Imyungu (Linamarine irura) n’Imbuto y’Imbuto (Amygdaline / Laetrile) Gufata: Guteba gufatwa n’ubumara bwa Cyanide mu mara¶

Kurya imyungu irura canke itatetswe neza imyungu irura (Manihot esculenta, manioc/yuca), gutafuna intete z’amapera zisharira, ibinogo vy’amapera/amapera/amapera bijanjaguwe, canke amapera arura, canke kumira ubundi buryo-ubuvuzi "Vitamine B17" (amygdalin canke laetrile) ivyo kurya vy’inyongera bitera ubuzima bw’umuntu mu kaga ugucererwa kw’amazi y’umubiri ( Hydrogène Cyanide ) mu nda (HCN) ubumara. Hamagara inomero y’ivyihutirwa yo mu karere kawe (911 muri Leta Zunze Ubumwe za Amerika na Canada, 112 mu bihugu vyose vy’Ubumwe bw’Uburaya, 999 mu Bwongereza) canke ubaze kuri . Ububiko bw'inomero z'ivyihutirwa mpuzamakungu ubwo nyene, maze ubwire uwumurungitse ko uwo murwayi akeneye Hydroxocobalamin (Cyanokit) canke Igikoresho co Gukingira Umuti w’Icyanide (Sodium Thiosulfate / Sodium Nitrite). Mu gihe urindiriye abaganga, ushire hamwe ubuvuzi bwawe ubwo nyene n’ubwacu cyanide na gazi y'inganda guhumeka ubufasha bwa mbere, gutandukanya amaraso y’umutuku ukeye y’ubumara bwa cyanide n’amaraso . isokoroti-inzobe y'umubiri, kandi witegurire . status y'igicuri gufatwa n'intandara igihe kirekire canke CPR.

Mu buryo butandukanye n’umuyaga w’ihydrogène cyanure umuntu ahumeka (utuma umuntu asenyuka mu 10 to 60 seconds), kumira glycosides zitera umunyu, canecane linamarin (mu mfuruka zisharira, mu bitunguru vya lima, no mu mbuto z’umukara) canke amygdaline / prunasin (mu mbuto z’amapera zisharira, mu mbuto z’amapera zisharira, mu mabuye y’ivyamwa vya Rosaceae, no mu mbuto z’imibavu), zifise ** decept30-minute to 4-hour idirisha ry'ubuzima ritagira ikimenyetso**. Muri ico kiringo c’uguceceka, intungamubiri zitwa beta-glucosidase na hydroxynitrile lyase zo mu bimera no mu mara ziguma zihindura amazi mu mara mato no mu mara y’umubiri, zigatuma hydrogène cyanure (HCN) mu maraso y’urugi. Cyanide inywanywa irafatanya cane n’ivyuma (Fe3+) atome y'icuma y'imitokondriya cytokrom c oxidase (Complex IV), bikaba bihagarika burundu uguhema kw’ingingo z’umubiri naho imitsi n’imitsi y’umurwayi iguma yuzuye umwuka w’ikirere (arterialization of venous blood). Ata gutanga 100% y’umwuka w’inyongera vyihuse, gukuraho ubumara bwo mu nda, no gutera Hydroxocobalamin (5 grams IV) canke Ivyuma vy’amazi (12.5 grams IV) + Nitrite ya sodiyumu (300 mg IV), abashikiwe n’ico kiza baratera imbere ningoga kubera gusinzira, gukorora, no guhema cane (Kussmaul breathing) ku ndwara y’amaraso y’umubiri (serum lactate > 8 to 10 mmol/L)**, gufatwa n’intandara muri rusangi, guhagarara kw’umutima, n’urupfu.

