Colchicine Overdose ndi Gloriosa Lily Poisoning: Chifukwa Chake Kumwa Mapiritsi Owonjezera a Gout kwa Flare Ndikoopsa¶

Colchicine (Colcrys, Mitigare, Gloperba) - anti-inflammatory alkaloid wazaka zana zomwe zimaperekedwa kwa matenda oopsa a gout, Mediterranean fever (FMF), ndi pericarditis - ali ndi mazenera ochepetsetsa, osakhululukidwa pazamankhwala onse azachipatala. Mosiyana ndi ibuprofen kapena acetaminophen, pamene wodwala angaganize molakwika kuti akhoza kumwa mapiritsi ochulukirapo pamene ululu wa gout wa zala zazikuluzikulu ukulephera kusintha, kumeza mapiritsi 10 mpaka 20 a 0.6-milligram colchicine (mamiligalamu 6 mpaka 12, kapena kupitirira 0.15 mamiligalamu tsiku lililonse) monga clarithromycin - imayambitsa poizoni woopsa, wa biphasic multi-organ popanda mankhwala omwe amapezeka kwambiri. Poyizoni wakupha wofananawo umachitika pamene odyetsa kapena ana amadya ma tubers, mababu, kapena masamba a Flame Lily (Gloriosa superba) ** kapena ** Autumn Crocus (Colchicum autumnale), kapena ikakhazikika podophyllin (podofilox) utomoni wa njerewere umamezedwa kapena kupakidwa pakhungu. Ngati wina wamwa mapiritsi atatu (1.8 mg) a colchicine opitilira 3 omwe adayikidwa m'maola 24, kapena amwa zomera za Colchicum kapena Gloriosa, imbani foni kwanuko. manambala angozi nthawi yomweyo - **ngakhale atakhala bwino kwa maola angapo oyamba **. Pazadzidzidzi zokhudzana ndi toxicological ndi hematological, funsani Kudya bowa wakuthengo ndi kudya mbewu zapoizoni, neutropenic fever ndi kuponderezedwa kwa mafupa,ndi chakudya poyizoni, pachimake gastroenteritis, ndi kutaya madzi m'thupi.

Poyizoni wa Colchicine ndi wapoizoni wapoizoni ** "bomba lopanda phokoso" ** lofanana ndi bowa wa amatoxin Death Cap ndi paraquat: pambuyo pakuchedwa kwachinyengo kwa maola 2 mpaka 12 popanda zizindikiro, Gawo 1 limagunda ndi kuphulika kwamagazi, kolera ngati kutsekula m'mimba komanso kugwedezeka kwa hypovolemic, kutsatiridwa ndi maola *24 mpaka 7 kupuma movutikira (ARDS), kulephera kwa chiwindi/impso, ndi aplasia ya m’mafupa athunthu (ziro maselo oyera a magazi ndi mapulateleti)**.

Chitani izi tsopano¶

1. Imbani foni pa nambala yanu yazadzidzi zadzidzidzi komanso Kuletsa Poizoni MWAMWAMBA ngati wina wameza mapiritsi atatu a colchicine (1.8 mg) pa tsiku, kapena ULIWONSE wa Autumn Crocus / Gloriosa Lily. Imbani 911 ku United States ndi Canada (US Poison Control 1-800-222-1222 1212), European Union kudera lonse la European Union. 000 ku Australia (Chidziwitso cha Poizoni 13 11 26), kapena funsani bukhu lathu la manambala angozi. **Musamadikire kuti m'mimba muyambe kupweteka kapena kusanza **; colchicine ikangoyamwa kuchokera m'matumbo ndikumanga m'maselo a thupi, siingathe kutulutsidwa m'magazi.
2. Thawirani ku dipatimenti yazadzidzidzi mkati mwa 1 mpaka 2 ola ladzidzidzi Loyambitsa Makala (Multidose Activated Charcoal). Chifukwa colchicine imalowa m'thupi enterohepatic recirculation (chiwindi chimatulutsa colchicine mu ndulu, yomwe imabwerera m'matumbo aang'ono kuti ibwererenso), chipatala chakumwa ** makala opangidwa mobwerezabwereza maola awiri mpaka 4** amatchera colchicine m'matumbo ang'onoang'ono ndipo amasiya kumwa mowa kwambiri kuchokera kumatumbo a m'matumbo. mafuta.
3. SIYANI kumwa colchicine nthawi yomweyo ngati mwapatsidwa mankhwala ALIYENSE a macrolide (clarithromycin kapena erythromycin), antifungal (itraconazole, ketoconazole), mankhwala a mtima (verapamil, diltiazem), kapena cyclosporine - kapena ngati munamwa madzi a manyumwa. Mankhwalawa amalepheretsa CYP3A4 enzyme ndi P-glycoprotein efflux pampu yomwe imayeretsa colchicine, kutembenuza mlingo wamba wa mapiritsi awiri a gout kukhala owopsa kwambiri mkati mwa 10.
4. Ngati Gawo 1 kusanza koopsa komanso kutsekula m'mimba kwamadzi / kwamagazi kwayamba kale, yambani kusintha madzi ankhanza pamene mukudikirira ambulansi - ndipo MUSAMApatse mankhwala oletsa kutsekula m'mimba.loperamide / Imodium). Colchicine imalepheretsa kugawanika kwa maselo a m'matumbo, kuchititsa malita a madzi a m'magazi ndi ma electrolyte kutuluka m'matumbo (cholera-like gastroenteritis). Kupereka loperamide kapena bismuth subsalicylate kumatchera colchicine wosayamwa mkati mwa matumbo kotero kuti chiphe chochulukirapo chimalowa m'magazi.
5. Ngati njerewere za podophyllin (podofilox) zinatayikira mwangozi pakhungu lalikulu kapena pa mucous nembanemba, sambani khungu nthawi yomweyo ndi sopo ndi madzi oyenda. Utoto wa podophyllin wokhazikika umatenga mwachangu kudzera pakhungu lokhazikika kapena lophwanyika ndipo zimayambitsa poizoni wofanana wa mitotic-spindle, chikomokere, zotumphukira neuropathy.
6. *Bweretsani botolo la mapiritsi a colchicine (kuti madokotala athe kuwerengera mapiritsi omwe akusowa ndikuwerengera ndendende mg/kg mlingo) kapena chithunzi/chitsanzo cha babu kapena duwa lomwe lamwedwa. Kudziwa ngati wodwalayo adamwa < 0.5 mg/kg, 0.5 to 0.8 mg/kg, kapena > 0.8 mg/kg nthawi yomweyo amauza gulu la odwala kwambiri za momwe wodwalayo alili komanso zofunikira za ICU.

