Indwara ya Auto-Brewery (Endogenous Gut Fermentation) vs Inzoga zifite ubumara (Methanol na Ethylene Glycol) Osmolal Gap Tage¶

Iyo umuntu agaragaje imvugo idasobanutse, ataxia (kugenda bitangaje), kuzunguruka, urujijo, cyangwa ubusinzi bugaragara mugihe ashimangira ko batigeze banywa igitonyanga na kimwe cyibinyobwa bisindisha, abaganga byihutirwa bahura nikibazo gikomeye cyo kwisuzumisha hagati yuburyo bubiri butandukanye: ** Auto-Brewery Syndrome (Endogenous Gut Fermentation Syndrome). mubisanzwe * Saccharomyces cerevisiae *, * Candida albicans *, cyangwa * Candida glabrata ) cyangwa bagiteri zitanga Ethanol nyinshi ( Klebsiella pneumoniae * na * Enterococcus faecium ***) imbere mu mara mato cyangwa uruhago rwinkari zihindura karubone nziza (umutsima, pasta, umutobe w'imbuto) . cyangwa ** Isopropanol ** (guswera inzoga, isuku y'intoki). Mugihe umurwayi ufite Syndrome ya Auto-Brewery afite urwego ** rwashyizwe hejuru ya serumu etanol ya ** (akenshi $ 100 inyandiko {kugeza} 400 inyandiko {mg / dL} $ nyuma yifunguro rya karubone) hamwe namaraso asanzwe ya arterial pH, serumu bicarbonate isanzwe, na zeru zidafite umubare wa osmolal **, umurwayi winjiye ** Methanol cyangwa etylene ** ya metero ** Serumu Osmolal Gap ($> 10 inyandiko {kugeza} 20 inyandiko {mOsm / kg} $) ** igenda ihinduka amasaha arenga 6 kugeza kuri 24 ikoresheje hepatike ** Alcool Dehydrogenase (ADH) ** ikica ** Acide-Anion-Gap Metabolic Acidose (HAGMA) **: ** acide formic ** iterwa na metani ya metani (itera umwijima ** itera metani). n'ifatwa ry'ubuhumekero) cyangwa ** glycolike na aside oxyde ** ikomoka kuri Ethylene glycol (igusha ** ibahasha ya calcium ya oxyde ya calcium ya oxyde ** imbere mu mpyiko, igatera ** kunanirwa kw'impyiko zikomeye, tetanyike ya hypocalcemic, na coma **). Niba hari umuntu ugaragara ko yasinze cyane atanyweye inzoga, cyangwa akagira icyerekezo kitagaragara / urubura, guhumeka byihuse (Kussmaul respirations), ububabare bwuruhande, gufatwa, cyangwa kutitabira, hamagara aho utuye nimero yihutirwa ako kanya. Ongera usubiremo abavandimwe bacu bayobora kuri methanol, antifreeze ya Ethylene glycol, n'uburozi bwa alcool, ubusinzi bwa alcool, hangover, hamwe no gutwara umutekano, na uburozi nuburozi guhura nubufasha bwambere.

Icyihutirwa cyawe mubusinzi ubwo aribwo bwose budasobanutse nukwirinda ** kwirinda hypoglycemia yangiza ubuzima hamwe no kunywa inzoga zubumara BWA MBERE *, ubare icyuho cya ** Serum Osmolal Gap (Gupima Freezing-Point Serum Osmolality ukuyemo Osmolarity, harimo na Ethanol igabanijwe-na-4,6) ** - administer ** Fomepizole yimitsi ( 4-methylpyrazole *, $ 15 inyandiko {mg / kg} $ IV yipakurura dose) ako kanya udategereje ibisubizo byoherejwe na gazi chromatografiya ** niba methanol cyangwa Ethylene glycol idashobora gukurwaho, fome Fizopizole hamwe na cofactor ya vitamine ** ya Acide [Leucovorine; ]

