticus prolonged seizure protocol, kusiyanitsa vuto la kagayidwe kachakudya ndi mankhwala sulfonylurea hypoglycemic overdose, ndikugwiritsa ntchito general pachimake poizoni thandizo loyamba.

Zonse ziwiri ackee (zipatso za dziko la Jamaica, zomwe zimakula kwambiri ku Caribbean, West Africa, Florida, ndi Central America) ndi lychee (pamodzi ndi longan ndi rambutan, azisuwani a banja la botanical Sapindaceae) ali ndi ma protoxin amphamvu a cyclopropyl amino acid: Hypoglycin A (L-methylenecyclopropylalanine) ndi mawu ake apansi akuti alpha-(methylenecyclopropyl)glycine (MCPG). Mwana kapena wachikulire akamadya ma ackee ackee osapsa, otsegulidwa mokakamiza (kapena kumwa madzi omwe adawiritsa ackee), kapena mwana wosadya zakudya zopatsa thanzi amadya ma lychees osapsa / osakhwima masana ndikukagona popanda kudya chakudya chamadzulo, poizoniyu amakhala chete. 4 to 12 hours pamene thupi likadali ndi glycogen m'chiwindi. M'mawa kwambiri (typically 3:00 AM to 8:00 AM), glycogen yachiwindi ikatha usiku wonse, thupi limayesa kusintha ku mafuta acid beta-oxidation ndi gluconeogenesis kuti ubongo uzikhala ndi shuga. Chifukwa MCPA-CoA (kuchokera ku Hypoglycin A) ndi MCPF-CoA (kuchokera ku MCPG) amatsekereza mitochondrial medium-chain acyl-CoA dehydrogenase (MCAD) ndi michere ya gluconeoogenic, shuga wa m'magazi amatsika kwambiri mpaka ku ziro pomwe ma acid a poizoni afupiafupi amasefukira muubongo, kumayambitsa edema yaubongo, matenda a khunyu, ndi kufa mkati. 12 to 48 hours pokhapokha nthawi yomweyo 10% Dextrose (D10W) bolus ndi kulowetsedwa kwa glucose kosalekeza kumayendetsedwa.

+-------------------------------------------------------------------------+
|       SAPINDACEAE FRUIT HYPOGLYCEMIC ENCEPHALOPATHY ACTION MATRIX       |
+-------------------------------------------------------------------------+
|  THE OVERNIGHT GLYCOGEN TRAP (WHY CHILDREN CRASH AT 4:00 TO 7:00 AM):   |
|  * Afternoon/Evening: Child eats unripe Ackee OR eats Lychees & skips   |
|    dinner -> Liver glycogen stores run completely dry by 3:00-6:00 AM   |
|  * Hypoglycin A (MCPA-CoA) & MCPG (MCPF-CoA) block fatty acid beta-     |
|    oxidation (MCAD/SCAD) and Pyruvate Carboxylase gluconeogenesis       |
|  * Result: Blood glucose drops < 20 mg/dL (< 1.1 mmol/L) + Toxic        |
|    organic acidemia -> Sudden vomiting, seizures, cerebral edema, coma  |
+-------------------------------------------------------------------------+
|  IMMEDIATE PRE-HOSPITAL & EMERGENCY DEPARTMENT RESCUE:                  |
|  1. Awake & Able to Swallow: Give 15-30 g fast oral sugar (sugar water, |
|     honey, fruit juice, glucose gel) immediately + complex carbs        |
|  2. Drowsy, Vomiting, or Seizuring: NEVER pour liquid in mouth; apply   |
|     buccal sugar/glucose gel inside cheek while awaiting EMS            |
|  3. Hospital IV Bolus: 2 to 5 mL/kg of 10% Dextrose (D10W) IV push      |
|  4. Continuous IV Infusion: 10% Dextrose at 6 to 8 mg/kg/minute (avoid  |
|     hypotonic fluids that worsen cerebral edema) + L-Carnitine/Glycine  |
+-------------------------------------------------------------------------+

