Colchicine (Crocus yo mu mpera z’umwaka) n’Igiti c’umukara c’ishamba n’ubumara bw’amazi (Cicutoxin) n’ubumara bw’igiti c’umukara (Coniine)¶

Kwihenda ko igiterwa co mw’ishamba cica ari imboga y’icatsi kibisi canke y’imizi iribwa ni kimwe mu bintu vyihutirwa vy’ubuvuzi vyihuta cane mu bijanye no kwisamaza hanze no mu guteka muhira. Iyo umuntu afise iseseme, akanwa gasha, akagira iseseme, umutima ugatera buhoro, imitsi igacika intege, canke akagira inkorora amaze kurya tunguru sumu y’ishamba (ramps), ivyatsi vy’ishamba, canke ivyatsi vy’ishamba, hamagara inomero y’ivyihutirwa yo mu karere iwanyu (911 muri Leta Zunze Ubumwe za Amerika no muri Kanada, 112 mu bihugu vyose vy’Ubumwe bw’Uburayi, 999 mu Bwongereza) canke ubaze inomero yacu . Ububiko bw'inomero z'ivyihutirwa mpuzamakungu ubwo nyene. Mu gihe urindiriye abaganga, subiramwo ivyacu vyagutse ibizinu vyo mw'ishamba n'ibiterwa bifise ubumara, witegurire status y'igicuri gufatwa n'intandara igihe kirekire iyo Water Hemlock yariwe, kandi witegure gutangura . gusubiza ubuzima mu mutima n'amahaha (CPR) iyo ubumara bwa Hemlock canke Autumn Crocus butera uguhema canke umutima guhagarara.

Mu Buraya bwose, muri Amerika y’Uburaruko no muri Aziya yo mu karere gashushe, hari imitego ibiri izwi cane isa n’iy’ibimera ari yo ituma ibimera vyinshi vy’ishamba bipfa ubumara: 1. Umutego w'amababi manini "Tunguru sumu y'ishamba": Abarondera ivyo barya bakorakoranya ivyo kurya Tunguru sumu y'ishamba / Ramsons (Allium ursinum) canke Amerika y'Uburaruko Ibarabara (Allium tricoccum) mu bisaka vy’impeshi vy’amazi vyimbura mu mpanuka amababi y’icatsi kibisi agenda arakura y’igiti citwa Crocus / Meadow Saffron (Colchicum autumnale)** canke Igikoko c'ikinyoma (Veratrum album / Veratrum viride), zikura iruhande n’uruhande mw’ivu rimwe nyene. Mu gihe Veratrum itera gutakara vuba, umutima uhagaze cane, n’ugucika intege kw’amaraso mu 30 to 120 minutes iyo yishuye cane ku atropine, Colchicum autumnale irimwo ubumara bw’umutsi w’umubiri colchicine, bwigana indwara y’ibihaha idashobora gutera ingorane ku bijanye n’ 24 hours imbere y’uko arekura ubumuga bw’ibihimba vyinshi vy’umubiri bwica, uguhungabana kw’umutima, n’uguhungabana kw’amagufa ata muti w’ubudandaji ukwiragiye. 2. Umutego w'Ikarati y'Ishamba yitwa Umbellifer: Abashaka ivyo kurya bimbura abo mu muryango w'ikaroti/Ikarati y'Ishamba (Apiaceae) ikosa Igikoko c'amazi (Cicuta maculata, Cicuta virosa, canke Oenanthe crocata) canke Igikoko c'ubumara (Conium maculatum) ku bijanye n’ikara ry’ishamba (urudodo rw’Umwamikazi Anne), ivyatsi vy’ishamba, angelica canke ivyatsi vy’ishamba. Naho zompi zifise izina rya "hemlock," ubumara bwazo burahushanye n'ubuvuzi: Igiti c'amazi kirimwo cicutoxin (canke oenanthotoxin), umuti w'ubukazi wo hagati wa GABA-A utera status ni epilepticus idashobora gukira mu minota 15 gushika kuri 60 aho Hemlock y'amazi, alkaloid coniine, itera ugusenyuka kw’impwemu nk’ukwa curare mu gihe uwurwaye aguma ari maso gushika aho hypoxia itangura.

+-------------------------------------------------------------------------+
|        CRITICAL WILD FORAGING POISONING IDENTIFICATION MATRIX           |
+-------------------------------------------------------------------------+
|  GROUP A: SPRING BROAD-LEAF LOOKALIKES (MISTAKEN FOR WILD GARLIC/RAMPS) |
|  1. AUTUMN CROCUS (Colchicum autumnale) -> Toxin: COLCHICINE            |
|     * Onset: Delayed 2 to 24 hours (cholera-like vomiting & diarrhea)   |
|     * Day 2-7: Cardiogenic shock, ARDS, DIC, Bone Marrow Aplasia        |
|     * Treatment: Early Multi-Dose Activated Charcoal + ICU + G-CSF      |
|  2. FALSE HELLEBORE (Veratrum album / viride) -> Toxin: VERATRUM ALK.   |
|     * Onset: Rapid 30 minutes to 3 hours (violent vomiting & paresthesia|
|     * Hallmark: Bezold-Jarisch Triad (Severe Bradycardia + Hypotension) |
|     * Treatment: IV Atropine (0.5-1.0 mg) + IV Fluids + Charcoal        |
+-------------------------------------------------------------------------+
|  GROUP B: APIACEAE CARROT-FAMILY LOOKALIKES (HOLLOW STEMS, WHITE UMBLES)|
|  3. WATER HEMLOCK (Cicuta maculata / virosa) -> Toxin: CICUTOXIN        |
|     * Onset: Ultra-rapid 15 to 60 minutes after chewing root or stem    |
|     * Hallmark: Explosive, continuous Tonic-Clonic Status Epilepticus   |
|     * Treatment: IV Benzodiazepines -> Phenobarbital / Propofol         |
|  4. POISON HEMLOCK (Conium maculatum) -> Toxin: CONIINE                 |
|     * Onset: 30 minutes to 2 hours (burning mouth, salivation, tremors) |
|     * Hallmark: Ascending Flaccid Respiratory Paralysis (Clear Mind)    |
|     * Treatment: Mechanical Ventilation for 24-72 hours (100% recovery) |
+-------------------------------------------------------------------------+