Kora ubu¶

1. ** Hamagara nimero yawe yihutirwa hamwe n’ikigo gishinzwe kurwanya uburozi ako kanya niba hari umuntu ugaragaje ubusinzi budasobanutse buherekejwe nimpinduka zigaragara, guhumeka byihuse, ububabare bukabije bwo munda / impande zombi, urujijo, cyangwa guhagarika umutima. nimero yihutirwa.
2. ** Reba Fingerstick Capillary Blood Glucose Ako kanya kandi urinde inzira yo guhumeka. Niba umurwayi asinziriye cyangwa aruka, uzunguruke kuruhande rwabo muri ** gukira kuruhande **.
3. ** Kugenzura Ahantu Ibinyabiziga, Urugo, cyangwa Ibikoresho Byakorewe mu rugo, CYANGWA Antibiyotike ya vuba / Carbhydrate Triggers: **
4. ** Ibimenyetso byuburozi bwinzoga: ** Reba ** amazi yubururu cyangwa yijimye yumuyaga wogesheje **, ** fluorescent yumuhondo-icyatsi cyangwa orange radiator antifreeze **, ** amavuta ya fondue yamashanyarazi **, ** irangi ryamabara **, ** isuku yintoki / guswera inzoga **, cyangwa amacupa yinzoga zitemewe.
5. ** Indwara ya Syndrome ya Auto-Brewery: ** Baza niba umurwayi afite syndrome ya mara magufi, indwara ya Crohn, Rass-en-Y gastric bypass, umwijima cirrhose / NAFLD, diyabete, cyangwa amasomo ya antibiyotike ya vuba ya **, kandi niba ibice byabo byibasiye ** amasaha 1 kugeza kuri 4 nyuma yo kurya karubone nyinshi (pizza, pasta, umutsima, soda) **.
6. ** Tegeka Ibice 5 bigize Ibitaro bya Tage Lab (Ikigereranyo cya Osmolality ukoresheje Freezing-Point Depression, Panel Metabolic Panel, Serum Ethanol, Gas Gas + Lactate, na Urinalysis hamwe na Microscopi). icyuho cya osmolal **).
7. ** Niba inzoga zifite ubumara (Methanol cyangwa Ethylene Glycol) Zikekwa: Administer Fomepizole (15 mg / kg IV mu minota 30) Ako kanya, Ntutegereze Icyemezo cya Chromatografiya. gufunga enzyme ifunze muminota mike kugirango zeru zeru zifite ubumara bwa aside cyangwa aside oxyde. .
8. ** Niba ibizamini bya Laboratwari byemeza Ethanol yuzuye (Syndrome de Auto-Brewery) Hamwe namaraso asanzwe pH, Bicarbonate isanzwe, na Zero Zitamenyekanye Osmolal: ** Shyira umurwayi kuri ** Zeru-Zoroshye-Isukari, Carbohydrate nkeya, -kugaburira amaraso ya Libiya, ** Kugenzura abarwayi 100g-200g Ikizamini cya Glucose yo mu kanwa **, amara yo mu nda / imico ya bagiteri, hamwe na ** antifungal (fluconazole, nystatin, cyangwa echinocandin) cyangwa imiti igabanya ubukana **.

Igiti cyemezo: ubusinzi bwamavuriro budasobanutse, icyuho cya osmolal, hamwe na triage ya anion¶

flowchart TD
    A["Umurwayi Yerekana Ubusinzi budasobanutse (Ataxia, Imvugo ituje, Urujijo, cyangwa Stupor) Guhakana kunywa inzoga"] --> B{"Ako kanya Ibitanda & STAT Laboratoire: Glucose yintoki + Yapimwe Gukonjesha-Ingingo Serum Osmolality + BMP (Na +, Cl-, HCO3-, Cr, Glucose, BUN) + Serumu Ethanol + Gazi Yamaraso"}
    B -->|Serum Ethanol ELEVATED (50 to 400 mg/dL) + Normal Blood pH (7.35-7.45) + Normal HCO3- + Osmolal Gap Fully Explained by Ethanol (OG < 10 after subtracting EtOH/4.6)| C{"Ese umurwayi afite inshuro nyinshi nyuma yo kurya Carbohydrate Yokunywa hamwe na Zero Zero Exogenous Yanyweye?"}
    C -->|YES: Episodes Triggered 1-4 Hrs After Bread/Pasta/Sugar in Patient with Short Bowel, Roux-en-Y, Crohn's, Cirrhosis, or Post-Antibiotics| D["SYNDROME YAKOMEYE AUTO-BREWERY (Endogenous Gut Fermentation na Saccharomyces, Candida, cyangwa Klebsiella pneumoniae)"]
    C -->|NO: Acute Exogenous Ethanol Ingestion| E["Ubuvuzi bwa Ethanol busanzwe: Kurinda umwuka, IV Thiamine (100 mg) mbere ya Glucose, Fluids, Indorerezi"]
    D --> F["Kwihutira Kwitaho: Byihuse-Carbohydrate / Indyo Yuzuye-Poroteyine + Indorerezi Yizewe Kugeza BAC = 0 + Kwemeza Kugenzura 24-Hr Kwiyiriza ubusa & Ikizamini cya Glucose Ikizamini + Ikigereranyo cya Antifungali (Fluconazole / Nystatin) cyangwa Ubuvuzi bwa Antibacterial"]
    B -->|Serum Ethanol ZERO or Low (or Unaccounted Osmolal Gap > 10 mOsm/kg After Subtracting Ethanol) OR High-Anion-Gap Metabolic Acidosis (pH < 7.30, HCO3- < 18)| G["BITEKEREZO BY'UBWOKO BWA ALCOHOL POISONING (Methanol, Ethylene Glycol, cyangwa Isopropanol)"]
    G --> H{"Reba Acide-Base Imiterere (Anion Gap) & Ibimenyetso bya Clinique"}
    H -->|Elevated Osmolal Gap (> 10-20) WITH Normal Anion Gap & Normal pH + Sweet/Fruity Acetone Breath + Ketonuria/Ketonemia (Zero Acidosis)| I["ISOPROPANOL (Kunywa inzoga) Kwinjiza: Metabolised by ADH to Acetone (Ketone, SI Acide); Kuvura witonze Gushyigikira GUSA (Ntutange Fomepizole)"]
    H -->|Visual Blurred/Snowstorm Vision, Blindness, Dilated Unreactive Pupils, Optic Disc Hyperemia + Severe HAGMA| J["METHANOL POISONING (Ubumara bwa Acide busanzwe)"]
    H -->|Flank Pain, Hematuria, Oliguria/AKI, Envelope/Needle Calcium Oxalate Crystals in Urine, Hypocalcemic Tetany + Severe HAGMA + Falsely Sky-High Point-of-Care Lactate| K["ETHYLENE GLYCOL POISONING (Uburozi bwa Glycolike & Oxalic)"]
    H -->|Very Early Presentation (< 1 to 6 Hours): High Osmolal Gap (> 15-20) with Normal Anion Gap (Before ADH Converts Parent Alcohol to Acid)| L["KERA METHANOL CYANGWA ETHYLENE GLYCOL INGESTION"]
    J --> M["SHAKA ANTIDOTE: Tanga IV FOMEPIZOLE 15 mg / kg Kurenga 30 Min NONAHA (Mbere y'ibisubizo bya Chromatografiya ya gaz) + IV Sodium Bicarbonate (niba pH <7.30)"]
    K --> M
    L --> M
    M --> N["Ongeramo Cofactors yihariye ya Metabolike: 1. Kuri Methanol: IV ACID FOLINIQUE (Leucovorin) 1 mg / kg (kugeza kuri mg 50) q4h; 2. Kuri Ethylene Glycol: IV PYRIDOXINE (Vit B6) 50-100 mg q6h + IV THIAMINE (Vit B1) 100 mg q6h"]
    N --> O{"Hari Ikimenyetso Cyerekana Hemodialyse Yihutirwa? ."}
    O -->|YES| P["HEMODIALYSIS YIHUTIRWA (Kongera inshuro ya Fomepizole kuri buri masaha 4 mugihe cya Dialysis)"]
    O -->|NO| Q["Komeza IV Fomepizole 10 mg / kg Buri Masaha 12 Kugeza Urwego <20 mg / dL na Acidose / Icyuho cya Osmolal gikemutse"]