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

Ivyo ubikore ubu¶

1. Hamagara abajejwe ivy’ubutabazi n’abajejwe gucungera ubumara ubwo nyene, naho uwo muntu yoba akiri mu buryo busanzwe. Hamagara 911 (Amerika na Canada), 112 (Ubumwe bw’Uburayi), 999 (Ubwongereza), 000 (Ostraliya), canke 111 (Nouvelle-Zélande). Bwira uwurungika ikintu nyaco wamize (bitter apricot kernels, laetrile / amygdalin tablets, bitter cassava / manioc, canke bitter almonds), ni imbuto zingahe canke amagarama angahe zataguwe, n’igihe co kuzinywa kugira ngo ibitaro vyakira bishobore gutegura Hydroxocobalamin (Cyanokit) na Sodium Thiosulfate ku kibanza co gusubiza ubuzima imbere y’uko umurwayi agwa.
2. Ntukigere utuma umuntu aruha, kandi ntukigere ukora igikorwa co gusubiza ubuzima mu kanwa ata n’igipfukisho co kumukingira. Iyo umurwayi yariye glycosides cyanogènes canke umunyu wa cyanure arutse, aside yo mu nda ihindura cyanide ikaba hydrogène cyanure (HCN) gazi (which smells weakly like bitter almonds to the 40% to 60% of people genetically able to detect the odor). Iyo umurwayi ahagaritse guhema, ukoreshe igipfukisho c'umufuko (BVM) canke igipfukisho co mu mufuko c’inzira imwe (CPR) gifise umwuka mwinshi aho gukorana n’akanwa n’akanwa.
3. Muhe umwuka mwinshi 100% abaganga bashitse. Naho pulse oximetry (SpO2) izosoma 98% to 100% kuko utugingo ngengabuzima dufise ubumara tudashobora gukura umwuka w’ikirere mu maraso, tugatanga 100% normobaric oxygen yongera ubushobozi bw’umwuka wo mu maraso, igahangana na cyanide ku bibanza bifatanya cytochrome c oxidase, kandi yongera ubufatanye bw’imiti irwanya indwara y’ibinyabuzima bita sodium thiosulfate na hydroxocobalamine.
4. Uhagarike Vitamine C yo mu kanwa (Ascorbic Acid) ivy’inyongera. Iyo umuntu afashe imbuto z’amapera canke mu kanwa . laetrile, musuzume nimba na bo nyene bafashe Vitamine C nyinshi. Vitamine C inywanywa cane (> 1 to 3 grams) vyihuta guhindura amygdaline mu nda ngo ibe hydrogène cyanure kandi bikagabanya ububiko bwa cystéine buri mu nda bukenewe n’umusemburo w’igitigu ukura ubumara bwitwa rhodanese.
5. Bika umufuko, umufuko w'imbuto, canke umuzi w'imyungu usigaye. Uzane igikoresho c'intete z'amapera, B17 icupa ry’inyongera, canke igiti c’imyungu kidatetse ku kigo c’ivy’ivyihutirwa. Harura canke ugereranije umubare nyawo w’intete ziriwe: gutagura gusa 5 to 10 bitter apricot kernels mu mwana muto canke 20 to 60 bitter apricot kernels (0.5 to 3.5 mg/kg y’ikingana na cyanide) mu muntu akuze bishobora gutuma umuntu agira ubumara bwa cyanide bushobora gutuma apfa canke bugatuma apfa.

Igiti c'ingingo: Guteba gutoranya glycoside y'amara n'uguhitamwo imiti¶

flowchart TD
    A["Gufata imyungu irura, ivyamwa vy’ibitoke vy’amapera, ivyumba vy’ivyamwa canke Laetrile (Amygdalin)"] --> B{"Ni igiki cariwe & Gute?"}
    B -->|"1-3 Ivyumba vy’Imbuto z’Imbuto z’Imbuto z’Imbuto z’Imbuto z’Imbuto z’Imbuto z’Imbuto z’Impumuro"| C["Icoba ari ikibazo gito: Impuzu y’imbuto idakomeretse irabuza Amygdalin kurekura; Niwihweze muhira kiretse iyo utaye"]
    B -->|"Intete z’Ibitoke Bisharira, Ivyamwa vy’Ikimera Bisharira, Ibipande vy’Ibitoke Bisharira, canke Imyungu Isharira"| D["AKAGA KANI KO GUTERERA UBUROMA HCN MU MARA (Igihe c’iminota 30 gushika ku masaha 4)"]
    D --> E["Hamagara kuri 911/112/999; Gukoresha 100% y’umwuka w’ikirere (Oxygène) ugenda cane; Gutanga amakara akoreshwa (1 g/kg gushika kuri 50-100 g) nimba < Amasaha 1-2 hanyuma ukavyuka"]
    E --> F["Gutegeka Stat Gaz y'amaraso yo mu mitsi (VBG), Gaz y'amaraso yo mu mitsi (ABG), Serum Lactate, n'Igice c'Ibanze c'Imibiri"]
    F --> G{"Gusuzuma uburemere bw'ubuvuzi n'amavuta yo mu maraso"}
    G -->|"Nta bimenyetso & Amabere < 3.0 mmol/L"| H["Kwihweza mu bitaro vya ED/ICU amasaha 6 gushika kuri 12 (Ivyuma bitera amazi mu mara); Gusubiramwo amabere q1-2h"]
    G -->|"Ihinduka ry'Ivyiyumviro, Gufatwa n'intandara, Gutera umutima, Guhema nabi, CANKE Laktate >= 8-10 mmol/L"| I["GUTANGA UBWO GUTANGA IMITI (NTUTEGEREZE urugero rwa cyanide rwo muri laboratwari)"]
    I --> J{"Ni uwuhe Muti wo Gukingira Cyanide Ushobora Guca Uboneka?"}
    J -->|"Igitera amazi (Cyanokit) kiraboneka (Ihitamwo rya mbere)"| K["Gutera umuti witwa Hydroxocobalamine 5 g IV (70 mg/kg mu bana) mu minota 15 + Wongeremwo Sodium Thiosulfate 12,5 g IV kugira ngo amara akomeze gusohoka"]
    J -->|"Nitrite + Tiyosulfate gusa nivyo biriho"| L["Ha Nitrite ya Sodiyumu 300 mg IV (10 mL ya 3%) mu minota 2-4 (Ubanze Suzume Hemoglobine) -> Ukurikire n'Isodiyumu Thiosulfate 12,5 g IV"]

Ivyerekeye indwara: Ingene glycosides z’ibimera zihinduka Hydrogène Cyanide (HCN) imbere mu mara y'umuntu¶

Birangiye 2,500 ubwoko bw’ibimera bukora cyanogenic glycosides nk’uburyo bwo kwikingira ibikoko birya ivyatsi. Mu mababi, mu mizi canke mu mbuto z’igitegwa zitagira ikizibu, iyo glycoside cyanogène ibikwa neza imbere mu bihimba vy’umubiri bifise utugingo ngengabuzima, ikaba itandukanye n’intungamubiri zayo zituma amazi akora (beta-glucosidase na hydroxynitrile lyase), zica mu ruhome rw’ingingo z’igitegwa canke mu gice c’umubiri citwa cytoplasme.