Chitani izi tsopano¶

1. Imbani azithandizo zadzidzidzi nthawi yomweyo ndikupempha othandizira odwala omwe ali ndi mtsempha wa Dextrose. Imbani 911 (US ndi Canada), 112 (European Union), 999 (United Kingdom), 119 / 911 (Jamaica ndi Caribbean), kapena 108 / 112 (India). Uzani wotumizayo kuti wodwalayo adadya zipatso za ackee kapena lychee ndipo akudwala acute toxic hypoglycemia ndi metabolic encephalopathy.
2. Ngati munthuyo ali maso ndipo akutha kumeza bwinobwino, perekani shuga wapakamwa wofulumira kwambiri. Sungunulani. 2 to 3 tablespoons (30 to 45 grams) shuga wa patebulo, uchi, madzi a chimanga, kapena ufa wa glucose m’kapu yamadzi kapena madzi a zipatso ndipo munthuyo amwe nthawi yomweyo. Ngakhale wina atazindikira kuti adangodya ackee osapsa kapena mwana adadya lychees m'mimba yopanda kanthu ndipo akumvabe bwino, **kupereka chakudya cham'magazi ndi zakumwa zotsekemera nthawi yomweyo ** kumasunga masitolo a glycogen m'chiwindi ndikulepheretsa kuti thupi lisatsegule njira ya okosijeni yamafuta otsekeka pamene mukupita kuchipatala.
3. Ngati munthuyo ali ndi tulo, wasokonezeka, akusanza, kapena akugwidwa ndi khunyu, MUSAMUthire zamadzimadzi mkamwa mwake. Pereka wodwalayo kumbali yake yakumanzere (malo ochira) kuti masanzi asalowe m'mapapo. Mutha kusisita pang'ono **glucose gel, uchi, kapena shuga wapa tebulo ** mwachindunji mkati mwa tsaya lakumunsi ndi mkamwa (buccal mucosa), koma kupulumutsa kotsimikizika kumafuna mtsempha 10% Dextrose (D10W) yoyendetsedwa ndi azachipatala kapena ogwira ntchito zadzidzidzi.
4. Mvetserani chifukwa chake Kubaya Glucagon SIKUGWIRITSA NTCHITO mu Ackee kapena Lychee poisoning. Mabanja kapena othandizira omwe amanyamula zida zadzidzidzi glucagon jakisoni ayenera kudziwa kuti glucagon imagwira ntchito pokha polimbikitsa chiwindi kuti chiwononge glycogen yosungidwa.glycogenolysis) ndi kupanga glucose watsopano (gluconeogenesis). Mu ackee ndi lychee encephalopathy, chiwindi cha glycogen chiri kale 100% yatha ndipo gluconeogenesis imatsekedwa ndi Hypoglycin A ndi MCPG, kutanthauza kuti glucagon ndiyosagwira ntchito. Kuwongolera mwachindunji kwa exogenous dextrose (glucose) kumapulumutsa ubongo.
5. *Sungani makoko a ackee otsala aiwisi kapena ophikidwa, madzi ophika, kapena zipatso za lychee. Musalole aliyense m'nyumbamo kuti adye mumphika womwewo, makamaka madzi ophikira (pot water) kapena gravy momwe ma ackee arils amawiritsidwa, ngati Hypoglycin A yosungunuka m'madzi imalowa molunjika mumadzimadzi.

Mtengo wosankha: Ackee ndi Lychee hypoglycemic encephalopathy triage¶

flowchart TD
    A["Amaganiziridwa kuti Ackee Osapsa kapena Kudya Lychee Kudya"] --> B{"Unikani Mkhalidwe Wachipatala & Chidziwitso"}
    B -->|"Asymptomatic (Kumeza Kwaposachedwa, Kugalamuka Kwambiri)"| C["Perekani Chakudya Cham'madzi Cham'madzi Nthawi yomweyo + Chakumwa cha Glucose Wapakamwa Kuti Mukhalebe ndi Vuto la Glycogen"]
    C --> D["Lowani Chipatala kwa Maola 24-48 Mopitilira 10% Kulowetsedwa kwa Dextrose & Kuwunika kwa Glucose wa Fingerstick Hourly"]
    B -->|"Kusanza Mwadzidzidzi, Kutuluka Thukuta, Kutaya mtima, Kukomoka, kapena Coma"| E["Yang'anani Stat Point-of-Care Glucose Wamagazi (Nthawi zambiri <20-30 mg/dL / 1.1-1.7 mmol/L) + Gasi wa Magazi/Lactate"]
    E --> F["Pompopompo IV Bolus: 10% Dextrose (D10W) 2 mpaka 5 mL/kg IV Kankhani (Akuluakulu: 50 mL ya D50W kapena 250 mL ya D10W)"]
    F --> G["Yambani mosalekeza IV 10% Dextrose (D10W mu 0.9% NaCl) pa Glucose Infusion Rate (GIR) ya 6 mpaka 8 mg/kg/min."]
    G --> H{"Matenda a Epilepticus kapena Cerebral Edema?"}
    H -->|"Inde"| I["IV Lorazepam/Midazolam + Kwezani Mutu 30 Madigiri + 3% Hypertonic Saline (Pewani Hypotonic Fluids)"]
    H -->|"Ayi"| J["Khalanibe ndi Glucose wa Magazi 100-150 mg/dL (5.5-8.3 mmol/L); Onjezani IV/Oral L-Carnitine + Glycine + Riboflavin (Vitamini B2)"]
    I --> J

Pathophysiology: Momwe Hypoglycin A ndi MCPG imatsekera metabolism yamphamvu yamunthu¶

Kuti mumvetse chifukwa chake mwana wathanzi amatha kugona akumwetulira atadya lychees kapena ackee ndikudzuka 5:00 AM atakomoka pachikomokere, asing'anga ayenera kuyang'ana momwe ma enzyme a mitochondrial atsekeredwera chifukwa cha Hypoglycin A ndi MCPG (nthawi zambiri amatchedwa acquired glutaric acidemia type II kapena kupeza kuperewera kwa ma acyl-CoA dehydrogenase [MADD]).