Nigute ushobora kubara icyuho cya Serumu Osmolal hamwe na Serumu Anion Gap kumuriri¶

Kubera ko laboratoire nyinshi zibitaro zidafite amasaha 24 murugo mu rugo rwa Chromatografiya (GC) kugirango bapime mu buryo butaziguye urugero rwa methanol yamaraso cyangwa etylene glycol, bohereza izo ngero hanze muri laboratoire ifata amasaha 12 kugeza kuri 48, abaganga byihutirwa bashingira kuri ** ibice bibiri byo kuryama kuburiri ** hiyongereyeho ** point-of-care-lactate gap trick ** kugirango basuzume muminota 15:

1. Ikigereranyo cya 1: Kubara Serumu Osmolal (Impamvu Ugomba Kugabana Ethanol na 4.6, Ntabwo 3.7)¶

Ubwa mbere, tegeka ** Serum Osmolality yapimwe ($ inyandiko {Osm} _ { inyandiko {yapimwe}} $) ** ukoresheje ** Kwiheba-Ingingo yo Kwiheba ** (bisanzwe: $ 275 inyandiko {kugeza} 295 inyandiko {mOsm / kg} \(). Icya kabiri, ubare ** Kubara Serumu Osmolarity (\) inyandiko {Osm} _ { inyandiko {yabazwe}} $) ** uhereye icyarimwe icyarimwe Metabolic Panel hamwe na Serum Ethanol:

• ** Mubice gakondo byabanyamerika ($ inyandiko {Glucose, BUN, na Ethanol muri mg / dL} $; $ Na + inyandiko {muri mmol / L} $): ** $$ inyandiko {Yabazwe Osmolarity} = 2 inshuro [Na +] + frac { inyandiko {Glucose}} {18} + frac { inyandiko {BUN}} {2.8} + frac { inyandiko {Ethanol (mg / dL)}} {4.6} $$ *.
• ** Muri SI Mpuzamahanga (Indangagaciro zose, $ Na +, inyandiko {Glucose, Urea, na Ethanol} $, bimaze kuba $ inyandiko {mmol / L} $): ** $$ inyandiko {Yabazwe Osmolarity} = 2 inshuro [Na +] + [ inyandiko {Glucose}] + [ inyandiko {Urea}] + [ inyandiko {Ethanol (mmol / L)}] $$
• ** Icyuho cya Serumu Osmolal ($ inyandiko {OG} $): ** $$ inyandiko {Icyuho cya Osmolal} = inyandiko {Igipimo cya Osmolality} - inyandiko {Kubara Osmolarity} $$
• ** Icyuho gisanzwe cya Osmolal: ** ** $ - 10 inyandiko {kugeza} +10 inyandiko {mOsm / kg} $ **.
• ** Muri Syndrome ya Auto-Brewery (cyangwa ibinyobwa bisukuye bya Ethanol): ** Iyo urwego rwa serumu etanol yapimwe umurwayi amaze gucomeka mu kuringaniza ($ inyandiko {Ethanol} / 4.6 \(), icyuho cya ** Osmolal gisigaye ni ibisanzwe rwose (\) <10 inyandiko {mOsm / kg} $) ** kuko ** 100 ku ijana by'inyongera osmoles ubwayo ituruka kuri Ethanol.
• ** Muri Methanol Yambere, Ethylene Glycol, cyangwa Isopropanol Uburozi: ** Kuberako formula yabazwe idashyizwemo methanol cyangwa Ethylene glycol, icyuho cya Osmolal ** kitarashyirwa hejuru cyane ($> 10 inyandiko {kugeza} 20 inyandiko {mOsm / kg} $, kandi akenshi $> 40 inyandiko {mOsm. .