1. Intambwe zibiri z’ugucapura kw’imitsi y’umubiri yitwa Amygdaline na Linamarine .¶

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

• Kubera iki mu kanwa Laetrile / Amygdalin ni ubumara incuro 40 kurusha ubumara bwo mu mitsi Laetrile: Abahinga mu vy'ubuhendanyi ba "Vitamine B17" mu mateka bavuga ko laetrile ataco ihungabanya kubera ko gutera imitsi mu bikoko bitera ubumara bukeyi buca butera. Iyo umuntu ayiteye mu mutsi, amygdaline idashobora gusama ica mu nzira ifata ibiribwa maze igasohoka . > 90% ntibihinduka mu mafyigo kubera ko amaraso n’imitsi y’umuntu bitagira intungamubiri zitwa beta-glucosidase. Ariko iyo umuntu ayifashe mu kanwa, imigera yo mu mara n’iyo mu mara mato irafise ubushobozi bwinshi bwa beta-glucosidase. Naho umuntu yoteka intete z’amapera kugira ngo ahindure ivy’ico giterwa . emulsin enzyme, canke akamira imiti isukuye . laetrile ibipande, imigera yo mu mara yabo bwite iracagura glycoside . 1 to 4 hours mu nyuma mu gice co hasi c’umubiri no mu gitereko c’umubiri, kigasesa umutsi w’urugi hydrogène cyanure (HCN).
• Igituma Imyungu irura itera ubumara imiryango mu gihe c'amapfa n'ubukene bw'ibifungurwa: Ubwoko bw'imyungu bushirwa mu imyungu "inzobe" (< 50 milligrams ya HCN ingana n’ikilo c’imizi mishasha, iri ahanini mu ruhu rw’inyuma) n’imyungu "irura" (100 to > 500 milligrams ya HCN ku kilo kigabanywa mu nyama yose y’imitsi). Mu gihe c’amapfa akomeye, ibiterwa vy’imyungu birongereza linamarin incuro zitatu canke zitanu. Gutegura neza imyungu irura mu buryo butekanye bisaba gusekura, gusesa/gujanjagura, kuyishira mu mazi imisi 3 gushika kuri 5 (kureka endogenous linamarase kugira ngo linamarine ihinduke cyanohydrine y’acetone), hanyuma izuba ryumye canke ryoke ku bushuhe bwinshi kugira ngo acetone cyanohydrine ihinduke umuyaga kandi . HCN gazi. Iyo umuryango ushonje utetse imizi y’imyungu irura itanyowe ku giciro c’amahera gusa 20 minutes, canke arya imyungu yinjijwe igice mu . 24 hours, ubushuhe burahindura . linamarase enzyme mbere y’uko linamarine imeneka, igasiga linamarine n’acetone cyanohydrine bitagiramwo ikintu mu vyo kurya. Iyo umuntu amaze kumira, acetone cyanohydrine irabora ubwo nyene ikaba ikintu cica . HCN imbere mu gitereko c’amaraso, mu gihe imigera yo mu mara ihindura amazi linamarine isigaye mu kiringo gikurikira . 2 to 6 hours.

Kugereranya inkomoko z'ivyo kurya vy'ibinyabuzima bita cyanogenic glycoside n'ubumara bwo mu bitaro¶

Gupima iruhande y'igitanda: Uko wokwemeza ubumara bukomeye bwa Cyanide imbere y'uko ama laboratwari agaruka¶

Ipima ry’ingero ry’amaraso yose ryitwa cyanide rifata amasaha canke imisi mu bigo vy’ubushakashatsi kandi ntiryigera riboneka mu gihe kugira ngo riyobore gusubiza ubuzima mu buryo bwihutirwa. Abaganga bemeza ko umuntu yarwaye ubumara bwa cyanide mu mara ku ruhande rw’igitanda mu mwaka w’2019. 5 minutes ukoresheje ibimenyetso bitatu vy’intoke bica bipima:

1. "Arterialisation" y'amaraso y'imitsi (Amaraso y'imitsi y'umutuku n'ay'umutuku A-V O2 Akarimbi)¶