Mtengo wosankha: colchicine, Gloriosa lily, ndi podophyllin poisoning triage¶

flowchart TD
    A["Kukayikiridwa kwa Colchicine Overdose, Gloriosa Lily / Autumn Crocus Ingestion, kapena Podophyllin Exposure"] --> B{"Kuwerengera mlingo wa Colchicine wolowetsedwa (mu mg/kg wa kulemera kwa thupi) kapena onani Kuyanjana kwa Mankhwala"}
    B -->|"Mlingo wamba + Clarithromycin / Verapamil / Cyclosporine + kutsegula m'mimba / kusanza kwatsopano"| C["IATROGENIC COLCHICINE TOXICITY: Siyani mankhwala onse awiri ndikupita ku ER nthawi yomweyo"]
    B -->|"Kuchulukirachulukira kopitilira 0.5 mg/kg (mwachitsanzo, 7 mpaka 30 mg mwa wamkulu wolemera makilogalamu 70)"| D["ZOCHITIKA KWAMBIRI: Zoyendera za EMS za Gastric Lavage (ngati < 1 hr) + Multidose Activated makala"]
    B -->|"Pachimake overdose 0.5 mpaka 0.8 mg/kg (35 mpaka 56 mg mu 70-kg wamkulu)"| E["ZOYENERA KUWOPSA MOYO WOYAMBIRA: Yembekezerani kugwedezeka kwakukulu kwa GI + Bone Marrow Aplasia (10% mpaka 50% kufa)"]
    B -->|"Pachimake overdose> 0.8 mg/kg (> 56 mg wamkulu 70-kg wamkulu) kapena lonse Gloriosa tuber"| F["FULMINANT LETHAL DOSE (Ikuyandikira kufa kwa 80% mpaka 100%): Kutumiza Kwaposachedwa kwa ICU / ECMO"]
    C --> G["Gawo 1 (Maola 2 mpaka 24): Aggressive IV Crystalloid Resuscitation for Cholera-Monga GI Fluid Loss"]
    D --> G
    E --> G
    F --> G
    G --> H["Gawo 2 (Masiku 1 mpaka 7): ICU Cardiac Support (Norepinephrine/VA-ECMO) + G-CSF (Filgrastim) ya Neutropenia"]

Momwe colchicine ndi podophyllin zimapha maselo: kutseka mitotic spindle¶

Kuti mumvetsetse chifukwa chake poizoni wa colchicine amawoneka ngati poyizoni wazakudya, kenako ngati vuto lalikulu la mtima, ndipo patatha masiku asanu ngati matenda oopsa a radiation kapena leukemia chemotherapy toxicity, onani momwe molekyulu imagwirira ntchito mkati mwa cell iliyonse yamunthu.