2. Ikigereranyo cya 2: Isano Itandukanye Hagati ya Osmolal Icyuho na Anion Gap mugihe¶

TIME-COURSE OF OSMOLAL GAP vs. ANION GAP IN TOXIC ALCOHOL POISONING
=======================================================================
Gap Magnitude
  |
  |  [OSMOLAL GAP]                            [ANION GAP (HAGMA)]
  |  (Unmetabolized Parent                    (Toxic Acid Metabolites:
  |   Methanol or Ethylene Glycol)             Formate or Glycolate/Oxalate)
  |   \                                               /
  |    \   HIGH OSMOLAL GAP                          /   HIGH ANION GAP
  |     \  + NORMAL ANION GAP                       /    + NORMAL OSMOLAL GAP
  |      \ (Hours 0 to 4)                          /     (Hours 12 to 36)
  |       \                 \                     /
  |        \                 \   BOTH ELEVATED   /
  |         \                 \ (Hours 4 to 12) /
  |          \_________________\_______________/_______________________
  +------------------------------------------------------------------->
  Hour 0 (Ingestion)        Hour 6          Hour 12         Hour 24-36
=======================================================================

3. Ikimenyetso cya "Lactate Gap" Ikimenyetso cyuburozi bwa Ethylene Glycol¶

Ikimenyetso cyiza cyihuse cyo kwisuzumisha mubyumba byihutirwa ni ukugereranya ** Ingingo-yo-Kwitaho Amaraso Yisesengura Amaraso ** na Laboratoire Nkuru ya Laboratwari **: - ** Acide Glycolike ** (aside nyamukuru metabolite ya ** Ethylene glycol antifreeze **) ifite imiterere yimiti isa na ** L-lactate **. - Hafi yigitanda ** Point-of-Care / Arterial Blood Gas (ABG) imashini ** ikoresha * L-lactate oxydease * electrode ko ** idashobora kubwira aside glycolike usibye lactate **, ikamenyesha ** lactate yo mu kirere cyibinyoma "lactate" ya $ 15 inyandiko {kugeza} 40 inyandiko {mmol / L} $ **, mugihe laboratoire yo hagati yibitaro * lactate dehydrogenase * } 4 inyandiko {mmol / L} $ **. Ikinyuranyo kinini cya Lactate ($> 10 inyandiko {mmol / L} $ itandukaniro riri hagati yimashini ya ABG na laboratoire yo hagati) ** ni pathognomonic kuri ** Uburozi bwa Ethylene Glycol **.

Kugereranya kuruhande: Syndrome ya Auto-Brewery na Methanol na Ethylene Glycol na Isopropanol¶

Kwibira cyane 1: Indwara ya Auto-Brewery Syndrome (Endogenous Gut Fermentation), Pathophysiology, Gusuzuma, no kuvura¶

1. Uburyo Igifu cyumuntu gihinduka Micro-Inzoga¶

Mu nzira nziza ya gastrointestinal yumuntu, ibimenyetso bya Ethanol ya endogenous (munsi y $ 0.5 inyandiko {kugeza} 1.0 umwandiko {mg / dL} $) bikozwe buri munsi na bagiteri zo mu bwoko bwa colonique kandi bigasukurwa bitagoranye ku nzira yabo ya mbere banyuze mumitsi ya hepatike ** Alcool Dehydrogenase (ADH) **. ** Syndrome ya Auto-Brewery (ABS) ** iturika iyo "umuyaga mwiza" wibintu bitatu bihuye: 1. ** Anatomical Stasis cyangwa Yahinduwe Gut Ubwubatsi: ** ** Indwara ngufi yo munda **, ** Roux-en-Y gastric bypass ** jejunum na ileum. 2. ** Dysbiose ikurikira Antibiyotike Yagutse: ** Inzira ndende cyangwa isubirwamo ya antibiyotike yagutse (nka amoxicillin-clavulanate, fluoroquinolone, tetracyclines, cyangwa cephalosporine) ihanagura ibintu birinda * Lactobacillus * na * Bifidobacterium * flora, bikemerera fermenta Sacca . 3. ** Kwiyuzuza Hepatike Yambere: ** Iyo umurwayi arya ibiryo bikungahaye kuri karubone (umutsima wera, igikonjo cya pizza, pasta, umuceri wera, imigati, cyangwa ibinyobwa birimo isukari), umusemburo cyangwa * Klebsiella * uhindura glucose na fructose ukoresheje pyruvate decarboxylase na alcool dehydrogenase muri ** ubwinshi bwamaraso ya endogenous etanol ** kugeza ** $ 80 inyandiko {kugeza} 400 inyandiko {mg / dL} $ ($ 0.08 \% $ kugeza $ 0.40 \% $) ** mugihe cya ** 1 kugeza 4 amasaha yo kurya **. - . uruhago urothelium mu maraso).