• Uburyo: Kubera ko cyanide ifunga umusemburo witwa cytochrome c oxidase (Complex IV) mu vyo ikora (Fe3+) igihugu, utugingo ngengabuzima two ku ruhande ntitushobora gukura umwuka w’ikirere mu mwuka w’ikirere (oxyhémoglobine) unyura.
• Ikimenyetso co iruhande y'igitanda: Iyo umuforoma canke umuganga w'amaraso akuye amaraso y'imitsi yo mu mpande, amaraso y'imitsi asa n'umutuku w'umutuku" (atatandukanywa n'amaraso y'imitsi) aho gusa n'umutuku w'umutuku w'agahama.
• Ivyemezo vy'umuyagankuba w'amaraso: Gereranya umuyagankuba w'amaraso wo mu mitsi (ABG)** n’ivyo hagati/inyuma Gaz y’amaraso y’imitsi (VBG:
• Mu gihe umutsi PaO2 n’ugupima umwuka w’umutima (SpO2) kuguma ari ibisanzwe (97% to 100%) mu ntango, uguhazwa kw’umwuka w’ikirere (ScvO2 canke SvO2) birenze 85% to 90% na imitsi PvO2 birenze 50 to 60 mmHg.
• Itandukaniro ry'umwuka w'ikirere (A-V O2 gradient) igabanuka ikaja munsi ya . 1 to 2 vol%, bigaragaza ko ubukene bw’umwuka w’ingingo ngenderwako (shared only by cyanide, hydrogen sulfide, sodium azide, and high-oxygen resuscitation).
• Ivyemezo bikoresheje fundoscopie: Gupima amaso ataco akora ku nzira y’amaso vyerekana imitsi y’amaso ifise ibara ry’umutuku ryiza cane n’imitsi y’amaso.

2. Amavuta yo mu maraso >= 8 to 10 mmol/L (Ikimenyetso c’Ikigereranyo c’Inzahabu)¶

• Kubera ko imyimenyerezo y’umubiri ATP gukoranya ibintu birahagarara (producing only 2 ATP molecules per glucose via anaerobic glycolysis instead of 36 ATP), ingingo zihindura pyruvate ningoga zigacika aside lactique.
• Ivyigwa vyerekeye ubumara bwo mu bitaro (Baud n’abandi, Ikinyamakuru c’ubuvuzi c’Ubwongereza bushasha) vyerekanye ko ku murwayi afise ubumara butanywa umwotsi, umubare w’amaraso wo mu maraso w’amaraso ugera ku 100.000. >= 8 mmol/L (72 mg/dL) (canke >= 10 mmol/L mu guhumeka umwotsi) afise > 90% ubushobozi bwo gutahura n’ubudasa bw’ubumara bukomeye bwa cyanide (blood cyanide > 40 micromoles/L canke > 1.0 mg/L) kandi ihuye n’umuzigo wa cyanide uri mu turemangingo.

3. Igiharuro c'amaraso n'uguhema¶

• Iciciro ca 1 (Ugutera imbere kw'imitsi y'umubiri, 30 to 90 minutes): Cyanide ivyura ata guca ku ruhande imitsi y'umubiri, igatuma umuntu agira "cyanide gasp" mu buryo butunguranye, hanyuma akagira uguhema cane / tachypnea (Kussmaul breathing), sinus tachycardie, umuvuduko w’amaraso, umutwe, umutwe, umuvurungano, n’ugutukura.
• Iciciro ca 2 (Ugutakaza Umwuka w'Igihugu, 1 to 4 hours): Nk'imbere mu turemangingo ATP n’ugusenyuka mu bwonko no mu mutima, umurwayi aca ahinduka bukwi na bukwi uguhagarika impwemu / guhagarika umutima, uguhagarika umutima mu bihaha canke AV block, uguhagarika umutima cane, ugufatwa n’indwara y’ibicurane rusangi, uguhagarara neza kw’ubwonko, n’uguhagarika umutima ata n’umwe akora (electriPEA) canke asistole.

Intambwe ku yindi y'imiti y'ibitaro n'amasezerano yo gukuraho ubuhumane¶

Kubera ko uguhinduka kw’amazi mu mara kwa amygdaline na linamarine kubandanya amasaha imbere mu nzira y’amaraso (bitandukanye n’uguhumeka rimwe gusa HCN gaz), kuvura ubumara bw’ibimera butera ubumara bwa cyanogenic glycoside bisaba ugukiza umuti wo gukingira indwara mu mutsi ubwo nyene NO gukomeza gukuraho ubumara bwo mu nda + gutera umuti w’ikibiriti mu gihe kirekire.

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

Intambwe ya 1: Gukuraho ubuhumane bwo mu nda (Activated Charcoal na Gastric Lavage)¶

• Naho amakara akoreshwa afise ubushobozi buke cane bwo gukora cyanure ya potassium (1 gram of charcoal adsorbs -35 mg of KCN), imiti isanzwe y’abantu bakuze (50 to 100 grams y’amakara akora) bishobora gufata bitagoranye ingano z’imiligramu zishobora kwica z’ibinyabuzima bita amygdaline, linamarine, n’ibindi bihimba vy’umubiri biva mu mazi HCN mu nda kandi bigatuma umuntu ashobora kurokoka mu gihe c’ubumara bwo kugerageza no mu buvuzi.
• Iyo umurwayi yerekanye mu 1 to 2 hours yo gufata imbuto z’amapera zisharira zijanjaguwe, ibipande vya laetrile, canke imyungu irura, ushire inzira y’impwemu (intubate if obtunded) hanyuma ukore gastric aspiration/lavage kugira ngo ukureho ku mubiri ibice vy’imbuto vyasigaye, hanyuma ugaca ukurikirwa n’Activated Charcoal (1 gram/kg, gushika ku 50 to 100 grams).