Microtubule depolymerization ndi kumangidwa kwa magawo a cell mu metaphase¶

Selo lililonse lamoyo m'thupi la munthu lili ndi chigoba chamkati komanso msewu wawukulu wopangidwa ndi machubu a protein opanda kanthu otchedwa microtubules, opangidwa kuchokera kumamanga otchedwa alpha-tubulin ndi beta-tubulin dimers. Ma Microtubules amagwira ntchito ziwiri zofunika:

1. ** Mitotic Spindle panthawi yogawa ma cell (mitosis):** Nthawi zonse pamene tsinde la m'matumbo mwako, m'mafupa, kapena m'mitsempha yatsitsi yagawanika m'malo mwa maselo akale, tinthu tating'onoting'ono timene timapanga tingwe tating'onoting'ono (mitotic spindle) timene timakoka ma chromosome kukhala maselo awiri aakazi atsopano.
2. Kuyendera kwapakati pa cell ndi contractility ya myocardial mkati mwa maselo osagawikana: Mkati mwa ma cell a minofu yamtima (cardiomyocytes), ma axon a minyewa, ndi ma cell a chiwindi, ma microtubules amakhala ngati malamba omwe amanyamula mitochondria, ma calcium, ndi ma neurotransmitter vesicles kudutsa selo.

Colchicine (komanso podophyllotoxin yochokera ku chomera cha Mayapple / wart resin, ndi vinca alkaloids yomwe imagwiritsidwa ntchito mu khansa ya chemotherapy) imamanga ndi kuyanjana kosasinthika ku sungunuka wa beta-tubulin dimers, kutsekereza kumapeto kwa microtubule kotero kuti imavundukula ndikusungunula (**microtubule depo *).

• Mumagulu ogawikana mwachangu (Gut mucosa ndi Bone marrow): Selo lililonse logawikana logawikana limaundana kosalekeza pakati pa ma cell (metaphase arrest) ndikumafa maselo opangidwa mwadongosolo.apoptosis). Chifukwa ma cell omwe ali m'matumbo anu ang'onoang'ono amadzilowetsa m'malo mwa maola 24 mpaka 48 aliwonse, matumbo onse amatsika pa Tsiku 1 (Phase 1-monga kolera). Chifukwa maselo oyera a magazi ndi mapulateleti a m'mafupa a m'mafupa amalowa m'malo mwa 3 mpaka 5 masiku aliwonse, chitetezo chanu chonse cha mthupi ndi kutsekeka kwa magazi kumasowa pa Masiku 3 mpaka 7 (** Phase 2 pancytopenia ndi sepsis **).
• Mu minofu ya mtima ndi ma cell a minyewa: Kusungunuka kwa netiweki ya microtubule mkati mwa maselo a minofu ya mtima kumasokoneza kasamalidwe ka sarcoplasmic kashiamu ndi kayendedwe ka mphamvu ya mitochondrial, kumayambitsa kudabwitsa kwa myocardial, kugwedezeka kwamtima, kutsekeka kwamtima kwathunthu, ndi asystole mwadzidzidzi pa maola 24 mpaka 72.

Chifukwa chiyani hemodialysis ndi hemoperfusion SINGATHE kuchotsa colchicine m'thupi¶

Mosiyana ndi caffeine, lithiamu, kapena salicylates (aspirin), yomwe imakhala yosungunuka m'madzi a m'magazi a m'magazi momwe makina a dialysis amatha kuwasefa, colchicine yomwe imamwa imatuluka m'magazi mkati mwa maola 1 mpaka 3 ndikutsekera mwamphamvu pamapuloteni a tubulin ** mkati mwa minyewa yolimba ya thupi , ndikupanga kugawa kwakukulu ( ** kuchuluka kwa magazi).Vd = 2 to 12 L/kg, mpaka 21 L/kg mu overdose). Chifukwa chakuti osachepera 1 mpaka 2 peresenti ya colchicine ya thupi imakhalabe ikuyandama m'magazi, **hemodialysis, hemofiltration, ndi makala a hemoperfusion alibe ntchito pa kuchotsa colchicine ** (ngakhale dialysis imagwiritsidwabe ntchito pothandizira odwala omwe impso zawo zimalephera mu Gawo 2). Ichi ndichifukwa chake kuchotsa m'matumbo msanga ndi Multidose Activated Makala isanakwane komanso panthawi yobwezeretsanso enterohepatic ndikofunikira kwambiri.

The weight-based lethality rule (Bismuth & Baud classification)¶

Mu toxicology yachipatala (yomwe idakhazikitsidwa ndi Bismuth, Baud, ndi anzake ku Paris Poison Control Center), kupulumuka kwa wodwala pambuyo pa kuwonjezereka kwa colchicine kumanenedweratu molondola kwambiri powerengera mlingo wolowetsedwa wa milligram wogawidwa ndi kulemera kwa thupi la wodwalayo mu kilogalamu.mg/kg):

Magawo atatu apadera azachipatala a Colchicine ndi Gloriosa Lily poisoning¶

Poyizoni wa Colchicine umadutsa magawo atatu otsatizana azachipatala masiku 10 mpaka 14:

Gawo 1: Gastrointestinal & Hypovolemic Phase (Maola 2 mpaka 24 pambuyo pakumeza)¶