2¶

Kubera ko abarwayi bashinjwaga gutwara ibinyabiziga (DUI) cyangwa ubusinzi ku kazi bakunze guhura n’abatizera n’abaganga n’inkiko, gusuzuma indwara ya Auto-Brewery Syndrome isaba ko itajenjetse, yerekana ko itemewe ** Ikurikiranwa ry’indwara ya Carbohydrate Ikibazo **: 1. ** Akarantine Y’amasaha 24 Yubahirijwe: ** Umurwayi yinjiye mu cyumba cy’ibitaro byakurikiranwe nyuma yo gushakisha ibintu byemeza ko ** zeru zinjira mu nzoga, inzoga zo mu kanwa, cyangwa isuku y’amaboko **, hamwe n’umwuka w’ibanze uhumeka hamwe n’urwego rw’amaraso ya Ethanol byemejwe kuri ** $ 0.0 inyandiko {mg / dL} $ ** nyuma y’igisibo nijoro. 2. ** Ikibazo cya Glucose yo mu kanwa ($ 100 inyandiko {kugeza} 200 inyandiko {garama} $): ** Umurwayi yinjiza ** $ 100 inyandiko {kugeza} 200 inyandiko {garama} $ ya glucose yo mu kanwa ** (cyangwa ifunguro risanzwe rya karubone nziza). 3. ** Serial Timed Venous Blood & Breath Ethanol Sampling: ** Urwego rwamaraso hamwe numwuka wa Ethanol ushushanywa kuri ** $ 0, 0.5, 1, 2, 4, 8, 16, inyandiko {na} 24 inyandiko {amasaha} $ ** (kwipimisha kugeza kumasaha 24 ni ngombwa kuko kunyura buhoro buhoro bishobora gutera impanuka itinze kumasaha 8 kugeza 16). Kuzamuka kwamaraso yimitsi cyangwa guhumeka Ethanol hejuru ya ** $ 20 inyandiko {kugeza} 50 inyandiko {mg / dL} $ ** ukurikiranwe ufunze byemeza ko Syndrome ya Auto-Brewery **. 4. ** Umuco wo hejuru wa GI Endoscopic / Jejunal Aspirate Umuco: ** Gastroenterologiste bakusanya ibyifuzo bya fluid biva mu gifu, duodenum, na jejunum yegeranye (hiyongereyeho urugero rw'intebe) kugira ngo ** umuco w’ibihumyo na bagiteri hamwe na antifungal / antibiyotike yanduye **.

3. Gahunda yo Kuvura Intambwe enye kuri Syndrome Yemewe-Yenga inzoga¶

1. ** Indyo Yicyiciro Cyiza (Isukari Zeru-Isukari, Buke-Buke-Carbohydrate, Diet-Proteine Yuzuye): ** Ako kanya ukata isukari yose yoroshye hamwe na karubone nziza itunganijwe neza yicisha inzara umusemburo / bacteri za substrate yazo, uhagarika umusaruro wa Ethanol endogenous mumasaha 24 kugeza 48.
2. ** Intego yo Kurwanya Antifungali cyangwa Antibacterial Kurandura (Kuyoborwa numuco wumuco): **
3. Kuri *** Saccharomyces cerevisiae * cyangwa * Candida albicans *: ** ** Fluconazole yo mu kanwa ($ 100 inyandiko {kugeza} 200 inyandiko {mg} $ buri munsi mu byumweru 3 kugeza kuri 6) ** na / cyangwa ** Umunwa udashobewe na Nystatin ($ 500,000 inyandiko {IU} $ inshuro enye buri munsi) ** cyangwa itraconazole / vor.
4. Kuri ** Azole-Kurwanya * Candida glabrata * cyangwa * Candida krusei *: ** ** Echinocandin yinjira (Micafungin $ 100 inyandiko {mg} $ IV buri munsi) ** cyangwa posaconazole.
5. Kuri **-Inzoga nyinshi-zitanga inzoga * Klebsiella pneumoniae *: ** Amasomo agenewe umunwa / IV antibiotique (nka karbapenem cyangwa fluoroquinolone ishingiye kuri sensitivité).
6. ** Kugarura Microbiome: ** Imbaraga nyinshi ** za bagiteri nyinshi za porotiyotike (* Lactobacillus acideophilus *, * Lacticaseibacillus rhamnosus *, * Bifidobacterium *) **, rwose ** wirinda * Saccharomyces boulardii * umusemburo wa porotiyotike **, ishobora gutera ububobere buke bwa fermental glycy Ibyumweru 12 mugihe ukurikirana urugo ruhumeka.