Intambwe ya 2: Umuti wo mu mutsi wo mu murongo wa mbere: Hydroxocobalamine (Cyanokit)¶

Ihidroxokobalamini (Cyanokit) ni umuti w’umurongo wa mbere ukundwa kw’isi yose wo gukingira ubumara bukomeye bwa cyanide muri Amerika ya Ruguru, Uburayi, Ubwongereza na Ostraliya kubera ko ufatanya ata guca ku ruhande cyanide iri mu turemangingo no mu mitsi kugira ngo ikore cyanocobalamin (Vitamin B12) ataco bihinduye ku hemoglobine itwara umwuka w’ikirere canke ngo bitere umuvurungano w’imitsi bitewe n’ivyo bita nitrites.

• Igitigiri c'abantu bakuze: Gusubiramwo amagarama 5 (one 5 g vial canke two 2.5 g vials) y’Ihydroxocobalamine mu 1990. 200 milliliters ya 0.9% sodium chlorure hanyuma ukayitera mu mutsi hejuru ya 15 minutes (-15 mL/minute).
• Igitigiri c'abana: Gutera 70 milligrams per kilogram (70 mg/kg, gushika ku rugero rwo hejuru rw’intango rwa . 5 grams) mu mutsi hejuru ya 15 minutes.
• Itegeko ryo gusubiramwo imiti kugira ngo umuntu atevye gukura amazi mu mara: Mu gihe umuntu arwaye ubumara bw’intete y’amapera, laetrile, canke imyungu irura, abarwayi kenshi baragira ugusubira gutera kw’amazi y’amaraso 2 to 6 hours inyuma y'uwa mbere 5 g Hydroxocobalamin dose nk’uko imigera yo mu mara ibandanya gucapura glycosides zitanywa mu mara. Nimba asidoze y’amavuta (> 4 mmol/L), hypotension, canke koma isubira canke igumaho, ushiremwo isegonda . 5 gram (70 mg/kg abana) ingano y’imiti y’i Hydroxocobalamine irenga 15 minutes to 2 hours.
• Ingaruka zitezwe (Ibara ry’umubiri ridatera ingorane n’ugutera ibara ry’umubiri): Hydroxocobalamin ni ibara ry’umutuku ry’agahama ry’agahama. Ubwo nyene bica bihindura urukoba rw’umurwayi, amarira, ivyuya, plasma, n’amasobe y’umutuku w’agahama (chromaturia)** ku 2 to 7 days (kandi gushika ku 28 days mu nkari). Gabisha laboratwari ko hydroxocobalamine ibangamira ivyigwa vy’ibara ry’umubiri ku bijanye n’ivyo bita creatinine, bilirubine, transaminases, magnésium, n’ivyo bita carboxyhémoglobine/methemoglobine, kureho imirongo y’amaraso y’intango ubwo nyene imbere yo gutangura gutera umuti w’umutuku.

Intambwe ya 3: Gutera hamwe umuti witwa sodium thiosulfate (12.5 Grams)¶

Kubera ko umubiri ufise umuti wo gukuraho ubumara bwa cyanide, ni ukuvuga rhodanese (thiosulfate sulfurtransferase) mu gifu no mu mitsi y’amagufa, bica bihera ningoga abatanga ikibiriti co mu mubiri mu gihe umuntu amara igihe kirekire anywa glycoside, gutanga Sodium Thiosulfate mu mutsi bitanga ikibiriti kidahera kugira ngo cyanide ihinduke thiocyanate (SCN-), ivyo bikaba biva mu mafyigo: * Igitigiri c'abantu bakuze: 12.5 grams (50 milliliters ya 25% Igisubizo ca Sodium Thiosulfate) gishizwe mu mutsi hejuru ya 10 to 30 minutes. * Idoze y'abana: 250 milligrams per kilogram (1.0 mL/kg ya 25% umuti, canke 412.5 mg/kg [1,65 mL/kg] bivanye n’amazi akoreshwa mu gutegura, gushika ku 1,65 mL. 12.5 grams) mu mutsi hejuru 10 to 30 minutes.

Intambwe ya 4: Uburyo bundi bwo gukingira indwara (Igihe Hydroxocobalamin itaboneka): Nitrite ya Sodiyumu + Thiosulfate ya Sodiyumu (Nithiodote) canke Edetate ya Dikobalti (Kelocyanor)¶