• Wonyenga zenera lobisika la maola 2 mpaka 12: Kwa maola 2 mpaka 6 oyambirira atameza mapiritsi owonjezera a colchicine kapena kudya mababu ophikidwa a Gloriosa / Colchicum, wodwalayo amadzimva kuti zili bwino ndithu (kupatulapo kupsa pang'ono mkamwa ndi pakhosi nthawi zina ndi zomera zosaphika). Osapusitsidwa kukhala kunyumba pawindo labatali.
• Kuphulika kwa "Cholera-Monga" Gastroenteritis (Maola 6 mpaka 24): Pamene matumbo a crypt mitosis amasiya ndipo maselo a mucosal akuchepa, wodwalayo amayamba nseru, kusanza, kupweteka m'mimba, ndi **madzi ochuluka, osalekeza, amadzimadzi ndi magazi.
• Hypovolemic Shock and Electrolyte Collapse: Kutaya madzi m'matumbo kumatha kupitirira 5 mpaka 10 malita (1.3 mpaka 2.6 malita) mu maola 24, kuchititsa mantha aakulu a hypovolemic, prerenal acute aimpso, lactic acidosis, hypokalemia, hyponatremia, hypokalemia, hyponatremia, hypocalcemia, hypocalcemia, hypokalemia, hypocalcemia kuchuluka kwa maselo oyera amagazi pamwamba pa 20,000/mcL m'mafupa a m'mafupa asanachitike).

Gawo 2: Kulephera kwa Multi-Organ, Cardiogenic Shock, ndi Bone Marrow Aplasia Phase (Masiku 1 mpaka 7)¶

Monga momwe kusanza ndi kutsekula m'mimba kumawoneka pang'onopang'ono pafupifupi Ola 24 mpaka 36, wodwalayo amalowa gawo lachiwiri lakupha:

1. Refractory Cardiogenic Shock and Arrhythmias (Maola 24 mpaka 72 - Chifukwa Chachikulu Cha Imfa):
2. Kuwonongeka kwa tubulin mkati mwa mtima wa myocyte kumayambitsa kulephera kwa mtima kwa biventricular (left ventricular ejection fraction dropping below 15% to 20%), hypotension yozama yomwe imasiya kuyankha madzi a IV ndi vasopressors, sinus bradycardia, atrioventricular heart block, ventricular tachycardia, ndi mwadzidzidzi asystolic cardiac arrest.
3. ** Complete Bone Marrow Aplasia / Pancytopenia (Masiku 3 mpaka 7):**
4. Pakati pa Tsiku la 3 ndi Tsiku la 7, chiwerengero cha neutrophil chamtheradi cha wodwala chimatsikira ku zero (agranulocytosis) ndipo mapulateleti amatsika pansi pa 10,000 mpaka 20,000/mcL (severe thrombocytopenia).
5. Chifukwa matumbo osokonekera adataya chotchinga chake motsutsana ndi mabakiteriya am'matumbo nthawi yomweyo thupi limakhala ndi zero maselo oyera amagazi, mabakiteriya a Gram-negative (E. coli, Klebsiella, Pseudomonas) kutsanulira mwachindunji kuchokera m'matumbo kulowa m'magazi, kuchititsa fulminant neutropenic septic shock ndi Disseminated Intravascular Coagulation (DIC).
6. Acute Respiratory Distress Syndrome (ARDS), Rhabdomyolysis, ndi Ascending Paralysis:
7. Kutuluka kwa capillary m'mapapo kumayambitsa edema yopanda cardiogenic pulmonary edema (ARDS) kumafuna mpweya wabwino wamakina.
8. Kuwonongeka kwachigoba kwachigoba komanso kuwonongeka kwa axonal microtubule kumayambitsa kwambiri myoneuropathy (kufooka kwa minofu yapakatikati kumatsanzira matenda a Guillain-Barré, creatine kinase okwera rhabdomyolysis, ndi kutayika kwa ma reflexes), pamodzi ndi kuvulala kwakukulu kwa chiwindi, kapamba, ndi ziwalo za ileus.

Gawo 3: Kuchira & Total Alopecia Phase (Tsiku 7 mpaka Sabata 3+)¶

Ngati wodwalayo apulumuka pamavuto amtima ndi septic a Phase 2 mu ICU:

• Rebound Leukocytosis: Maselo a m'mafupa a m'mafupa amayambanso kugawikana pakati pa Tsiku 7 mpaka 10, zomwe zimapangitsa kuti maselo oyera a magazi abwererenso kwambiri.
• Kutayika kwathunthu, tsitsi lodabwitsa (Total Alopecia): Patsiku la 7 mpaka 14, chifukwa maselo a tsitsi-follicle matrix amagawanika mofulumira monga odwala chemotherapy, **pamutu, nsidze, ndi tsitsi lonse la thupi limagwera m'magulu ** (mapeto ake amakulanso miyezi 3 mpaka 6). Kufooka kwa Neuromyopathy kumatha kutenga milungu kapena miyezi kuti abwezeretsedwe.