Kwibira cyane 2: Porotokole yo Kurwanya Ibitaro bya Methanol na Ethylene Glycol Uburozi¶

METABOLIC BLOCKADE & COFACTOR SHUNTING IN TOXIC ALCOHOL POISONING
=======================================================================
1. METHANOL PATHWAY:
   [Methanol] ==(ADH - BLOCKED BY FOMEPIZOLE)==> [Formaldehyde] ==> [FORMIC ACID]
                                                                          |
                                     +------------------------------------+
                                     |  <== IV FOLINIC ACID (Leucovorin 50 mg q4h)
                                     v      Accelerates 10-Formyl-THF Synthetase.
                          [Harmless CO2 + H2O Exhaled by Lungs]

2. ETHYLENE GLYCOL PATHWAY:
   [Ethylene Glycol] ==(ADH - BLOCKED BY FOMEPIZOLE)==> [Glycolic Acid]
                                                                |
                                                                v
                                                        [Glyoxylic Acid]
                                                       /                \
        +--(IV PYRIDOXINE [Vit B6] 50-100 mg q6h)--+  /                  \
        |   & IV THIAMINE [Vit B1] 100 mg q6h       |v                    v
        +==> [Harmless Glycine & Alpha-OH-Beta-Ketoadipate]     [TOXIC OXALIC ACID]
                                                                (Calcium Oxalate Stones)
=======================================================================

1. Fomepizole yimitsi (* Antizol *) Gukoresha Porotokole (Harimo Guhindura Dialysis)¶

• ** Igipimo cyo gupakira: ** ** $ 15 inyandiko {mg / kg} $ IV yashizwemo mu minota 30 ** (ivanze $ 100 inyandiko {mL} $ ya $ 0.9 \% $ umunyu usanzwe cyangwa $ inyandiko {D5W} $).
• ** Gufata neza (Hatabayeho Hemodialyse): ** ** $ 10 inyandiko {mg / kg} $ IV buri masaha 12 kuri dosiye 4 (amasaha 48) **, hanyuma ** kwiyongera kugeza $ 15 inyandiko {mg / kg} $ IV buri masaha 12 ** guhera kumasaha 48 (kuko Fomepizole itera cytochrome P450 2E1 metabolism nyuma yamasaha 48).
• ** Guhindura Ibipimo Byateganijwe Mugihe cya Hemodialyse: ** Kuberako Fomepizole ari molekile ntoya, ikabura amazi-isukuye vuba mumaraso na filteri ya hemodialysis **, ugomba ** ugomba kongera inshuro ya Fomepizole kumasaha 4 mugihe cya hemodialysis ** (cyangwa ugatanga IV ihoraho ya $ 1 inyandiko {mg / kugeza {1.5 inyandiko {

2.¶

Iyo amaraso ya arterial pH agabanutse munsi y $ 7,30 \(, aside ionic ** ya acide ya ** na ** glycolike ** yambuka byoroshye uturemangingo twa lipide muri ** retina, nervice optique, ubwonko bwa basal ganglia, na selile tubular selile ** (** "ion umutego" **). - Gucunga ** Sodium Bicarbonate ya Sodium (\) 1 inyandiko {kugeza} 2 inyandiko {mEq / kg} $ IV bolus, hanyuma hakurikiraho kwinjiza isotonic ya $ 132 umwandiko {kugeza} 150 inyandiko {mEq} $ sodium bicarbonate muri $ 1 inyandiko {Liter} $ ya $ inyandiko {D5W} $ kuri $ 150 inyandiko %

3. Guhiga Vitamine yihariye¶

• ** Mu Burozi bwa Methanol Byemejwe cyangwa Bikekwa: ** Tanga ** Acide Folinic Acide (Leucovorin) $ 1 inyandiko {mg / kg} $ (kugeza $ 50 inyandiko {mg} $) IV buri masaha 4 kugeza kuri 6 ** (cyangwa ** IV Acide Folike $ 50 inyandiko {mg} $ buri masaha 4 ** niba leucovorin itaboneka). Folate itanga cofactor ikora ya tetrahydrofolate isabwa na hepatike * 10-formyl-THF synthetase * kugirango ihindure aside aside yubumara ** ya dioxyde de carbone itagira ingaruka ($ inyandiko {CO} _2 $) namazi **.
• ** Mu Burozi bwa Ethylene Glycol Byemejwe cyangwa Bikekwa: ** Tanga ** Pyridoxine Yinjiza (Vitamine B6) $ 50 inyandiko {kugeza} 100 inyandiko {mg} $ IV buri masaha 6 ** PLUS ** Thiamine yinjira (Vitamine B1) $ 100 inyandiko {mg} $ IV buri masaha 6 **. Thiamine na pyridoxine birinda uburozi hagati ya ** glyoxylic aside ** kure yo gukora impyiko zangiza ** aside oxyde ** hanyuma ikohereza muri glycine itagira ingaruka ** na $ alpha $ -hydroxy - $ beta $ -ketoadipate.