1. Kusintha kwa ma protoxin kukhala akupha a CoA thioesters¶

Ngakhale Hypoglycin A (L-alpha-amino-beta-[methylenecyclopropyl]propionic acid) kapena MCPG (alpha-[methylenecyclopropyl]glycine) ndi poizoni mwachindunji mu mawonekedwe ake a amino acid. Akatengeka kuchokera m'matumbo aang'ono, amalowa mu mitochondrial branched-chain amino acid catabolic njira: * Cytosolic ndi mitochondrial transaminase amasintha Hypoglycin A kukhala methylenecyclopropylpyruvic acid (MCPP), ndi branched-chain alpha-keto acid dehydrogenase oxidative decarboxylates kuti ikhale yakupha poizoni: methylenecyclopropylacetyl-CoA (MCPA-CoA). * Momwemonso, MCPG (yochuluka mu nthanga za lychee zosapsa/zokhwima, komanso mbewu za ackee) zimasinthidwa kukhala methylenecyclopropylformyl-CoA (MCPF-CoA).

+-------------------------------------------------------------------------+
|       MITOCHONDRIAL BLOCKADE BY HYPOGLYCIN A (MCPA-CoA) & MCPG          |
+-------------------------------------------------------------------------+
|                                                                         |
|   Unripe Ackee / Lychee  --->  Hypoglycin A & MCPG                      |
|                                       |                                 |
|                                       v  (Transamination & CoA binding) |
|                            MCPA-CoA  and  MCPF-CoA                      |
|                                       |                                 |
|         +-----------------------------+-----------------------------+   |
|         |                             |                             |   |
|         v                             v                             v   |
|  1. BLOCKS FATTY ACID          2. BLOCKS GLUCONEOGENESIS     3. TOXIC   |
|     BETA-OXIDATION:               * Depletes Free CoA-SH        ACIDS:  |
|     * Irreversibly inactivates      and Carnitine               * Accum.|
|       FAD cofactor of MCAD,       * Depletes Acetyl-CoA &         of C4 |
|       SCAD, IVD, and GCDH           NADH needed to activate       to C10|
|     * Zero ketones produced         Pyruvate Carboxylase          acids |
|                                                                         |
+-------------------------------------------------------------------------+
|   RESULT ONCE OVERNIGHT LIVER GLYCOGEN RUNS OUT (3:00 TO 7:00 AM):      |
|   * Profound Non-Ketotic Hypoglycemia (< 20 mg/dL / 1.1 mmol/L)         |
|   * Volatile short-chain fatty acids (isovaleric, butyric, glutaric,    |
|     hexanoic) cross blood-brain barrier -> Vomiting, Coma, Brain Edema  |
+-------------------------------------------------------------------------+

2. Chifukwa chiyani mafuta acid beta-oxidation ndi gluconeogenesis onse amalephera¶

1. Kuletsa kudzipha kwa Flavin (FADAcyl-CoA Dehydrogenases: MCPA-CoA ndi MCPF-CoA amagwira ntchito ngati zoletsa zosasinthika ("kudzipha") za flavin adenine dinucleotide.FAD) gulu lodzipangira pa mitochondrial short-chain acyl-CoA dehydrogenase (SCAD), medium-chain acyl-CoA dehydrogenase (MCAD), isovaleryl-CoA dehydrogenase (IVD), ndi glutaryl-CoA dehydrogenase (GCDH). Chifukwa thupi silingathenso kutulutsa mafuta acids panthawi yosala kudya, minofu imakakamizika kuwotcha shuga mwachangu pomwe **ketone body synthesis (acetoacetate ndi beta-hydroxybutyrate) yatsekedwa kwathunthu **.
2. Kuyimitsidwa kwa Hepatic Gluconeogenesis: Chiwindi cha glycogen chikatha.4 to 10 hours mutadya chakudya chomaliza, mofulumira kwambiri mwa ana aang'ono omwe ali ndi kulemera kwakukulu kwa ubongo ndi chiwindi kapena kuperewera kwa zakudya zopatsa thanzi), chiwindi chimayesa kupanga shuga watsopano kuchokera ku lactate, alanine, ndi glycerol kudzera gluconeogenesis. Komabe, puloteni yoyamba yochepetsera mlingo wa gluconeogenesis, pyruvate carboxylase, imafuna acetyl-CoA ngati yovomerezeka ya allosteric activator ndi ATP + NADH (yopangidwa ndi mafuta acid beta-oxidation) kuti iyende. Komanso, un-metabolized acyl-CoA esters ndi MCPA-CoA sequester onse aulere mitochondrial **Coenzyme A (CoA-SH) ** ndi ** L-carnitine **. Popanda ATP, NADH, acetyl-CoA, kapena mfulu CoA-SH, hepatic gluconeogenesis igaya mpaka kuyima kotheratu.
3. Kuunjikana kwa Neurotoxic Branched and Short-Chain Organic Acids: Kutsekeka kwa beta-oxidation ndi amino acid catabolism kumapangitsa kuchulukana kwamafuta amfupi komanso apakatikati amafuta acids (**butyric, isobutyric, isovaleric, 2-methylbutyric, glutaric, adipic, ndi subacibe). Ma organic acids awa amalepheretsa mapampu oteteza ubongo apakati pa mitsempha, amayambitsa chemoreceptor trigger zone mu ubongo (kuyambitsa kusanza kwadzidzidzi), kusagwirizana ndi mitochondria ya neuronal, ndikupanga cytotoxic cerebral edema popanda shuga wochepa wamagazi.