Mu turere twinshi turiko turatera imbere aho ibiza vy’imyungu irura bishika, canke mu mavuriro mato mato yo mu misozi ata Cyanokit, abaganga bakoresha uburyo bwa kera bw’intambwe zibiri Nitrite + Thiosulfate: 1. Amyl Nitrite (Ikiraro co guhumeka imbere y’uko umuntu afata IV): Janjagura ampoule ya amyl nitrite (0.3 mL) mu gaze maze ukayifata munsi y’izuru ry’umurwayi (canke hejuru y’aho umufuko-valve-masque ufata) kugeza . 15 to 30 seconds y’umunota wose mu gihe ashinga IV access. 2. Nitrite ya Sodium iterwa mu mutsi (3% umuti): * Uburyo: Bitera umwuka 10% to 20% y’umubiri ugendagenda (Fe2+) mu methemoglobine (Fe3+). Kubera ko cyanide ifise ubushobozi bwinshi bwo gukorana n’ Fe3+, methemoglobine ikura cyanide ku mitochondrie c oxidase kugira ngo ikore cyanmethemoglobine. * Igitigiri c'abantu bakuze: 300 milligrams (10 milliliters ya 3% Nitrite ya Sodium) iterwa mu mutsi hejuru ya 2 to 4 minutes (gukurikirana neza umuvuduko w’amaraso, kuko nitrites zituma imitsi iguma igwira cane kandi igatuma umuvuduko w’amaraso ugabanuka). * Idoze y'abana (Must Adjust for Hemoglobin to Prevent Fatal Methemoglobinemia):6 to 10 mg/kg (0.2 to 0.33 mL/kg ya 3% umuti, vyinshi 300 mg), bigabanywa cane iyo umwana afise amaraso make (hemoglobin < 10 g/dL). Suzuma urugero rwa methemoglobine ku 30 minutes kandi ugumize methemoglobine yose hamwe hasi 20% to 30%. 3. Igitera umutsi w'amazi (25% umuti): Kurikiza ubwo nyene (after flushing the line) hamwe 12.5 grams (50 mL ya 25% umuti; ubuvuzi bw'abana 1.0 to 1.65 mL/kg) guhindura cyanméthemoglobine ubudasiba ngo ibe thiocyanate y’amasobe. 4. Edetate ya dikobaliti (Kelocyanor - Ububiko bw'Iragi ry'Ubwongereza/Ubumwe bw'ibihugu vy'Uburayi): Burongowe nk'300 mg (20 mL) IV hejuru ya 1 minute hakurikirwa ubwo nyene n’ 50 mL ya 50% Dekitorose. Kubera ko cobalt y’ubuntu itera ububabare bukomeye bw’umutima, ububabare bwo mu maso/mu kanwa, n’ugucika intege kw’umutima iyo ata cyanide iri mu maraso, **Dicobalt Edetate itegerezwa guhabwa GUSA abarwayi bafise ubumara bukomeye bw’umutima (coma, proneck to)la, canke abarwayi.

Gutegura neza imyungu hamwe n'imipaka y'amategeko ku mbuto z'amapera¶

• Uko wokura ubumara bw'imyungu irura muhira (OMS / FAO "Uburyo bwo gutobera"):
• Grate canke pound umuzi w'imyungu yasembuwe mu mfuruka nziza canke ifu (gucagura inkuta z'ingingo kugira ngo linamarase abahuza linamarin).
• Nishire / ushiremwo iyo nkoko mu mazi kugira ngo 3 to 5 days (canke nimba ukoresha ifarini y’imyungu imaze kwuma kandi ikaba ikiryoshe, uvange iyo farini n’amazi mu gitereko gitose maze uyishire mu gitutu kugira ngo 5 hours kuri 30 degrees Celsius rero amasigarira linamarase ihindura amazi iyo linamarine ikaba acetone ishobora guhungabana).
• Teka canke woke neza mu nkono yuguruye rero acetone yose cyanohydrin na HCN gaze ihinduka umwuka mu kirere, maze ujugunye amazi atose/atetse.
• Imburi zijanye n'amategeko ku bijanye n'intete z'amapera:
• Ikigo c’Uburaya kijejwe umutekano w’ibifungurwa (EFSA) n’ikigo c’Ubwongereza kijejwe gucungera ibifungurwa (FSA)** vyashizeho urugero rw’imiti (ARfD) ya 20 micrograms/kg ya cyanide, bagashika ku ciyumviro c’uko kurya utugingo ngengabuzima dutoduto tw’amapera turura turenga 1 canke 3 mu bantu bakuze (canke igice c’utugingo ngengabuzima dutoduto tumwe mu bana batobato) birenze urugero rwo gukingira. Bompi EU (Regulation 2017/1237) n’Ubwongereza bwabujije kugurisha intete z’amapera arura ku baguzi barenga 100.000. 20 mg/kg y’aside y’amazi, na Australiya/Nouvelle-Zélande bibuza ugurisha mu bucuruzi ivyamwa vy’amapera bitagiramwo ibinure nk’ibifungurwa vyose.
• Muri Leta Zunze Ubumwe za Amerika no muri Kanada, FDA ya Amerika irabuza laetrile (amygdalin) nk’ikintu kitemewe, c’ubuhendanyi, kandi gifise ubumara bwinshi, kandi Health Canada igabanya igitigiri cose c’ivyatsi bishobora gukurwa mu mbuto z’amapera zigurishwa ku 100.000. 20 ppm mu gihe ariko aragabisha abantu bakuze ko batokwigera barya imbuto zisharira.