Inomero zihutirwa zo mukarere hamwe na protocole yikigo¶

• ** Amerika na Kanada: ** Hamagara ** 911 ** ako kanya kubantu bose bakekwaho kunywa inzoga zifite uburozi cyangwa ubusinzi bukabije budasobanutse, hanyuma uhamagare ** Igenzura ry’uburozi muri Amerika kuri 1-800-222-1222 ** (cyangwa Ibigo by’uburozi byo muri Kanada byo mu ntara kuri ** 1-844-POISON-X **). Kurikiza ** Ishuri Rikuru ry’Abanyamerika ry’uburozi (AACT) ** na ** KUGARAGAZA (Ubuvuzi bwa Extracorporeal mu Burozi) Itsinda ryabakozi ** amabwiriza ya IV Fomepizole na hemodialyse.
• ** Ubwongereza: ** Hamagara ** 999 ** kubera uburozi bukabije cyangwa guhindura imyumvire. Abaganga b’amavuriro barabaza ikigo cy’igihugu gishinzwe amakuru y’uburozi (NPIS / TOXBASE) ** kugira ngo byihutirwa ** IV Fomepizole ** kunywa, kuvura cofactor, hamwe n’ibipimo bya hemodialyse.
• ** Umuryango w’ubumwe bw’ibihugu by’i Burayi: ** Hamagara ** 112 ** mu bihugu byose bigize Umuryango w’ubumwe bw’ibihugu by’Uburayi. Ibigo by’uburozi by’i Burayi bikurikiza ** Ishyirahamwe ry’ibihugu by’i Burayi by’Uburozi n’ubuvuzi bw’uburozi (EAPCCT) ** na ** EXTRIP ** amabwiriza.
• ** Australiya na Nouvelle-Zélande: ** Hamagara ** 000 ** muri Ositaraliya (na ** Ikigo gishinzwe amakuru y’uburozi bwa Ositaraliya kuri 13 11 26 **) cyangwa ** 111 ** muri Nouvelle-Zélande (Ikigo cy’uburozi cy’igihugu ** 0800 764 766 **).
• ** Aziya-Pasifika: ** Hamagara ** 119 ** mu Buyapani no muri Koreya y'Epfo, ** 995 ** muri Singapuru, ** 999 ** muri Maleziya na Hong Kong, cyangwa ** 112/108 ** mu Buhinde gutwara ibitaro byihutirwa.

Ibibazo bikunze kubazwa¶

Nigute umuntu ashobora gusinda byemewe n'amategeko ahumeka atanyweye igitonyanga na kimwe cya alcool (Syndrome de Auto-Brewery)?¶

Muri Syndrome ya Auto-Brewery (ivuriro izwi ku izina rya Endogenous Gut Fermentation Syndrome), amara mato cyangwa igifu cy'umurwayi biba ubukoloni bukabije bitewe n'umusemburo usembuye (nk'umusemburo wa Saccharomyces cerevisiae] bypass, syndrome de montage, indwara ya Crohn, cyangwa diyabete. Igihe cyose umuntu arya ifunguro ryinshi rya karubone, nka pizza, pasta, umutsima, umuceri, cyangwa soda ya sukari, izo mikorobe zo munda zitera karubone mu nda mu buryo butaziguye inzoga ya Ethyl (Ethanol). Mu masaha 1 kugeza kuri 4 yo kurya, Ethanol nyinshi yinjira mumitsi yumutima kuburyo umwijima udashobora kuyisiba vuba bihagije, bigatuma urugero rwinzoga rwamaraso rwiyongera kuri mg / dL 100 kugeza 400 (0.10% kugeza 0.40%) nubwo umuntu yanyweye inzoga zeru.

Nigute abaganga bo mubyihutirwa babwira vuba Syndrome ya Auto-Brewery usibye uburozi bwa Methanol cyangwa Ethylene Glycol?¶

Kugenzura amaraso atatu ninkari bitandukanya Syndrome ya Auto-Brewery nuburozi bwinzoga zifite uburozi muminota 30: (1) Urwego rwa Serum Ethanol: Muri Syndrome ya Auto-Brewery, isuzuma ryamaraso ya Ethanol risanzwe ni ryinshi (kubera ko umusemburo wo munda ukora Ethanol nyayo), mugihe muri methanol yuzuye cyangwa uburozi bwa antifreeze, ikizamini cya Ethanol ni zeru; . hamwe na

Ni ukubera iki umurwayi wanyweye antifreeze cyangwa umuyaga wogesheje ikirahure ashobora kugira Anion Gap isanzwe kare kare, na Gapi isanzwe ya Osmolal nyuma?¶

Iyo umuntu yamize bwa mbere methanol (umuyaga wogeje wumuyaga) cyangwa Ethylene glycol (antifreeze), molekile yababyeyi idafite metabolisiyumu ireremba mumaraso, igatwara Serum Osmolal Gap ikirere hejuru mugihe amaraso pH na Anion Gap bikomeza kuba bisanzwe mumasaha 1 kugeza 6. Mu masaha 6 kugeza kuri 24 ari imbere, umusemburo wa Alcool Dehydrogenase (ADH) umwijima urya buhoro buhoro urya inzoga zababyeyi ukayihindura aside yica (acide formic cyangwa glycolike / aside oxyde). Mugihe inzoga zababyeyi zabuze zigahinduka aside, Gap ya Osmolal igabanuka ikamanuka mubisanzwe mugihe Anion Gap irasa. Kubera iyi ngaruka yo kureba, abaganga bahora bagenzura BYINSHI icyuho cya Osmolal na Anion Gap.