Kuyerekeza Matenda Osanza a Jamaican (Ackee) vs. Fasting Lychee Encephalopathy¶

Ndondomeko yam'chipatala yapam'pang'onopang'ono¶

Mwana kapena wamkulu akafika ndi kusanza, kusintha maganizo, kapena kukomoka atadya ackee kapena lychee, mphindi iliyonse ya hypoglycemia yosachiritsika ndi organic acidemia imawonjezera chiopsezo cha kuwonongeka kosatha kwa ubongo wa hypoxic-ischemic kapena kupha koopsa kwa ubongo.

1. Mwamsanga Mtsempha 10% Dextrose (D10W) Kutsitsimula¶

Osadikirira kuti mapanelo a chemistry a labotale abwerere musanapereke dextrose; yang'anani shuga m'magazi nthawi yomweyo ndi chala chanu (ndipo jambulani chubu chamagazi chofiira/chobiriwira/chofiirira kuti mudziwe mbiri ya toxicology/acylcarnitine ngati nkotheka, osachedwetsa kulandira chithandizo ngakhale pang'ono. 60 seconds).

• Chifukwa chiyani 10% Dextrose (D10W) imakondedwa kuposa 25% kapena 50% Dextrose mwa ana: Yokhazikika 50% dextrose (D50W, 2,525 mOsm/L) ndi hyperosmolar kwambiri ndipo imayambitsa kwambiri venous sclerosis, necrosis ya minofu ngati itatuluka, komanso kusuntha koopsa kwa osmotic kudutsa chotchinga chapachiwopsezo cha magazi ndi ubongo. Standard 5% dextrose (D5W) sichipereka shuga wokwanira kutsekereza kuthamangitsidwa kwamafuta acid. 10% Dextrose (D10W, 100 mg of glucose per mL) ndiye muyeso wagolide wamabolu onse oyamba komanso kulowetsedwa kosalekeza.
• Mlingo Woyamba wa IV Bolus:
• Ana: Yang'anirani 2 to 5 milliliters per kilogram (2 to 5 mL/kg, kupereka 0.2 to 0.5 grams/kg wa glucose). 10% Dextrose (D10W) kudzera m'mitsempha 2 to 5 minutes.
• Akuluakulu: Otsogolera 250 milliliters za 10% Dextrose (D10W) (kapena 50 milliliters za 50% Dextrose [D50W]) kudzera m'mitsempha.
• Kufunika Kopitilira Mlingo Wapamwamba 10% Kulowetsedwa kwa dextrose (To Shut Down Lipolysis):
• Lamulo lofunikira lazathupi: Bolus limodzi la dextrose limakweza shuga m'magazi kokha 20 to 30 minutes. Choyipa kwambiri, mu Hypoglycin A ndi MCPG poyizoni, cholinga cha mankhwala a dextrose osati kungosunga shuga m'magazi. 70 mg/dL, koma kuti tilimbikitse kutulutsidwa kwa insulin** kokwanira kuti kutsekereza lipase yomva mahomoni mu minofu ya adipose. Bola pamene thupi limayesetsa kusonkhanitsa ufulu mafuta zidulo kuchokera mafuta masitolo, poizoni MCPA-CoA, MCPF-CoA, ndipo ma asidi afupiafupi a unyolo amapitiriza kuwunjikana mkati mwa mitochondria ndi kuipitsa ubongo.
• Mlingo wa kulowetsedwa (Glucose Infusion Rate [GIR]): Nthawi yomweyo yambani kulowetsedwa kosalekeza kwa mtsempha wa 10% Dextrose mu 0.9% Saline wamba (D10NS) (kapena D10 1/2NS potaziyamu yoyenera ikatsimikiziridwa kugwira ntchito kwa aimpso) paKulowetsedwa kwa Glucose (GIR) cha 6 to 8 milligrams per kilogram per minute (roughly 3.6 to 4.8 mL/kg/hour za D10W), titrating kusunga seramu shuga pakati 100 and 150 mg/dL (5.5 to 8.3 mmol/L) kwa osachepera 24 to 48 hours.