Ivyihutirwa vyo mu karere n'amategeko yo kuronka imiti¶

• Leta Zunze Ubumwe za Amerika na Canada: Hamagara 911 ubwo nyene maze uhamagare 1-800-222-1222 (Ifashanyo y’Ubumara bwa Amerika) canke 1-844-UBUMARO-X (1-844-764-7669 muri Kanada). Infashanyo y'ubuzima iteye imbere (ALS) imodoka zitwara abarwayi n’ibigo vy’ibitaro vyihutirwa muri Amerika y’Uburaruko Hydroxocobalamin (Cyanokit, 5 g amacupa) na Nitiyodote (Sodium Nitrite + Sodium Thiosulfate).
• Ubwongereza n'Ubumwe bw'Uburaya: Hamagara 999 (Ubwongereza) canke 112 (Ubumwe bw'Uburayi). Abaganga barabaza NPIS / TOXBASE (Ubwongereza) canke ibigo vy’igihugu vy’ubumara vy’Ubumwe bw’Uburayi (CAPTV, Giftnotruf). Mu Bwongereza no mu Bumwe bw’Uburayi, amashirahamwe y’ivy’ivyihutirwa arabika Hydroxocobalamin (Cyanokit) na Sodium Thiosulfate mu kabati k’imiti yo gusubiza ubuzima mu mubiri (Category A Antidotes required immediately at every acute hospital).
• Ostraliya na Nouvelle-Zélande: Hamagara kuri 000 (Ostraliya) canke 111 (Nouvelle-Zélande), maze ubaze Ikigo kijejwe amakuru yerekeye ubumara (13 11 26 muri Ostraliya; 0800 764 766 muri Nouvelle-Zélande) kugira ngo ubone Cyanokit na Sodium Thiosulfate ubuyobozi.
• Afirika yo munsi ya Sahara, Amerika y’Epfo, na Aziya y’Epfo: Mu turere dukunda imyungu (Democratic Republic of the Congo, Mozambique, Tanzania, Nigeria, Brazil, Indonesia, Philippines), aho Cyanokit ntibishobora kubikwa mu mavuriro yo mu misozi, umuntu ahita atanga 100% y’umwuka w’ikirere + amakara akoreshwa + sodium thiosulfate yo mu mutsi (25%, 50 mL IV) + Bicarbonate ya Sodium iterwa mu mutsi (kugira ngo umuntu akosore asidose y’amavuta ikaze) irakiza ubuzima kandi irabikwa cane.

Ibibazo bikunda kubazwa¶

Ni kuki ubumara bwa cyanide buva mu mbuto z’amapera canke mu mfuruka irura bufata amasaha 1 gushika kuri 4 kugira ngo butangure?¶

Mu buryo butandukanye n’umuyaga w’ihydrogène cyanure umuntu ahumeka (winjira mu mahaha no mu maraso mu masegonda makeyi), ivyamwa vy’amapera n’ivy’imyungu irura birimwo ibintu bifatanye n’isukari y’ibimera vyitwa cyanogène glycosides (amygdaline na linamarine). Ivyo bihimba ntibigira akamaro gushika aho enzymes z’ibimera (zikoreshwa n’ugutafuna) be n’imigera yo mu mara y’umuntu bica buhoro buhoro utugingo ngengabuzima tw’isukari turi mu mara mato n’amaraso y’umubiri, bikarekura gaze y’ubuntu yitwa hydrogène cyanure mu maraso iminota 30 gushika ku masaha 4 inyuma y’ifunguro.

Ni kuki gufata "Vitamine B17" (Laetrile) mu kanwa bishobora kwica cane kuruta gutera imitsi?¶

Amaraso y’umuntu n’ibihimba vy’umubiri ntibigira enzyme beta-glucosidase ikenewe kugira ngo amygdaline imeneke ibe cyanide, ni co gituma iyo laetrile itewe mu mutsi, ibice birenga 90% vyayo biva mu maraso ataco bihinduye. Ariko rero, iyo imigera kamere amamiliyaridi n’amamiliyaridi iba mu mara mato y’umuntu no mu mara y’umuntu ayimira, iratanga intungamubiri nyinshi zitwa beta-glucosidase zicapura laetrile yo mu kanwa ata guca ku ruhande igahinduka hydrogène cyanure yica, ivyo bikaba bituma imiti yo mu kanwa igira ubumara incuro nka 40 kuruta iyo umuntu ayifata mu mutsi.

Bigenda gute iyo umwana amira mu mpanuka ikinogo cose c’umuceri canke ibuye ry’umuceri ataco arya?¶

Iyo ikinogo c’igiti c’umukaraba, ikinogo c’igiti c’umukaraba, ibuye ry’igiti c’umukaraba canke imbuto y’igiti c’umukaraba imizwe yose, igihimba caco co hanze gikomeye c’ibiti kitavunitse, iyo amygdaline iguma yugarijwe neza imbere mu gipfukisho c’imbuto maze ico kinogo kigasohoka ata co gikoze mu mfuruka z’umubiri mu kiringo c’imisi 1 canke 3. Ubumara bwa cyanide bushika gusa iyo imbuto canke ivyobo bitaguwe, bijanjaguwe, biseye, bivanzwe canke bifunguwe imbere y’uko bimira.

Abaganga b’ivyihutirwa bamenya gute ubumara bwa cyanide mu minota 5 iyo gupima cyanide mu maraso bifata imisi?¶

Abaganga barondera ibimenyetso bibiri bidashobora kwihenda ku ruhande rw’igitanda vyerekana ko umwuka w’ikirere uhagaze: ica mbere, amaraso y’imitsi y’inyuma akuwe mu kuboko asa n’ay’umutuku w’umukara (nk’amaraso y’imitsi) afise umwuka w’ikirere w’imitsi uri hejuru ya 85% gushika kuri 90% kubera ko amaraso y’imitsi y’umubiri (poisoned extrabloodoxygen) adashobora gukoresha; kandi ica kabiri, urugero rwa lactate mu maraso ruraduga rukaja hejuru ya 8 gushika kuri 10 mmol/L kubera uguhinduka kw’ibihimba vy’umubiri bitunguranye.