Kugwiritsa Ntchito Mankhwala Osokoneza Bongo: Momwe mlingo wabwinobwino wa mapiritsi a 2 gout umakhala wowopsa kwambiri¶

Kuposa theka la mankhwala omwe amapha colchicine poyizoni m'zipatala samachokera ku kumwa mapiritsi mwadala; zimachitika mwa odwala omwe amamwa mapiritsi awo a 0.6-mg colchicine omwe amapatsidwa nthawi imodzi ndi maantibayotiki wamba kapena mapiritsi amtima, kapena omwe ali ndi matenda a impso kapena chiwindi.

The CYP3A4 ndi P-glycoprotein (P-gp) chiwombankhanga cha kuchotsedwa¶

Nthawi zambiri, maselo aumunthu amadziteteza ku colchicine pogwiritsa ntchito mapampu awiri achilengedwe:

1. P-glycoprotein (P-gp / ABCB1):** Pampu yogwira ntchito ya cell efflux pamwamba pa ma cell a matumbo, chiwindi cha biliary canaliculi, ndi machubu a impso omwe amapopa mwachangu colchicine kuchokera m'maselo kupita ku chopondapo ndi mkodzo.
2. Cytochrome P450 3A4 (CYP3A4): Enzayimu ya m’chiwindi imene imachotsa ndi kuchititsa colchicine.

Zofanana ndi Botanical: Gloriosa Superba (Flame Lily) ndi Colchicum Autumnale (Autumn Crocus)¶

Zomera ziwiri zokongola komanso zakuthengo zomwe zabzalidwa kwambiri zimakhala ndi colchicine wokhazikika wachilengedwe ndipo zimayambitsa ziphe zambiri chaka chilichonse pakati pa olima kunyumba, odyetsera adyo zakuthengo, ndi ana:

1. Colchicum autumnale (Autumn Crocus / Meadow Saffron / Naked Ladies)¶

• ** Garlic Wam'tchire (Allium ursinum / Ramps) Msampha Wodyera:** Chakumapeto, Colchicum autumnale imatumiza masamba obiriwira, onyezimira owoneka ngati mipingo kuchokera ku mababu apansi panthaka m'madambo achinyezi a ku Europe ndi North America - nthawi zambiri amamera ** pafupi ndi Garlic Wakutchire (Allium ursinum / adyo wa chimbalangondo)** kapena ma ramp. Odyera akutola masamba a adyo wakuthengo wa pesto kapena supu mwangozi amasonkhanitsa masamba a Colchicum pamodzi ndi adyoyo.
• Mmene mungawalekanitse: Kuphwanya tsamba lodyedwa la adyo wakuthengo kumatulutsa fungo loipa la adyo **, ndipo masamba ake amamera pachokha kuchokera ku babu; Masamba akupha a Colchicum autumnale ali ndi fungo la adyo ZERO, ndi olimba, ndipo amangirirana mwamphamvu m'chimake pansi. Kudya masamba kapena maluwa ochepa a Colchicum kumapereka mlingo wakupha wa colchicine. (Dziwani: Colchicum autumnale ndiyosiyananso ndi zokometsera zenizeni Safroni [Crocus sativus], wa banja la iris Iridaceae ndipo ali ndi misala 3, pomwe Colchicum yapoizoni ndi yake Colchicaceae ndipo ali ndi ma stameni 6).

2. Gloriosa superba (Flame Lily / Glory Lily / Climbing Lily)¶

• The Sweet Potato / Yam / Ginger Tuber Trap: Gloriosa superba ndi mpesa wochititsa chidwi wokwera wokwera wokhala ndi maluwa owoneka ngati lawi lofiira ndi lachikasu lomwe limamera ku Asia, Africa, Australia, komanso ngati chomera chokongoletsera ku US ndi Europe. Pansi pa nthaka, zimamera zooneka ngati V kapena zooneka ngati L machubu apansi panthaka omwe amaoneka ngati mbatata, zilazi, chinangwa, kapena mizu ya ginger.
• Kupha koopsa: Tuber imodzi ya 20-to-50-gram Gloriosa superba ili ndi 60 mpaka 150 milligrams ya pure colchicine ndi gloriosine - yokwanira kupha akuluakulu awiri kapena atatu. Aliyense amene amaphika mwangozi ndi kudya tuber ya Gloriosa amafunikira kuchotsedwa m'mimba mwamsanga m'mimba ngakhale m'mimba musanayambe.

Podophyllin (Podofilox / Mayapple) Poyizoni: kuwopsa kwa wart-resin¶

Podophyllin ndi utomoni wokhazikika womwe umachokera ku mizu ya Mayapple waku America (Podophyllum peltatum, yomwe ili ndi poizoni wa microtubule podophyllotoxin (podofilox / Condylox). Amapangidwa ngati 0.5% solution/gel kapena ophatikizidwa ngati 10% mpaka 25% benzoin tincture kuti awotche njerewere zakumaliseche.condyloma acuminata) ndi njerewere za plantar.