Ivyo ubikore ubu¶

1. Hamagara abajejwe ivy’ubutabazi n’abajejwe gucungera ubumara ubwo nyene. Hamagara 911 (Amerika na Canada), 112 (Ubumwe bw’Uburayi), 999 (Ubwongereza), 000 (Ostraliya), canke 111 (Nouvelle-Zélande). Ntutegereze ko ibimenyetso bitangura iyo umuntu abonye ko ahejeje kumira igiti c’umukaraba, igiti c’amazi, igiti c’ubumara, canke igiti c’ikinyoma: colchicine irafise uburyo bwo guhenda 2 to 12 hour igihe c’uguceceka aho gukuraho ubuhumane bw’amara mu bitaro mbere y’igihe ari co kintu conyene co gukingira ukuntu utugingo ngengabuzima dushobora kwica.
2. Kwegeranya kandi ufate amafoto y’igitegwa kitagira ikibazo, harimwo n’igiti/imizi, igishingo c’uruti, n’amababi. Shira ivyerekanwa bitatetswe vy’amababi, igiti, ibitoke, canke amababi (ushizemwo isupu yose yasigaye, pesto, canke isaladi) mu gafuko k’impapuro canke mu gitereko maze ubizane n’umurwayi mu cumba c’ivyihutirwa. Abahinga mu vy’ubumara bw’ivyihutirwa be n’abahinga mu vy’ibimera bifasha mu guhamagara, barakoresha ivyumba vy’imizi, ibice vy’imitsi, imitsi y’amababi be n’akamoto k’umunyu w’umukara kugira ngo bamenye ubumara nyabwo mu minota mikeyi.
3. Ntukigere utera urusenda muhira. Ntuhe sirop ya ipecac, amazi y’umunyu, canke gutera urutoke. Iyo igiterwa cari Igiti c’amazi (Cicuta), ubukazi rusangi bushobora gutera mu 15 minutes y’ugufata, bigatuma umuntu agira impwemu y’amahaha iyo ariko araruha.
4. Shira umurwayi aryamye ku ruhande rwiwe maze witegure gufatwa n'intandara canke guhumeka nabi.
5. Iyo uwo muntu yariye umuzi/igiti gifise ivyumba iruhande y’umugezi canke igisaka (Water Hemlock), n’ushire kure ibintu bisongoye maze ushire umutwe wiwe mu kwitegurira gufatwa n’indwara y’ibicurane.
6. Iyo uwo muntu yariye uruti rw’ibitoke rufise amabara y’umuyugubwe canke amababi ameze nk’ay’igiti c’umuberoshi (Poison Hemlock), urabe neza igifu ciwe kiduga: iyo amaguru yiwe yumva aremereye kandi impwemu yiwe igacika igitutu canke igahagarara, tangura uguhema gukiza / impwemu y’umufuko-valve-mask (canke CPR full immediate iyo ata pulse ifise)
7. Iyo umuntu yumva afise ibicurane afise umutima utera buhoro buhoro munsi . 45 beats per minute umaze kurya amababi manini manini y’icatsi kibisi (False Hellebore), uyarambika hasi maze ushire amaguru hejuru . 30 centimeters (12 inches) kugira ngo amaraso asubire mu mutima gushika abaganga bafashe atropine mu mutsi.
8. Mugabishe abandi bose basangiye ivyo kurya ubwo nyene. Pesto y’itunguru ry’ishamba, isupu ya ramp, n’amasaladi y’ibifungurwa bikunda gusangira n’abagize umuryango, abashitsi bo ku mfungurwa zo ku mugoroba, canke abo bari kumwe mu nkambi. Umuntu wese yariye mbere n’ibabi rimwe canke ikiyiko c’umutobe wo guteka (colchicine na veratrum alkaloids zishobora guhangana n’ubushuhe kandi zigaca zija mu mazi y’isupu) ategerezwa guca aja mu bitaro naho yoba yumva ameze neza.

Igiti c'ingingo: Imenyekanisha ry'ibimera n'ugutoranya ubumara bwo mu buvuzi¶

flowchart TD
    A["Indwara ikaze canke kuyifata inyuma yo gushaka ivyo kurya ku bimera vyo mw'ishamba"] --> B{"Ni Ubwoko Ubuhe bw’Igiterwa Casaruwe?"}
    B -->|"Amababi y'icatsi kibisi yagutse (yihenda ngo ni tunguru sumu y'ishamba / amabarabara)"| C{"Suzuma intango y'ibimenyetso n'umutima"}
    B -->|"Amababi ameze nk’ay’ibiti vy’imiberoshi canke amashurwe / imizi y’umutaka yera (Yihenda ngo ni karoti y’ishamba / Parsnip)"| D{"Suzuma ikimenyetso gikomeye c'imitsi"}
    C -->|"Gutangura vuba (iminota 30-120) + Umutima uhagaze cane (HR < 45) + Ugutera umuvuduko w'amaraso"| E["IKINYOMA C'IBIMENYETSO (Veratrum album / viride) - Ivyiyumviro vya Bezold-Jarisch"]
    C -->|"Gutangura gutevye (amasaha 2-24) + Indwara y’umusonga imeze nk’iya Kolera + Indwara y’umutima"| F["IGITERWA C'IGIHUGU (Colchicum autumnale) - Ubumara bwa Colchicine"]
    E --> G["Gutanga Amakara Akora (< 1-2h); IV 0,9% Umunyu + IV Atropine (0,5-1,0 mg q3-5m) -> Dopamine/Fenilefrine iyo bikenewe"]
    F --> H["Amakara akoreshwa n'imiti myinshi (MDAC q4-6h) + Gusubiza ubuzima mu bitaro vy'abarwayi bikomeye + G-CSF ku ndwara y'amaraso"]
    D -->|"Ubukazi busanzwe bw'igicuri mu minota 15-60"| I["AMAZI HEMLOCK (Igikoko c'umukara / igikoko c'umukara) - Cicutoxin"]
    D -->|"Kuduga kw'imitsi n'uguhema n'ubwenge butomoye"| J["UBUROMA HEMLOCK (Conium maculatum) - Uguhagarika Nikotini"]
    I --> K["Gukingira Inzira y’Impwemu; Igitigiri kinini c'imiti y'ibinyabuzima -> Phenobarbital canke Propofol + Gukonjesha bikora + Bikarbonate y'imitsi y'amaraso"]
    J --> L["Ubwo nyene gutera umuti wo mu mfuruka y’umubiri n’ugutera umwuka mu buryo bw’ubuhinga mu kiringo c’amasaha 24-72 (Irinde Succinylcholine) + Amakara akoreshwa"]