Ni kuki abaganga batanga imiti YOSE y’ubumara bw’intete y’amapera?¶

Igitigiri kimwe c’imiti yitwa Hydroxocobalamin (Cyanokit) c’amagarama 5, gica gica gihindura iyo cyanide ubu iriko iragendagenda mu maraso no mu bihimba vy’umubiri, igahinduka Vitamine B12 idashobora gutera ingorane, igakiza umutima n’ubwonko mu minota mikeyi. Ariko rero, kubera ko imbuto z’amapera zijanjaguwe canke imyungu irura zikomeza kwicara mu mara zikarekura cyanide nshasha mu kiringo c’amasaha 4 gushika ku 12, kwongerako Sodium abb Thiosulfate mu mutsi (biciye mu murongo w’amara utandukanye canke usukuye) bitanga enzyme y’igitigu yitwa rhodanese n’intungamubiri y’igitigu iguma itera neutralize sulfur kugira ngo ikomeze gutera neutralize cyanide.

"Konzo" ni iki kandi ifatanye gute n'imyungu irura?¶

Konzo ni indwara itera ubwoba, idashobora gusubira inyuma, ifata amaguru yompi (spastic paraparesis) itera abana n’abagore bari mu myaka yo kuvyara umwana mu misozi yo muri Afirika yo mu Bumanuko bwa Sahara mu gihe c’amapfa n’inzara. Bishika iyo imiryango igoberewe kurya imyungu irura yashizwe mu mazi atabereye indwi ku yindi mu gihe ifise ubukene bukomeye bw’amaproteine ​​(kubura aside amino zirimwo ikibiriti zitwa methionine na cysteine ​​zikenewe n’igitigu kugira ngo gikuremwo ubumara bwa cyanide bube thiocyanate).

Kugira ngo ushobore guhangana n’ubumara, inzira y’impwemu, n’ivyihutirwa vy’umutima, niwiyumvire kurangiza inyigisho y’ubutabazi bwa mbere n’ubuvuzi bw’umutima (CPR) iva ku musaraba utukura, St John Ambulance, canke ishirahamwe ryemewe ry’amahugurwa ryo mu karere.

Inyobora zifitaniye isano¶

• Cyanide, Sulfure d'hydrogène, na gaz y'inganda guhumeka imfashanyo ya mbere
• Methemoglobinemie (Amaraso y’Ibara ry’Ibara ry’Isokoroti), Gutera Ubumara bwa Benzocaine, n’Ubumara bwa Nitrate
• Gushaka ivyokurya vy'ibizinu vyo mw'ishamba (Amatoxin) n'ugufata ibiterwa bifise ubumara
• Status Elepticus, Gufata igihe kirekire, n’imiti yo gukiza
• Ubumara rusangi Ubufasha bwa mbere n'ugukuraho ubuhumane

Amasoko n'ubuyobozi buzwi¶

• Ishirahamwe mpuzamakungu ry’ubuzima (OMS) & Ishirahamwe ry’ibifungurwa n’uburimyi (FAO): Inyandiko mpuzamakungu y’isuzuma ry’imiti 61: Hydrogène Cyanide na Cyanides: Imice y’ubuzima bw’umuntu; Glycosides zitera ivyatsi mu mfuruka z’imyungu n’imibavu (Genève).
• Ikigo c’Uburayi kijejwe umutekano w’ibifungurwa (EFSA) Ishirahamwe ry’ibihumanya biri mu ruhererekane rw’ibifungurwa: Ibibazo bikomeye ku buzima bijanye n’ukubaho kw’ibinyabuzima bita cyanogenic glycosides mu mbuto z’amapera n’ibiva mu mbuto z’amapera zidatetse (EFSA Journal).
• TWEBWE. Ibigo bijejwe kugenzura no kwirinda indwara (CDC) / ATSDR: Ingingo ngenderwako z’ubuvuzi ku bijanye n’imiti y’amazi, y’amazi y’amazi, n’ibindi bitera amazi y’amazi (Leta Zunze Ubumwe za Amerika).
• Ikigo c’Igihugu c’Ubwongereza kijejwe amakuru yerekeye ubumara (NPIS) / TOXBASE & Royal College of Emergency Medicine: Ingingo ngenderwako z’imiti: Hydroxocobalamine (Cyanokit), Thiosulfate ya Sodium, na Sodium Nitrite mu Bumara bukomeye bwa Cyanide n’ubumara bwa Glycoside (Ubwongereza).
• Baud FJ, Barriot P, Toffis V n’abandi. / Hall AH, Rumack BH: Ivyiyumviro vy’amaraso vy’ivyatsi vy’ivyatsi vy’ivyatsi vy’ivyatsi vy’ivyatsi vy’ivyatsi vy’ivyatsi vy’ivyatsi vy’ivyatsi vy’ivyatsi vy’ivyatsi; Laetrile (Amygdalin) n’ubumara bw’intete z’amapera (Ikinyamakuru c’ubuvuzi co mu Bwongereza bushasha / Ivya kera vy’ubuvuzi bw’ibihe vyihutirwa).