• Mmene poizoni amachitikira: Kumeza mwangozi botolo lochotsa njerewere ndi mwana, kudya zipatso zobiriwira za Mayapple/mizu m'nkhalango, kapena **kupaka 10% mpaka 25% podophyllin utomoni pa njere zazikulu, zobiriwira, zotuluka magazi kumaliseche kapena kumaliseche ndikulephera kuzitsuka pambuyo pa maola 1 mpaka 4.
• Kusokonekera kwapadera kwa minyewa pamodzi ndi kulephera kwa mafupa: Monga colchicine, podophyllin imatseka mitotic spindle ndipo imayambitsa Kusanza/kutsekula m'mimba koopsa kwa Gawo 2 **mafupa pancytopenia, kulephera kwa chiwindi, ndi mantha **. Kuphatikiza apo, podophyllin imawoloka chotchinga chamagazi-muubongo mwamphamvu kwambiri kuposa colchicine, kuchititsa **acute central nervous system encephalopathy (chisokonezo, kuyerekezera zinthu m'maganizo, kufooka, chikomokere, kukomoka) mkati mwa maola 6 mpaka 24 **, kutsatiridwa ndi zovuta, zokhalitsa ** sensorimotor peripheral neuropathy/kuwotcha * kupweteka, kupweteka kwam'mutu, kupweteka kwam'mutu, kupweteka kwam'mutu, kupweteka kwam'mutu, kupweteka kwam'mutu, kupweteka kwam'mutu, kupweteka kwam'mutu, kupweteka kwam'mutu, kupweteka kwam'mimba, kupweteka kwam'mutu, kukomoka, kukomoka. ileus.

Chipatala cha ICU kasamalidwe ka Colchicine ndi Podophyllin poizoni¶

1. Kutsuka M'mimba Mwamsanga (mkati mwa mphindi 60) ndi Multidose Activated Charcoal (MDAC):
2. Chifukwa chakuti imfa pamwamba pa 0.5 mpaka 0.8 mg/kg ndi yochuluka kwambiri ndipo dialysis imalephera, madokotala amachita mwamsanga nasogastric aspiration / lavage ngati wodwalayo afika mkati mwa ola la 1 atamwa ndikupereka ** makala opangidwa ndi 50 g poyamba, kutsatiridwa ndi 25 g maola 2 mpaka 4 maola * * pamodzi ndi IV pa reruption interrupt.
3. Kutsitsimutsa Kwambiri Kwambiri kwa Hemodynamic ndi VA-ECMO:
4. Kusintha kwakukulu kwamadzimadzi a crystalloid (0.9% normal saline kapena Ringer's lactate) motsogozedwa ndi bedi echocardiography pa Phase 1, kusintha mofulumira ku **norepinephrine / epinephrine infusions ** ndi oyambirira Veno-Arterial Extracorporeal Membrane Oxygenation (VA-ECMO) ngati refractory cardiogenic shock ikuyamba mu Phase 2 (VA-ECMO yapulumutsa mgg / microcardio ya odwala ambiri mpaka 8 microcardio). kubadwanso masiku 5 mpaka 7 pambuyo pake).
5. Chinthu Choyambitsa Granulocyte Colony-Stimulating Factor (G-CSF / Filgrastim) ndi Neutropenic Sepsis Precautions:
6. Maselo oyera amagazi asanayambe kapena atangoyamba kutsika pa Tsiku 2 mpaka 3, akatswiri a magazi ndi a toxicologists amapereka tsiku ndi tsiku subcutaneous kapena intravenous filgrastim.G-CSF, 5 mcg/kg/tsiku) kuti alimbikitse tsinde la m'mafupa omwe atsala ndi kufupikitsa nthawi ya imfa ya neutropenia, kuphatikizapo mankhwala opha tizilombo toyambitsa matenda (intravenous antibiotic).cefepime, piperacillin-tazobactam, kapena meropenem) ndi kuikidwa magazi.
7. Zidutswa Zakufufuza za Colchicine-Specific Fab Antibody: M'malo osankhidwa a ku Europe (France), zoyeserera zidutswa za Fab za colchicine zenizeni (zopangidwa mofanana ndi Digibind/DigiFab zomwe zimagwiritsidwa ntchito powonjezera mankhwala a digoxin) zatulutsa colchicine kuchokera mumkodzo ndikugwiritsanso ntchito mkodzo mumkodzo. ndondomeko.