Igereranyo ry'ibimera n'ubuvuzi ry'indwara 4 zitera urupfu¶

Igice ca 1: Igiti c’umukara c’ishamba: Crocus y’izuba (Colchicine) n’Igikoko c’Ikinyoma (Veratrum)¶

Buri mpera z’umwaka mu Buraya, mu Bwongereza no muri Amerika y’Uburaruko, abantu ibihumbi n’ibihumbi bararondera ivyo barya mu mashyamba y’amababi atose kugira ngo baronke Wild Garlic (Allium ursinum) canke Ibarabara (Allium tricoccum) gukora pesto y’itunguru ry’ishamba, isupu, canke ivyatsi vy’umukara. Kubera ko tunguru sumu y’ishamba ikura mu matapi menshi cane biciye mu bice vy’ibiti vy’i Autumn Crocus (Colchicum autumnale) na Igikoko c'ikinyoma (Veratrum album mu Buraya; Veratrum viride muri Amerika y’Uburaruko), urushinge rumwe rw’amababi afashwe kenshi rurimwo ubwo bwoko bwose butatu. Ikindi, iyo intoke z'umuhinguzi w'ibifungurwa zimaze gupfukwa n'umutobe w'itunguru ry'ishamba ryajanjaguwe, ibiganza vyabo biranuka nk'inyama z'ingurube, bikaba bihenda "ikigeragezo co guhonya" iyo basuzuma amababi akurikira.

Indwara 1A: Igikoko co mu mpera z'umwaka (Colchicum autumnale) na Lili y’Ubuninahazwa (Gloriosa superba): Ubumara bwa Colchicine¶

Ibice vyose vy’igiti ca Colchicum autumnale (amababi, igiti c’umukaraba/igiti c’umukaraba, imbuto, n’amashurwe yo mu gihe c’izuba) n’ibimera vyo mu karere k’ubushuhe Gloriosa superba birimwo ivyuma vyinshi (0.1% to 0.6%) y’umuti witwa alkaloïde kolkisine. Gufata ibirenze . 0.5 mg/kg ya kolisini (roughly 2 to 5 fresh leaves of Autumn Crocus ku muntu akuze, canke . 1 leaf ku mwana) akenshi iraca, kandi imiti irenga . 0.8 mg/kg Impamvu hafi 100% urupfu ruterwa n’uguhungabana kw’umutima n’ugusenyuka kw’ibihimba vyinshi.

Ivyerekeye umubiri n'inzira 3 z'ubuvuzi z'ubumara bwa Colchicine¶

Colchicine ifatanya ataco ihinduye n’ibihimba vy’umubiri bita alpha- na beta-tubulin** biri mu turemangingo, bikabibuza guhinduka ibihimba bitobito. Iyo ata microtubules zikora, ingingo ntizishobora gukora umurongo w’imitotic kugira ngo zigabanye (zifata ingingo zose zigabanywa ningoga mu metaphase), kandi ingingo zitagabanya (nk’imitsi y’umutima n’imitsi y’inyuma) zitakaza ugutwara n’ugufatanya kw’ingingo ziri mu ngingo.

+-------------------------------------------------------------------------+
|            THE 3 CLINICAL STAGES OF COLCHICINE POISONING                |
+-------------------------------------------------------------------------+
|  STAGE 1 (2 TO 24 HOURS POST-INGESTION): GASTROINTESTINAL / CHOLERAIC   |
|  * Mucosal crypt cells of the small intestine divide faster than any    |
|    other tissue; mitotic arrest causes massive mucosal sloughing        |
|  * Profuse, intractable vomiting, fiery abdominal pain, and liters of   |
|    watery/bloody cholera-like diarrhea -> Severe hypovolemic shock      |
|  * Marked initial leukocytosis (white blood cell count > 20,000/mm3)    |
+-------------------------------------------------------------------------+
|  STAGE 2 (DAYS 2 TO 7): MULTI-ORGAN FAILURE & BONE MARROW APLASIA       |
|  * Direct myocardial microtubule poisoning -> Refractory Cardiogenic    |
|    Shock, malignant arrhythmias, and sudden cardiac arrest (Days 2-4)   |
|  * ARDS (non-cardiogenic pulmonary edema), rhabdomyolysis, acute renal  |
|    failure, hepatic necrosis, DIC, and ascending metabolic neuropathy   |
|  * Bone marrow collapse (Days 4-8): Profound Pancytopenia / Agranulo-   |
|    cytosis (WBC < 500/mm3, Platelets < 10,000/mm3) -> Fulminant Sepsis  |
+-------------------------------------------------------------------------+
|  STAGE 3 (DAYS 7 TO 21+): MARROW RECOVERY & ANAGEN ALOPECIA             |
|  * If the patient survives Stage 2, rebound leukocytosis occurs along   |
|    with sudden, complete, reversible scalp hair loss (Alopecia)         |
+-------------------------------------------------------------------------+