2. Metabolic Cofactor ndi Conjugation Rescue (L-Carnitine, Glycine,ndi Riboflavin)¶

Chifukwa MCPA-CoA ndi MCPF-CoA tcherani zonse zaulere za mitochondrial Coenzyme A (CoA-SH) ndi carnitine pamene akuwononga flavin adenine dinucleotide (FAD) ma cofactors, ma protocol azachipatala a toxicology amagwiritsa ntchito zida zitatu zomwe zimayang'ana kagayidwe kachakudya kuti achotse pakati papoizoni:

1. ** Mtsempha kapena Oral L-Carnitine (Levocarnitine):**
2. Njira: Zowonjezera L-carnitine zimamanga mitochondrial yotsekeka MCPA-CoA, MCPF-CoA, isovaleryl-CoA, ndi mamolekyu apakati acyl-CoA kudzera mu carnitine acyltransferase, kuwasandutsa kukhala osungunuka m'madzi acylcarnitine esters (MCPA-carnitine) zomwe zimatulutsidwa kuchokera ku mitochondria ndikutuluka mumkodzo, kumasula mpweya wovuta. CoA-SH kwa kuzungulira kwa Krebs.
3. Mlingo: 100 milligrams per kilogram per day (100 mg/kg/day) mtsempha (kapena pakamwa ngati ali maso) anagawa aliyense 6 to 8 hours (up to 2 to 3 grams/day).
4. ** Glycine ya Oral kapena Enteral: **
5. Njira: Enzyme ya mitochondrial glycine N-acyltransferase imalumikizana MCPA-CoA ndi MCPF-CoA ndi amino acid glycine kupanga yopanda poizoni MCPA-glycine ndi MCPF-glycine, yomwe imachotsedwa mwachangu ndi impso.
6. Mlingo: 150 to 250 milligrams per kilogram per day pakamwa kapena kudzera pa nasogastric chubu yogawidwa iliyonse 6 to 8 hours.
7. Mlingo wambiri wa Riboflavin (Vitamin B2):*
8. Njira: Chifukwa MCPA-CoA covalently inactivates the FAD gulu la prosthetic la acyl-CoA dehydrogenases, kupereka mlingo wapamwamba Riboflavin (the direct precursor of FAD and FMN, **100 milligrams pakamwa kapena kudzera pa NG chubu 2 ku 3 nthawi tsiku ndi tsiku **) imathandizira kusinthika kwachangu MCAD ndi SCAD ma enzyme.

3. Kuletsa Kukomoka, Cerebral Edema, ndi Acidosis¶

• Kuwongolera khunyu: Kuwongolera hypoglycemia ndi 10% Dextrose nthawi yomweyo imayimitsa kugwedezeka kwa odwala ambiri omwe akuyamba kumene. Ngati kukomoka kukupitilirabe ngakhale kukhazikika kwa glucose m'magazi (due to already-established cerebral edema or organic acid neurotoxicity), perekani mtsempha lorazepam (0.1 mg/kg IV), midazolam (0.1 to 0.2 mg/kg IV/IM), kapena levetiracetam (Keppra, 20 to 40 mg/kg IV) (strictly avoid Valproic Acid [Depakote], which itself sequesters carnitine, inhibits mitochondrial beta-oxidation, and worsens hyperammonemia and cerebral edema).
• Kusamalira edema yaubongo: Kwezani mutu wa bedi kuti 30 degreeskukhala ndi normocarbia (PaCO2 35 to 40 mmHg) ndi endotracheal intubation yoyambirira ngati Glasgow Coma Scale (GCS) ndi < 8, ndi kulowetsa 3% Hypertonic Saline (3 to 5 mL/kg IV pa 15 to 20 minutes) kapena Mannitol (0.5 g/kg IV).
• Sodium bicarbonate: Pazovuta za metabolic acidosis (arterial pH < 7.15), perekani mosamala mtsempha wa mtsempha sodium bicarbonate ndikusunga kulowetsedwa kwa glucose mosalekeza.