Nambala zangozi zachigawo ndi ndondomeko za bungwe¶

• United States ndi Canada: Imbani 911 ndi US Poison Control pa 1-800-222-1222 (Canada: 1-844-POISON-X). Bungwe la US Food and Drug Administration (FDA) Colcrys (Colchicine) Safety Labeling limapereka lamulo lokhwima 1.8 mg lapamwamba la mapiritsi 3 acute gout flare cap (1.2 mg wotsatiridwa ndi 0.6 mg 1 ola pambuyo pake) ndipo amanyamula zotsutsana ndi Black Box motsutsana ndi kugwiritsira ntchito colchicine ndi CYP3A4/P-gp zoletsa (clarithromycin, ritonavir/Paxlovid, cyclosporine) mwa odwala aimpso kapena kwa chiwindi kuwonongeka.
• United Kingdom: Imbani 999 nthawi yomweyo ngati mukuganiziridwa kuti ndi colchicine kapena Colchicum overdose. Bungwe la UK Medicines and Healthcare Products Regulatory Agency (MHRA) ndi National Poisons Information Service (NPIS / TOXBASE) amaika mopitirira muyeso ALIYENSE mwadala kapena mwangozi ngati chipatala choopsa chomwe chimafuna kuti munthu agoneke kuchipatala, Multidose Activated Charcoal, ndi osachepera maola 24 a mtima / biochemical observation.
• European Union: Imbani 112. Malangizo a European Alliance of Associations for Rheumatology (EULAR) gout ndi French Poison Control / European Association of Poisons Centers and Clinical Toxicologists (EAPCCT) amawongolera kutsika kwa colchicine, kupewa kwambiri macrolide, komanso kutumiza kwa ICU/VA-ECMO koyambirira kuti amwe>= 0.5 mg/kg.
• Australia ndi New Zealand: Imbani 000 ku Australia (Chidziwitso cha Poizoni 13 11 26) kapena 111 ku New Zealand (0800 764 766). Therapeutic Goods Administration (TGA) ndi Medsafe NZ akuchenjeza mwamphamvu za "kutenga mpaka kutsekula m'mimba" mlingo wa gout.
• India ndi Asia-Pacific: Imbani 112 ku India, 995 ku Singapore, 119 ku Japan ndi South Korea, kapena 999 ku Malaysia ndi Hong Kong. Ku India ndi Sri Lanka, Gloriosa superba (Karthigai Kilangu / Niyagala) poizoni wa tuber ndi chifukwa chachikulu chodziwika cha pancytopenia yoopsa komanso kugwedezeka kwamtima komwe kumafunikira kutumizidwa kuchipatala chapamwamba. Onani chikwatu chathu cha manambala adzidzidzi padziko lonse lapansi.

Mafunso omwe amafunsidwa pafupipafupi¶

Kodi mapiritsi otetezeka a colchicine ndi otani omwe mungamwe mukadwala gout?¶

Masiku ano FDA ndi mayiko rheumatology malangizo (kutengera mbiri AGREE chipatala mayesero) zimatsimikizira kuti pazipita otetezeka ndi ogwira mlingo wa pachimake gout flare mwa munthu wamkulu ndi impso wabwinobwino ndi chiwindi ndi awiri 0.6-milligram mapiritsi (1.2 mg) kutengedwa pachizindikiro choyamba cha moto, kutsatiridwa ndi MMODZI wowonjezera 0.6-milligram piritsi (0.6-milligram piritsi pambuyo pake - 0.6 mg ola limodzi ndendende). Muyenera kuyima ndikudikirira maola 72 musanatenge maphunziro ena owopsa. Kumwa mapiritsi 6, 10, kapena 15 patsiku sikupangitsa kuti kupweteka kwa gout kuthe msanga ndipo kungayambitse poizoni wa ziwalo zambiri.

N’chifukwa chiyani madokotala m’mbuyomu ankauza odwala matenda a gout kuti azingomwa colchicine ola lililonse mpaka atatsekula m’mimba, ndipo n’chifukwa chiyani zimenezi zinaletsedwa?¶

Kwa zaka makumi ambiri maphunziro amakono okhudzana ndi mlingo asanayambe kuchitidwa, madokotala analibe njira zina zotetezeka zolimbana ndi kutupa ndipo anadalira lamulo lovomerezeka la zaka za m'ma 1900 lopereka piritsi limodzi la colchicine ola limodzi mpaka wodwalayo atatsekula m'mimba kwambiri ndi kusanza. Medical toxicologists potsirizira pake anazindikira kuti colchicine-anachititsa kutsegula m'mimba si vuto vuto mbali - ndi chizindikiro mwachindunji kuti mankhwala wapha poizoni ndi kupha kugawanika tsinde maselo alimbane m'matumbo anu aang'ono, ndi kuti mlingo kuchititsa kutsegula m'mimba zimadutsana mwachindunji ndi mlingo umene umayambitsa m`mafupa kulephera ndi amapha mtima kulephera.