Intambwe ku yindi yo gucungera ubumara bwa Colchicine mu bitaro¶

1. Gukuraho ubuhumane bw'amara ubwo nyene kandi ugasubiramwo (Even if Presenting Late): Kubera ko colchicine igira ugusubira gutembera kw’amaraso (isohoka mu maraso maze igasubira mu mara mato) kandi igatuma amara agenda buhoro, ushobora gutanga ugukura/ugusukura inda hakiri kare (niba mu 1 to 2 hours y’ukurya amababi) maze ugatangura Amakara akoreshwa n’imiti myinshi (MDAC: 50 grams mu ntango, hanyuma 25 grams buri 4 to 6 hours kubera 24 to 48 hours). Amakara akoreshwa afatanya cane colchicine mu nzira y’amaraso kandi ni yo nzira imwe rudende ikora neza cane yo kugabanya urupfu rw’umubiri.
2. Ugusubiza ubuzima mu buryo bukomeye bw’amaraso n’ugusubiza ubuzima mu bitaro: Gutera amaraso menshi cane mu gihe c’Intambwe ya mbere kugira ngo asubirire 5 to 10 liters y’ugutakaza amazi yo mu GI ameze nk’aya kolera. Gukora echocardiography iruhande y’igitanda hakiri kare: nk’uko inzira ya mbere y’uguhungabana kw’umutima ihinduka Intambwe ya 2 y’uguhungabana kw’umutima gutomoye (typically at 24 to 72 hours), uhindure ukava ku mazi afise uburemere bwinshi ukaja ku binyabuzima bita inotrope (norepinephrine + dobutamine canke epinephrine) maze wiyumvire hakiri kare Ugutanga umwuka w’umubiri (V-A ECMO) imbere y’uko asystole y’umubiri ibaho.
3. Ikintu gitera intege amakoloni y'ibihimba vy'umubiri (G-CSF / Filgrastim): Gukurikirana igitigiri c’amaraso yose incuro zibiri ku musi. Igihe utugingo ngengabuzima twera (WBC) igiharuro gitangura gutonyanga cane (typically Day 3 to 4), gutangura gutera munsi y’urukoba Filgrastim (G-CSF, 5 micrograms/kg/day) maze bamushire mu kibanza c’uburinzi c’imitsi y’amagufa (neutropenic isolation) hakoreshejwe imiti igabanya ubukana bw’indwara y’amagufa n’imiti y’amaraso kugira ngo ashobore kurokoka iyo ndwara y’amagufa yitwa aplasie nadir.
4. Igituma Dialyse Inanirwa & Ibice vya Fab: Kubera ko colchicine yinjira mu ngingo vyihuta kandi ifise umubare munini w’ugukwiragira (2 to 12 L/kg), gusukura amaraso no gutera amaraso ntibikuraho umuti witwa colchicine (naho CRRT ikoreshwa mu kuvura indwara y’amafyigo n’indwara y’amafyigo). Igerageza ibice vy’imiti y’intama yihariye ya colchicine birahindura cane ubumara mu nyigisho z’ubuvuzi, naho nyene ububiko bw’ubudandaji ari buke cane kw’isi yose; uce ubaza Poison Control ubwo nyene kugira ngo umenye nimba ubushakashatsi buriho.

Indwara 1B: Igikoko c’ikinyoma (Veratrum album, Veratrum viride, Veratrum californicum): Indwara y'umutima yitwa Bezold-Jarisch¶

Mu buryo butandukanye n’urupfu rw’igiti citwa Autumn Crocus, kurya amababi ya False Hellebore (canke kunywa inzoga y’igiti citwa gentian ikozwe mu nzu ikozwe mu makosa n’imizi ya Veratrum album) bitera ibimenyetso biteye ubwoba mu 30 minutes to 3 hours.

• Uburyo: Ubwoko bwa Veratrum burimwo ibinyabuzima bita veratrum (veratridine, protoveratrine A and B, germerine, na jervine). Ubu bumara bushobora gusenyuka mu mavuta burafatanya kugira ngo bufungure sodium ikoreshwa n’umuriro (Na+) imirongo mu mutsi w’umubiri, barorecepteurs sinus carotide, n’imirongo y’umubiri y’ibubamfu, bikaba bibuza imiyoboro ya sodium kudakora. Gukomeza gusubiramwo gutera kw’imitsi y’umutima ikora Bezold-Jarisch reflex: ubwonko burabona ko umutima uremerewe cane maze bugasubiza mu kurekura ijwi ry’umutima ryinshi cane mu gihe rifunga ijwi ry’imitsi y’umutima.
• Ivyerekanwa vy'ubuvuzi: Mu 30 to 120 minutes, umurwayi aca agira umuriro mwinshi wo mu nyuma, akaruha cane, akagira ububabare n’ugucika intege hirya no hino y’akanwa n’intoke (paresthesia), uguhungabana kw’amaso (xanthopsia), ububabare bukomeye bw'umutima (heart rate 30 to 45 beats per minute), umutima (AV) umutima uhagaze, n’ugucika intege cane kw’imitsi (systolic BP < 60 to 70 mmHg).
• Ubuvuzi bugenewe:
• Imiti imwe y'amakara akoreshwa (50 grams mu majambo nimba mu 1 to 2 hours kandi inzira y’impwemu iratekanye) + imiti igabanya ububabare (ondansetron).
• Ugutera amazi yihuta mu mutsi: Gutanga 1 to 2 liters ya 0.9% umunyu usanzwe.
• Atropine yo mu mutsi (The Specific Physiologic Antagonist): Gutanga Atropine 0.5 to 1.0 mg IV gusunika buri 3 to 5 minutes (up to 3 mg total mu bantu bakuze; 0.02 mg/kg mu bana). Atropine ibuza imitsi y’umutima (muscarinic vagal receptors) iri ku nzira y’umutima n’iy’umutima, igaca ihindura ubwo nyene umutima n’umutima.
• Ivyuma bigabanya umuvuduko w’amaraso: Kubera ko reflexe ya Bezold-Jarisch na yo nyene ituma umutima uhagarara (vasodilation périphérique) iruhande y’ugukura kw’imitsi y’amaraso, umuvuduko w’amaraso ushobora kuguma uri hasi gatoyi mbere n’inyuma y’aho atropine isubiye gutera umutima mu buryo busanzwe; wongereko umuti w’imiti mikeyi fenilefrini, dopamine, canke norepinefrini ku bijanye n’ 12 to 24 hours gushika akize bimwe bishitse (virtually 100% of Veratrum patients recover fully within 24 to 48 hours with supportive care).