Kupewa: Momwe mungadziwire Ackee yakucha yotetezeka ku Ackee yosapsa, komanso malamulo otetezeka a Lychee kwa ana¶

1. Malamulo 4 Agolide Okonzekera Kukonzekera kwa Ackee¶

+-------------------------------------------------------------------------+
|         VISUAL GUIDE: TOXIC UNRIPE vs. SAFE RIPE ACKEE FRUIT            |
+-------------------------------------------------------------------------+
|  TOXIC UNRIPE ACKEE (DO NOT EAT - 1,000 ppm HYPOGLYCIN A):              |
|  [ (=======) ]  Pod is completely closed, green, or only slightly split |
|                 Forced open with a knife or cracked by hitting ground   |
|                 Arils are hard, pale cream, or small seeds are soft/red |
+-------------------------------------------------------------------------+
|  SAFE NATURALLY RIPE ACKEE (< 10 ppm HYPOGLYCIN A WHEN CLEANED):        |
|    /   |   \    Pod turned bright red/yellow-orange and YAWNED WIDE     |
|   | (O)|(O) |   OPEN naturally on the tree branch in full sunlight      |
|    \   |   /    3 large glossy black seeds are fully exposed to view    |
|                 Yellow aril flesh is firm-soft; remove all seeds & pink |
|                 membrane, wash thoroughly, and DISCARD BOILING WATER    |
+-------------------------------------------------------------------------+

1. Lolani kuti poto "yasamuke" itseguke mwachibadwa pamtengo: Musakolole kapena kuphika nyemba za ackee zomwe sizinatseguke mwachibadwa pamene zikadali pamtengo. Osakakamiza kuti khola lotsekedwa litseguke, ndipo musasiye madontho otsekedwa pawindo la dzuwa kapena padenga akudikirira kuti atseguke kuchokera mumtengo (makoko otsekeka samachotsa Hypoglycin A kuchokera mumbewu).
2. Chotsani njere iliyonse ndi kansalu kofiira ka pinki (raphe): Njere zakuda zonyezimira ndi kansalu kofiira kofiira kamene kamamangiriza nsonga yachikasu ku beseni la njere zimakhala zapoizoni kwamuyaya (containing high levels of Hypoglycin A and B) ngakhale mu zipatso zakupsa. Tsukani nembanemba yonse ya pinki ndikutsuka machiritso achikasu bwino m'madzi ozizira musanaphike.
3. Wiritsani padera ndipo NTHAWI ZONSE mutaya madzi ophika: Wiritsani ma ackee ackee otsukidwa m'madzi opanda kanthu kaye, atsitsireni mu colander, ndipo **kuthirani madzi otentha molunjika pansi pa sinki **. Osaphika mpunga, chilazi, nthochi, dumplings, kapena supu m'madzi omwewo omwe amawiritsa ackee.
4. Chitetezo cha Ackee cholowetsedwa m'zitini: Ku United States, Canada, UK, ndi EU, malonda a ackee otumizidwa kunja amayang'aniridwa ndi US FDA ndi akuluakulu a chitetezo cha chakudya kuti atsimikizire kuti Hypoglycin A ili pansi 100 parts per million (ppm). Ngakhale ndi ackee zam'chitini zamalonda, tsitsani ndi kutsuka brine musanaphike ndi saltfish.

2. Malamulo a 3 a Zaumoyo Wa Anthu Amene Anathetsa Kuphulika kwa Ubwana Wa Lychee Encephalopathy¶

Kutsatira kafukufuku wodziwika bwino wa Indian National Center for Disease Control (NCDC) ndi US CDC ku Muzaffarpur, Bihar (komwe ana mazana ambiri amamwalira mwezi wa May ndi June pa nthawi yokolola lychee), akuluakulu a zaumoyo anakhazikitsa malamulo atatu osavuta a mabanja omwe amachepetsa imfa mopitirira malire. 80%: 1. Musalole ana kuti agone osadya chakudya chamadzulo chophikidwa (chakudya chamadzulo): Kudya chakudya chamadzulo chamadzulo chodzaza ndi ma carbohydrate kumawonjezera nkhokwe za glycogen m'chiwindi kotero kuti chiwindi cha mwanayo chisadalire kutsekeka kwa mafuta a acid beta-oxidation usiku wonse. 2. Chepetsani kuchuluka kwa ma lychees omwe ana ang'onoang'ono amadya, ndipo pewani zipatso zosapsa/zogwa: Musalole kuti ana azidya malichi osapsa kapena okhwima m'minda ya zipatso, chifukwa malichi osapsa amakhala ndi kuchuluka kwa MCPG ndi Hypoglycin A opezeka mu zipatso zofiira kuwirikiza kawiri. 3. Perekani shuga wapakamwa nthawi yomweyo ndikuthamangira kuchipatala ndi 10% Dextrose pachizindikiro cham'mawa: Mwana aliyense m'dera la lychee kapena ackee yemwe amadzuka ndikusanza, kufooka, kapena kunjenjemera ayenera kulandira **10% Dextrose ** mkati mwa ola loyamba (administering D10W within 4 hours of symptom onset reduces fatality from > 44% to < 5%).