Chifukwa chiyani ndizowopsa kumwa antibiotic clarithromycin kapena COVID-19 Paxlovid mukamamwa colchicine tsiku lililonse?¶

Thupi lanu limadalira pampu yam'manja yotchedwa P-glycoprotein ndi enzyme ya chiwindi yotchedwa CYP3A4 kuti itulutse colchicine kuchokera m'maselo anu kupita ku bile ndi mkodzo kuti zisamangidwe. Clarithromycin (Biaxin), erythromycin, antifungal mankhwala monga itraconazole, ndi ritonavir chigawo cha COVID-19 Paxlovid anatseka kwathunthu P-glycoprotein ndi CYP3A4. Ngati mukupitiriza kumwa mapiritsi anu a 1 kapena 2 a tsiku ndi tsiku a colchicine pamene mukumwa clarithromycin kapena Paxlovid, colchicine imatsekera mkati mwa mtima wanu ndi m'mafupa nthawi 3 mpaka 4, zomwe zimayambitsa poizoni wakupha m'masiku ochepa.

Ngati wina anameza mapiritsi owonjezera a colchicine maola atatu apitawo ndipo akumvabe kuti ali bwino 100%, kodi ali pachiwopsezo?¶

Ayi - zenera lopanda chizindikiro ndilo msampha wowopsa kwambiri wa poizoni wa colchicine. Colchicine amatenga 2 kwa maola 12 kuti asokoneze ma spindles a microtubule mkati mogawanitsa maselo am'mimba, kotero wodwala aliyense amamva bwino kwa maola angapo oyambirira atameza mlingo wakupha. Kudikirira kunyumba mpaka kusanza koopsa ndi kutsekula m'mimba kotaya magazi kumatanthauza kuti poizoni wachoka kale m'matumbo ndikutsekera mkati mwa minofu yamtima ndi m'mafupa, momwe dialysis singafike. Kupita kuchipinda chodzidzimutsa panthawi yabata yoyamba 1 mpaka 2 ola la makala oyaka kungathe kupulumutsa moyo wa wodwalayo.

Kodi anthu amamwa bwanji poizoni mwangozi ndi zomera za Autumn Crocus kapena Gloriosa Lily?¶

M'chaka, masamba akupha a Autumn Crocus (Colchicum autumnale) amamera m'malo achinyezi pafupi ndi adyo wakuthengo (Allium ursinum / ramps); Odyera omwe samanunkhiza tsamba lililonse chifukwa cha fungo la adyo amasakaniza mwangozi masamba a Colchicum kukhala pesto kapena supu. M'madera otentha ndi otentha (komanso m'nyumba zokhala ndi maluwa okongola okwera), machubu apansi panthaka a Flame Lily (Gloriosa superba) amawoneka ngati mbatata yaing'ono, zilazi, kapena mizu ya ginger, ndipo kudya ngakhale theka la tuber kumapereka mlingo waukulu, wakupha wa colchicine.

Magwero ndi malangizo ovomerezeka¶

• Ulamuliro wa US Food and Drug Administration (FDA, United States): Kufotokozera Chidziwitso ndi Chitsogozo cha Mankhwala a Colcrys (Colchicine, USP) Tablets ndi FDA Drug Safety Communication: Fatal Drug Interactions Pakati pa Colchicine ndi P-Glycoprotein / Strong CYP3A4 Inhibitors (Clarithromyrine, Cyclonavir)
• Terkeltaub RA et al. (Arthritis & Rheumatism, The AGREE Trial): *High Versus Low Dosing of Oral Colchicine for Early Acute Gout Flare: Zotsatira za Maola Makumi Awiri ndi Zinai za First Multicenter, Randomized, Double-Blind, Placebo-Controlled, Parallel-Group, Colchicine Study.
• Finkelstein Y, Aks SE, Hutson JR, Juurlink DN, Baud FJ et al. (Clinical Toxicology): Colchicine Poisoning: The Dark Side of an Ancient Drug (Bismuth/Baud-based weight-based mg/kg kufa kwa stratification, 3-gawo lachipatala kupita patsogolo, enterohepatic recirculation, Multidose Activated Makala, ndi G-CSF/VA-ECMO kwambiri chisamaliro).
• Medicines and Healthcare Products Regulatory Agency (MHRA) & National Poisons Information Service (NPIS, United Kingdom): Zosintha Zotetezedwa pa Mankhwala Osokoneza Bongo: Colchicine - Extremely Narrow Therapeutic Index ndi Chiwopsezo cha Kuopsa Kwambiri.
• World Health Organization (WHO) & Poison Centers Guidelines: Clinical Management of Plant Poisonings: Colchicum autumnale (Autumn Crocus), Gloriosa superba (Flame Lily), ndi Podophyllum peltatum (Podophyllin Resin).

Maupangiri ogwirizana¶

• Kudya bowa wakuthengo, amatoxin, ndi kumeza mbewu zapoizoni
• Neutropenic fever, chemotherapy matenda, ndi oncologic zachipatala mwadzidzidzi
• Kuvulala kwakukulu kwa impso, rhabdomyolysis, ndi kuyesa kwa mkodzo wakuda
• Chakudya poyizoni, pachimake gastroenteritis, ndi kutaya madzi m'thupi
• Poizoni thandizo loyamba ndi kukhudzana poizoni