Igice ca 2: Umuryango w'Ikarati (Apiaceae) Ivyo bisa n’ivyo: Igikoko c’amazi (Cicutoxin) n'ubumara bwa Hemlock (Coniine)¶

Umuryango w'ibimera Apiaceae (Umbelliferae) harimwo ibifungurwa biryoshe cane vyo guteka (ikara, ibitoke vy’umukara, ibitoke vy’umukara, ibitoke vy’umukara, ibitoke vy’umukara, ibitoke vy’umukara, ibitoke vy’umukara) hamwe n’ibimera bibiri vyica cane mu bwonko mu gice c’isi co mu Buraruko: Water Hemlock (Cicuta ubwoko na Oenanthe crocata) na Igikoko c'ubumara (Conium maculatum). Ivyo vyose bifise amashurwe yera, ameze nk’umutaka (compound umbels), inkomoko zifise imyobo zifatanye, n’amababi y’uruvange agabanijwe neza.

+-------------------------------------------------------------------------+
|     HOW TO TELL WATER HEMLOCK vs. POISON HEMLOCK AT THE BEDSIDE         |
+-------------------------------------------------------------------------+
|  WATER HEMLOCK (Cicuta maculata / Cicuta virosa / Oenanthe crocata):    |
|  * Habitat: Grows IN or right along stream banks, marshes, wet ditches  |
|  * Root Cut Open: Chambered bamboo-like compartments leaking yellow oil |
|  * Toxin: CICUTOXIN (Polyacetylenic alcohol -> GABA-A receptor blocker) |
|  * Clinical Effect: CENTRAL EXCITATORY -> Violent Status Epilepticus    |
|    within 15 to 60 minutes; patient is unconscious and convulsing       |
+-------------------------------------------------------------------------+
|  POISON HEMLOCK (Conium maculatum - The Plant That Killed Socrates):    |
|  * Habitat: Dry roadsides, waste ground, field edges, disturbed soil    |
|  * Stem & Odor: Smooth hairless stem with PURPLE BLOTCHES; mousey odor  |
|  * Toxin: CONIINE (Piperidine alkaloid -> Nicotinic AChR blocker)       |
|  * Clinical Effect: PERIPHERAL PARALYTIC -> Ascending curare-like       |
|    flaccid respiratory paralysis; patient is AWAKE until hypoxia hits   |
+-------------------------------------------------------------------------+

Indwara 2A: Igikoko co mu mazi (Cicuta maculata, Cicuta virosa) n’Igiti c’Amazi c’Ikimera c’Ikimera (Oenanthe crocata): Cicutoxin Igihugu c'Igicuri¶

Igiti c’amazi citwa Hemlock ni co gifatwa cane nk’igiterwa c’imvukira gifise ubumara bukomeye cane muri Amerika ya ruguru no mu buraruko bw’Uburayi. Imizi y’ibitoke iryoshe cane, ifise akamoto k’umukaraba n’ivyumba vyo hasi vy’igiti c’umukaraba birimwo amazi manini manini, y’umuhondo, afise amavuta menshi, afise cicutoxin (canke oenanthotoxin muri Oenanthe crocata, asanzwe mu Bwongereza no mu Buraya bwo mu Burengero), amazi atagiramwo amavuta . C17 inzoga y’ivyatsi vy’ivyatsi. Ururimi rumwe (2 to 3 centimeters) y’umuzi wa Water Hemlock, canke mbere umwana akoresheje uruti rufise umwobo nk’igikoresho co gutera ibitoke canke igikoresho co gutera ifirimbi, birashobora gutanga urugero rwica.