Ndondomeko zoyendetsera ngozi zadzidzidzi ndi poyizoni¶

• Jamaica ndi Caribbean: Imbani 119 (Ambulansi ya ku Jamaica / Apolisi) kapena 911 / 999 (kudutsa madera aku Caribbean) ndikuthamangira ku dipatimenti yadzidzidzi yakuchipatala yapafupi kuti mukalowe m'mitsempha. 10% Dextrose. Unduna wa Zaumoyo ndi Ubwino wa ku Jamaica umasungabe njira zotsitsimula za Ackee Poisoning (Jamaican Vomiting Sickness) pazipatala zonse za parishi ndi zipatala.
• United States ndi Canada: Imbani 911 nthawi yomweyo ndikuyimba 1-800-222-1222 (Thandizo la Poizoni ku US) kapena 1-844-POISON-X (1-844-764-7669 ku Canada). Ackee watsopano amakula ku South Florida (where trees are occasionally harvested by residents unfamiliar with the "natural yawn" rule), ndi ackee wozizira/ wamzitini amagulitsidwa m'misika yaku Caribbean kudutsa North America.
• India, Vietnam, Bangladesh, ndi Southeast Asia: Imbani 108 kapena 112 (India), 115 (Vietnam), kapena 999 (Bangladesh/Malaysia). Nthawi ya Meyi mpaka Julayi lychee (litchi), longan, ndi rambutan nyengo yokolola, zipatala zoyambira ku Bihar (India) ndi ma glucometer akumpoto kwa Vietnam ndi 10% Matumba a dextrose makamaka opulumutsa odwala a hypoglycemic encephalopathy.
• United Kingdom, European Union, and West Africa: Imbani 999 (UK), 112 (EU), kapena 112 / 199 (Nigeria, Ghana, Côte d'Ivoire, Burkina Faso, komwe Blighia sapida imakula kwambiri ndipo imayambitsa chiphe cha ana chomwe chimadziwika kuti "ackee poisoning" kapena "finsan" toxicity). Madokotala ku UK/EU akuyenera kufunsa NPIS / TOXBASE kapena malo opangira poyizoni adziko lonse kuti atsimikizire matenda a urinary acylcarnitine/organic acid ndi L-carnitine mlingo.

Mafunso omwe amafunsidwa pafupipafupi¶

Kodi nchifukwa ninji ana amene ali ndi poizoni wa lychees kapena ackee wosapsa nthaŵi zambiri amadwala mbandakucha?¶

Hypoglycin A ndi MCPG amaletsa michere ya mitochondrial yofunikira kuwotcha mafuta amthupi ndikupanga shuga watsopano (gluconeogenesis), koma samaletsa chiwindi kutulutsa glycogen yomwe yasungidwa kale. Mwana akamadya ackee osapsa kapena kudya lychees ndikugona popanda chakudya chamadzulo, glycogen yake yosungidwa m'chiwindi imasunga shuga wawo wamagazi kukhala wabwinobwino kwa maola 4 mpaka 10 oyamba; pakati pa 3:00 AM ndi 8:00 AM, chiwindi cha glycogen chimatha kwathunthu, kuchititsa kuti shuga m'magazi awonongeke pansi pa 20 mg/dL pomwe mafuta owopsa apakati amasefukira muubongo.

Chifukwa chiyani jakisoni wamwadzidzi wa Glucagon samagwira ntchito ya Ackee kapena Lychee hypoglycemia?¶

Glucagon imakweza shuga m'magazi pokhapokha ndikulamula chiwindi kuti chiwononge glycogen yosungidwa ndi kupanga shuga watsopano kudzera mu gluconeogenesis. Mu ackee ndi lychee poisoning, chiwindi cha glycogen cha wodwalayo chimakhala kale chopanda kanthu ndipo ma enzyme awo a gluconeogenic amatsekedwa ndi MCPA-CoA ndi MCPF-CoA, kutanthauza kuti glucagon ilibe mphamvu; wodwala ayenera kulandira mwachindunji m`kamwa shuga (ngati maso) kapena mtsempha 10% Dextrose.

Chifukwa chiyani Valproic Acid (Depakote) ndi yowopsa chifukwa cha khunyu chifukwa cha Ackee kapena Lychee poisoning?¶

Valproic acid ndi nthambi zamafuta acid omwe amadya mitochondrial L-carnitine, amalepheretsa mafuta acid beta-oxidation enzymes, ndikukweza ammonia ammonia. Kupereka valproic acid kwa wodwala yemwe njira yake ya beta-oxidation ili kale poizoni ndi Hypoglycin A kapena MCPG imakulitsa kwambiri metabolic acidosis, hyperammonemia, ndi edema yaubongo yakupha; Madokotala ayenera kugwiritsa ntchito benzodiazepines, levetiracetam (Keppra), kapena phenobarbital pamodzi ndi 10% Dextrose m'malo mwake.