• Uburyo: Cicutoxin ijabuka uruzitiro rw’amaraso n’ubwonko vyihuta maze igafatanya mu buryo butagiramwo uguhiganwa n’aho picrotoxin iri ku nzira y’imitsi yo hagati GABA-A receptor-ionophore complexes, igahagarika burundu umuyoboro wa chloride. Iyo ata n’imwe ibuza GABA, imitsi y’ubwonko n’iy’ubwonko irabandanya gusenyuka.
• Ivyerekanwa vy'ubuvuzi (15 to 60 minutes): Muri 15 minutes iyo umuntu amira umuzi, aragira iseseme, akava amacandwe menshi, akagira ububabare bwo mu nda, akagira iseseme, kandi akagira amaso agutse (mydriasis), hanyuma bukwi na bukwi ibicurane vy’ubukazi, bisubira inyuma (status epilepticus). Ivyo bihimba vy’umubiri birakomeye cane ku buryo abarwayi kenshi bacika ururimi, opisthotonos, imitsi y’umugongo, hyperthermie (> 41 degrees Celsius), ugusenyuka kw'amaraso (creatine kinase > 50,000 U/L), indwara y’umutima ikomeye cane asidoze y’amaraso (pH < 6.9), ubumuga bw’amafyigo bw’imitsi y’amafyigo, n’uguhagarara kw’umutima kubera ubukene bw’umwuka.
• Uburongozi bw'ibitaro vyihutirwa:
• Ugucungera indwara y’umutima n’imiti itera GABA: Ntutaze umwanya ukoresheje umuti witwa phenytoin (ineffective against GABA-A blockade). Gutanga imiti myinshi mu mutsi benzodiazépines (lorazepam 4 mg IV canke diazepam 10 mg IV), bigaca bitera imbere ubwo nyene bikaja ku miti phenobarbital (15 to 20 mg/kg) canke gutera umuti mu mubiri mu buryo bwihuta, ukoresheje umuti witwa propofol canke midazolam udasiba.
• Uguhagarika imitsi n’ugukonjesha bikomeye ku ndwara ya Rhabdomyolyse: Nimba imitsi ikomeye n’ubushuhe bwinshi bigumaho naho woba ufise umuti wo guhagarika umutima cane, ushiremwo umuti wo guhagarika imitsi y’ubwonko (rocuronium canke vecuronium; kwirinda succinylcholine kubera ingorane y’ugutera amaraso menshi) mu gukurikirana EEG ubudasiba kugira ngo uhagarike ubwo nyene ubushuhe buva mu mitsi y’amagufa n’ugusohoka kwa myoglobine.
• Bicarbonate ya sodium n’amazi y’umubiri: Gutera isotropic crystalloids mu mutsi n’bicarbonate ya sodium mu mutsi kugira ngo ukosore asidose ikaze y’ibihimba vy’umubiri no gutuma amasobe aba alkali (target urine pH > 6.5), bikabuza myoglobine gutera mu nzira y’amafyigo. Gukora hemodialyse hakiri kare iyo umuntu afise hyperkalemie refractaire, acidose canke insuffisance renal anurique.

Indwara ya 2B: Ubumara bw'Ikimera (Conium maculatum): Ubumuga bwo mu bihimba vy'impwemu butera Coniine¶

Igikoko c'ubumara (Conium maculatum), izwi cane muri kahise ka kera nk’ubumara bwo kwica umunyabwenge Socrate mu 1914. 399 BCE, irimwo ibinyabuzima bita piperidine umunani bishobora guhungabana, ahanini koniine na gamma-koniseine. Kubera ko amababi yayo ameze nk’ay’ibiti vy’imiberoshi asa hafi n’ay’amababi y’ibiti vy’imiberoshi, ivy’ibiti vy’imiberoshi canke vy’amababi y’ibitoke vy’ishamba (kandi umuzi wayo w’umweru usa n’uw’ibiti vy’imiberoshi), abatembera mu misozi be n’abarimyi bo mu rugo barakunda kuyirya mu makosa.

• Uburyo (Uguhagarika Nikotine Biphasique): Coniine ifise imiterere y’imiti n’ibikorwa vy’imiti bisa cane na nikotine na curare. Ikora mu bice bibiri bitandukanye ku nzira y’imitsi y’amagufa n’imitsi y’amagufa (nicotinic acetylcholine receptors [nAChR]**:
• Iciciro ca 1 (Ivyuka vy’intango vy’Nikotini, 15 to 60 minutes): Gusha mu kanwa no mu muhogo, gusohoka amacandwe menshi, gusesa amaraso, gusesa amaraso, gusesa amaraso mu nda, gutera umutima, gutera umuvuduko w’amaraso, amaso agenda araguka, n’uguhungabana kw’imitsi y’umubiri.
• Iciciro ca 2 (Uguhagarika imitsi y'ubwonko, 1 to 4 hours): Ugufatanya kw’ibihimba vy’umubiri bikomeye bituma ibihimba vy’umubiri bifata nicotinic acetylcholine bibura ubushobozi bwo gukora, bikaba bituma umuntu agira ugusenyuka kw’ibihimba vy’umubiri bimeze nk’ivy’umubiri.
• "Ikimenyetso ca Socrate" (Ukuduga kw'Ubumuga n'Umutima Utomoye): Ugumuga gutangura mu maguru no mu birenge (gutera ataxia y'ugutsitara no kutabasha guhagarara), kuduga buhoro buhoro biciye mu matako, mu gifu, no mu maboko, maze amaherezo gusenyuka **imitsi iri hagati y'amafyigo n'imitsi y'imbere, **pa diaphragm. Gushika aho ububabare bukomeye bwo mu bwonko buva ku guhagarika guhema, umurwayi aguma avyuka neza, abona neza, kandi afise ubwoba, adashobora kwinyiganza canke guhema. Coniine irashobora kandi gutuma umubiri ugira rabdomyolyse directement n’ugupfa kw’imitsi y’amaraso.
• Uburongozi bw'ibitaro vyihutirwa:
• Gutera umuti wo mu muhogo mbere y'igihe no gutera umwuka mu buryo bw'ubuhinga (The Definitive Cure): Nta muti wo gukingira coniine (kandi imiti igabanya ubukana bw’indwara nk’iya neostigmine canke physostigmine NTIGOMBA gutangwa, kuko ishobora gutuma ububabare bw’umubiri butera ububabare bw’umubiri butera ububabare bw’umubiri). Ahubwo, ugukoresha ubuhinga bwo gusohora umwuka ni 100% bikiza ubuzima. Intubate umurwayi kare igihe ubushobozi bwo guhema ku nguvu canke inguvu mbi zo guhema zicitse intege (avoid succinylcholine), gutanga umuti wo gutera umunezero ukwiye (propofol/midazolam rero umurwayi amugaye afise ubwenge ntavyuka ari ku gikoresho co guhumeka), bamuhe amakara akora biciye ku nzira y’amaso, hanyuma bamuhe impwemu 24 to 72 hours. Igihe igitigu n’amahaha bimaze guhindura ibiribwa no gusohora coniine, inkomezi z’imitsi y’ubwonko ziragaruka rwose ata n’inkurikizi zihoraho z’imitsi y’ubwonko.

Ivyihutirwa vyo mu karere n'amabwirizwa yo gucungera ubumara¶

• 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). Muri Amerika y’Uburaruko, Igiti c’amazi (Cicuta maculata na Cicuta douglasii), Igikoko c'ubumara (Conium maculatum), na Igiti c’Ikinyoma / Igiti c’Ibigori (Veratrum viride na Veratrum californicum) zikwiragiye cane mu bibanza vy’ibitovu, mu biyaya vyo mu misozi no ku nkengera z’inzira; Ivyumba vy’ubumara vyo mu karere birabungabunga imirongo y’isuzuma ry’amashusho y’ubuhinga bwa none 24/7 n’abahinga mu vy’ubumara n’abahinga mu vy’ibimera kugira ngo bamenye ivyerekanwa vy’ibimera vyafashwe amafoto vyoherejwe bivuye mu vyumba vy’ubuvuzi vyihutirwa.
• Ubwongereza n'Ubumwe bw'Uburaya: Hamagara 999 (Ubwongereza) canke 112 (Ubumwe bw'Uburayi). Mu Budagi, Otirishiya, Ubusuwisi, Ubufaransa, Ubutaliyano, Sloveniya, n’Ubwongereza, igihe c’impeshi kiratera urujijo hagati ya Bärlauch / Ramsons (Allium ursinum) na Ivyatsi (Colchicum autumnale) canke Umunyagihugu (Veratrum album) bituma abantu amajana n’amajana bajanwa mu bitaro vy’abarwayi bikomeye (ICU) bagapfa buri kwezi kwa Ndamukiza na Rusama. Mu Bwongereza no mu Buraya bwo ku nkengera y’ikiyaga, Igikoko citwa Hemlock Water Dropwort (Oenanthe crocata, "Intoke z'Umuntu Yapfuye") ibitoke vyozwa ku nkengera y'uruzi no ku nkengera y'ikiyaga bitera ubumara bw'igicuri bwihuta busa n'ubwa Cicuta. Abaganga bakwiye kwibaza NPIS / TOXBASE (Ubwongereza) canke ibigo vy’igihugu vy’ubumara vy’Ubumwe bw’Uburayi (Giftnotruf / Tox Info Suisse / CAPTV) ubwo nyene.
• 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). Yashizweho Ubumara bwa Hemlock (Conium maculatum) n’ivy’ugushaza Igiti c’umusukoni (Gloriosa superba, zifise ubumara bwa colchicine) ni zo zituma ibiterwa bifatwa n’ubumara mu bihugu vyose bibiri.
• Aziya n’intara z’ubushuhe: Mu Buhindi bwose, muri Sri Lanka, no muri Aziya y’amajepfo, hariho ibitoke vy’igiti citwa Igiti citwa Flame Lily / Glory Lily (Gloriosa superba) ni imvo nyamukuru y’ubumara bukomeye bwa colchicine (buvuye ku mpanuka canke buvuye ku ntumbero), buvugwa n’amakara akoreshwa n’imiti myinshi, uburyo bwo gufasha amaraso mu bitaro vya ICU, n’uburyo bwa G-CSF bukoreshwa kuri Colchicum autumnale.

Ibibazo bikunda kubazwa¶

Ni gute abantu bivanga n’igiti cica c’i Autumn Crocus canke False Hellebore n’igiti citwa Garlic c’ishamba kiribwa?¶

Mu ntango z’impeshi imbere y’uko amashurwe aboneka, ivyamwa vy’umukara (Allium ursinum) n’ivyatsi vy’umukara (Allium tricoccum) biribwa birarungika amababi yagutse, y’icatsi kibisi, ameze nk’icumu mu butaka bw’amashamba butoshe iruhande nyene y’amababi y’icatsi kibisi agenda arakura y’ivyatsi vy’ivyatsi vy’ivyatsi vy’ivyatsi vy’ivyatsi vy’ivyatsi vy’ivyatsi vy’ivyatsi vy’ivyatsi vy’ivyatsi. Iyo umushakashatsi afashe urushinge rw’amababi ya tunguru sumu y’ishamba icarimwe, aca afata bitagoranye ibabi ry’igiti citwa Autumn Crocus canke False Hellebore rikura hagati muri ico gice, kandi kubera ko ibiganza vyavyo bimaze gupfukwa amavuta ya tunguru sumu, ayo mababi y’ubumara atagira akamoto na yo nyene asa n’aho anuka nk’iyitwa tunguru sumu.

None umuganga yomenya gute nimba umuntu arwaye arya ibifungurwa vy’umukara w’ishamba yariye igiti citwa Autumn Crocus canke igiti citwa False Hellebore?¶

Igihe n’ugutera kw’umutima bica bitandukanya ivyo bibiri: Hellebore y’ikinyoma (Veratrum) itera ningoga mu minota 30 gushika ku masaha 3, igatuma umuntu aruha cane hamwe n’ugutera kw’umutima guteye cane (sinus bradycardie ikaze iri munsi ya 45 bpm) n’umuvuduko w’amaraso muto cane. Autumn Crocus (colchicine) irateba amasaha 2 gushika kuri 24 imbere y’uko itera indwara y’umutima imeze nk’iya kolera n’ugutera kw’umutima vyihuta (tachycardie), igatera imbere mu misi 2 gushika ku 7 gushika ku guhungabana kw’umutima kwica no kubura ubushobozi bw’amagufa.