Kodi mungadziwe bwanji ngati chipatso cha Ackee chili chabwino kuti muthyole ndikuphika?¶

Chidutswa chatsopano cha ackee chimakhala chotetezeka pokhapokha chikasanduka chofiira komanso chachikasu-lalanje ndikung'ambika mwachibadwa ("yawned") chikulendewera pamtengo padzuwa, ndikuwonetsetsa mbewu zitatu zakuda zonyezimira. Musamaphike poto wosatsegula, musamaumirize poto kutsegula ndi mpeni, nthawi zonse chotsani njere zakuda ndi nembanemba yofiira yapinki, ndipo nthawi zonse tsanulirani madzi otentha mumtsinje.

Chifukwa chiyani madokotala amasunga kudontha kwa 10% Dextrose IV kwa maola 24 mpaka 48 ngakhale shuga wamagazi atabwerera mwakale?¶

Kupereka bolus limodzi la glucose kumakonza shuga wotsika m'magazi kwa mphindi 20 mpaka 30 zokha. Kuthamanga kwa 10% kulowetsedwa kwa Dextrose (pa 6 mpaka 8 mg/kg/mphindi) kumapangitsa kuti shuga wa magazi azikwera pang'ono (100 mpaka 150 mg/dL), zomwe zimathandizira kuti insulini ya wodwalayo itseke kusweka kwamafuta m'minyewa ya adipose ndikuletsa thupi kupanga ma organic acid ochulukirapo a neurotoxic mpaka liver organic acid.

Kodi akavalo ndi agalu alinso poizoni ndi Hypoglycin A ndi MCPG kuchokera ku mbewu zamitengo?¶

Inde, mahatchi odyetsera msipu m'dzinja ndi masika nthawi zambiri amadwala matenda oopsa kwambiri otchedwa Equine Atypical Myopathy (ku Ulaya/UK) kapena Seasonal Pasture Myopathy (ku North America) atadya mbewu zamapiko ("helicopter samaras") ndi mbande za Sycamore Maple (Acer pseudoplatanus) ndi Box Elder omwe ndi a banja la Sapinda (Acer pseudoplatanus) ackee ndi lychee ndipo ali ndi milingo yambiri ya Hypoglycin A.

Kuti muyankhe bwino pazochitika zadzidzidzi za ana, kagayidwe kachakudya, ndi poizoni, ganizirani kutenga chithandizo choyamba ndi CPR kuchokera ku Red Cross, St John Ambulance, kapena wothandizira maphunziro adzidzidzi.

Maupangiri ogwirizana¶

• Sulfonylurea (Glipizide, Glyburide) Overdose, Recurrent Hypoglycemia, ndi Octreotide Triage
• Matenda a Epilepticus, Kukomoka Kwambiri, ndi Mankhwala Opulumutsa
• Kukomoka: Thandizo Loyamba ndi Chitetezo cha Airway
• Poizoni Chakudya, Acute Gastroenteritis, ndi Kutaya madzi m'thupi
• General Poisoning First Aid ndi Decontamination

Magwero ndi malangizo ovomerezeka¶

• U.S. Centers for Disease Control and Prevention (CDC) & National Center for Disease Control (NCDC, India): Shrivastava A, et al.: Association of acute toxic encephalopathy with litchi consumption in an outbreak in Muzaffarpur, India, 2014: a case-control study (The Lancet Global Health).
• Unduna wa Zaumoyo ndi Ubwino wa Jamaica & Caribbean Public Health Agency (CARPHA): Malangizo Othandizira Zachipatala a Ackee Poisoning (Jamaican Vomiting Sickness / Hypoglycin A Intoxication) (Kingston, Jamaica).
• U.S. Food and Drug Administration (FDA): Import Alert 21-11 & Compliance Policy Guide: Kutsekereza Ackee Yazitini Kapena Yowumitsidwa Yokhala Ndi Kuposa 100 ppm Hypoglycin A (United States).
• World Health Organization (WHO) / ​​FAO Joint Expert Committee on Food Additives: Kuwunika Chitetezo cha Zakudya Zina Zowonongeka: Hypoglycin A mu Ackee Fruit (Blighia sapida) ndi MCPG ku Sapindaceae Fruits (Geneva).
• Sherratt HSA / Tanaka K, Isselbacher KJ: Hypoglycin, poizoni wa chipatso cha ackee chosapsa: biochemical mechanism of inhibition of beta-oxidation and gluconeogenesis (Biochemical Pharmacology / New England Journal of Medicine).