Ni itandukaniro irihe riri hagati y’Igiti c’Amazi (Cicuta) n’Igiti c’Ubumara (Conium)?¶

Naho zompi ziri mu muryango w’ibimera vy’ikaroti bifise amashurwe yera nk’umutaka be n’imitsi y’ibitoke, zitera imitsi y’umubiri mu buryo butandukanye. Igiti citwa Water Hemlock (ubwoko bwa Cicuta) gikura mu bishanga vy’amazi, gifise imizi ivuye mu mavuta y’umuhondo, kandi kirimwo cicutoxin, ibuza ubwonko kwakira GABA-A kugira ngo umuntu agire indwara y’igicuri iguma iturika mu minota 15 gushika kuri 60. Igiti c’ubumara citwa Poison Hemlock (Conium maculatum) gikura ku butaka bwumye, gifise imizi y’amabara y’umuyugubwe, kandi kirimwo igiti citwa coniine, kikaba kibuza imitsi y’inyuma kugira ngo umuntu ashobore guhumeka neza mu gihe umurwayi aguma ari maso.

Ni kuki amakara akoreshwa mu gihe c’ijoro ari ngirakamaro cane iyo umuntu arya Autumn Crocus?¶

Iyo colchicine yinjiye mu mitsi y’umutima no mu ngingo z’amagufa maze igafunga ku tubuline iri mu ngingo, hemodialyse ntishobora kuyikuraho kandi nta muti usanzwe wo kuyirwanya uboneka cane. Ariko rero, colchicine iguma isohoka n’igitigu ikaja mu maraso, igasubira mu mara mato; gutanga imiti isubiramwo amakara akoreshwa buri masaha 4 canke 6 bifata colchicine mu nzira y’amaraso, bikahagarika ugusubira gukora kw’amaraso, kandi bishobora gukingira umutima wo mu rwego rwa 2 ushobora kwica.

Mbega umuntu yoshobora kurokoka ubumara bw’umukaraba (Conium maculatum) iyo impwemu yiwe ihagaze?¶

Ego, n’ubuvuzi bw’ivyihutirwa bwo muri iki gihe, ukurokoka Poison Hemlock ni hafi 100% iyo guhema mu gukiza no gukoresha ubuhinga bwo guhumeka mu bitaro bitanguye imbere y’uko ubwonko bugira ingorane z’ubumara. Kubera ko coniine idashobora kwonona ubwonko canke imitsi ubudasiba, gushiramwo umurwayi ku gikoresho co guhumeka gikoreshwa n’amaboko gifise umuti wo kumuruhutsa mu kiringo c’amasaha 24 gushika ku 72, bituma umubiri ushobora guhindura ubumara no kubusohora gushika inkomezi z’imitsi zigarutse.

Mbega guteka canke guteka ivyatsi vy’ishamba vyoba bisenyura ubumara buri mu giti c’umukara canke c’umukara?¶

Oya, guteka, guteka, guteka canke kwumisha ntibishobora gusenyura colchicine, alkaloïdes ya veratrum canke cicutoxine. Nkako, guteka amababi y’igiti citwa Autumn Crocus canke False Hellebore mu mazi y’isupu canke y’amapasta, bikura ubumara bushobora gusenyuka mu mazi buca buja mu mazi yo guteka, bigatuma umuntu wese arya uwo mutobe agira ubumara.

Kugira ngo ugume utekanye mu gihe c’imyidagaduro yo hanze no mu bihe vy’ivyihutirwa vyo mu bugaragwa, niwiyumvire gufata inyigisho y’ubutabazi bwa mbere n’ubuvuzi bwa CPR iva ku Musaraba Mutukura, St John Ambulance, canke umuganga w’ubugaragwa yemerewe.

Inyobora zifitaniye isano¶

• Gushaka ivyokurya vy'ibizinu vyo mw'ishamba (Amatoxin) n'ugufata ibiterwa bifise ubumara
• Status Elepticus, Gufata igihe kirekire, n’imiti yo gukiza
• CPR: Intambwe ku yindi yo gusubiza ubuzima mu mutima n'amahaha
• Ubumara bw’ibifungurwa, Indwara y’Inda, n’Ukubura Amazi
• Ubumara rusangi Ubufasha bwa mbere n'ugukuraho ubuhumane

Amasoko n'ubuyobozi buzwi¶

• TWEBWE. Ibiro bijejwe kugenzura no kwirinda indwara (CDC): Raporo y’indwi ku ndwi yerekeye indwara n’urupfu (MMWR): Ubumara bw’ibikoko vyo mu mazi (Cicuta maculata), ibikoko vyo mu mazi (Conium maculatum), n’ivyo mu bwoko bw’ibinyoma (Veratrum viride) bujanye n’ugushaka ivyo kurya (Leta Zunze Ubumwe za Amerika).
• Ikigo c’Ubudage kijejwe gupima ingaruka (BfR) & Ikigo c’amakuru y’ubumara co mu Busuwisi (Tox Info Suisse): *Imburi ku baguzi n’ubuyobozi bw’ubuvuzi ku bijanye no gutera urujijo ivyatsi vy’umukara (Allium ursinum) n’ivyatsi vy’umukara (Colchicum autumnale) n’ivyatsi vy’umukara (E Verat).
• Ikigo c’igihugu c’Ubwongereza kijejwe amakuru yerekeye ubumara (NPIS) / TOXBASE: Ubuvuzi bw’ibimera vy’ibimera vy’ibimera vy’ibimera vy’ibimera vy’ibimera vy’ibimera vy’ibimera vy’ibimera vy’ibimera vy’ibimera vy’ibimera vy’ibimera vy’ibimera vy’ibimera vy’ibimera vy’ibimera (Ubwongereza).
• Finkelstein Y, Aks SE, Hutson JR, Juurlink DN, n’abandi: Ubumara bwa Colchicine: uruhande rw’umwiza rw’umuti wa kera (Ubumara bw’ubuvuzi).
• Schep LJ, Slaughter RJ, Becket G, Beasley DM: Ubumara buterwa n’igiti c’umukaraba co mu mazi (ubwoko bwa Cicuta) n’igiti c’umukaraba c’ubumara (Conium maculatum) (Ivy’ubumara bwo mu bitaro / Ikigo c’igihugu c’ubumara co muri Nouvelle-Zélande).