Nigute antidote Fomepizole (* Antizol *) ikiza icyerekezo cyawe nimpyiko nyuma yuburozi bwa methanol cyangwa antifreeze?¶

Methanol na Ethylene glycol ntibishobora kwangiza imitsi ya optique cyangwa impyiko kugeza igihe umusemburo wa Alcool Dehydrogenase (ADH) umwijima wawe ubihinduye aside aside cyangwa aside aside. Fomepizole (4-methylpyrazole) ni antidote yuzuye imitsi ihuza urubuga rukora rwa Alcool Dehydrogenase ifite imbaraga zikubye inshuro 8000 kuruta methanol cyangwa glycol ya Ethylene. Mu minota mike ya dose ya IV ya Fomepizole, enzyme ya ADH ifunze burundu, ihagarika umusaruro wa acide uburozi wapfuye mumihanda yayo kugirango methanol cyangwa metylene glycol idashobora gukurwaho neza nimpyiko cyangwa imashini ya hemodialyse.

Niki "Ingingo-yo-Kwitaho Lactate Gap", kandi nigute byerekana ko umuntu yanyweye antifreeze ya Ethylene glycol?¶

Iyo umwijima umennye antifreeze ya Ethylene glycol, itanga aside irike ya glycolike. Acide ya glycolike ifite imiterere ya molekuline isa na aside ya lactique (lactate). Iyo umuforomo wo mu cyumba cyihutirwa akoresha igitonyanga cyamaraso ku gitanda Point-of-Care Arterial Blood Gas (ABG), imashini ya L-lactate oxydease ya mashini yashutswe na aside glycolike kandi ikavuga ko urwego rwa "lactate" rwibeshya (akenshi rufite mm 15/40 mmol / L). Ariko, mugihe icyitegererezo kimwe cyamaraso gikorerwa muri laboratoire nkuru yibitaro ukoresheje enzyme itandukanye (lactate dehydrogenase), lactate yukuri igaruka hafi yubusanzwe (1 kugeza 3 mmol / L). Itandukaniro rinini hagati y'ibizamini byombi byitwa lactate, byitwa icyiza cyiza cya Lactate, bihita byerekana ko uburozi bwa Ethylene glycol mbere yamasaha yo kohereza ibisubizo byuburozi.

Nigute abaganga bemeza neza Syndrome ya Auto-Brewery iyo uburozi bwihutirwa butemewe?¶

Kugirango bagaragaze ko Syndrome de Auto-Brewery ivurwa no gukingirwa n’amategeko, abaganga bemerera umurwayi mu cyumba cy’ibitaro gikurikiranwa aho basuzumwa amasaha 24 bafite inzoga zeru hanze kandi bakemeza ko bafite umuvuduko w’amaraso wa 0.0 mg / dL. Umurwayi noneho ahabwa ikinyobwa gisanzwe cya glucose kugeza kuri 200 kugeza kuri 200, kandi urugero rwinzoga rwamaraso hamwe nuguhumeka bipimwa kumasaha 0, 0.5, 1, 2, 4, 8, 16, na 24. Igicucu cyanditse muri Ethanol yamaraso nyuma yo kurya glucose yuzuye, ihujwe na endoskopi ntoya-mara yo mu nda cyangwa imico yintebe ikura fermentation Saccharomyces cerevisiae, Candida, cyangwa Klebsiella pneumoniae, yemeza ko isuzumye kandi ikanayobora imiti igabanya ubukana bwa antifungali cyangwa antibiotique.

Inkomoko nubuyobozi¶

• ** Ishuri Rikuru ry’Abanyamerika ryita ku burozi (AACT) n’ishyirahamwe ry’iburayi ry’ibigo by’uburozi n’abashinzwe uburozi bw’ubuvuzi (EAPCCT): ** * Amabwiriza ngenderwaho yerekeye kuvura uburozi bwa Methanol na Ethylene Glycol (Osmolal Gap na Anion Gap Kinetics, Dome ya Fomepizole / Sodium Bicarbonate).
• ** KUGARAGAZA (Kuvura Extracorporeal mu Burozi) Itsinda ryakazi: ** * Gusubiramo buri gihe no Kwemeranya Ibyifuzo byo Kuvura Extracorporeal (Intermittent Hemodialysis) muri Methanol na Ethylene Glycol Uburozi *.
• ** Ikigo cyigihugu gishinzwe amakuru y’ibinyabuzima (NCBI / StatPearls) hamwe n’ishuri rikuru ry’Abanyamerika rya Gastroenterology (ACG) Ubwumvikane buke bw’amavuriro (Malik F, Cordell BJ, McCarthy D): ** Ubuvuzi bwa Antifungal *.
• ** Ikigo cy’igihugu gishinzwe amakuru y’uburozi (NPIS / TOXBASE, Ubwongereza) hamwe n’ubuvuzi bwo kuvura uburozi (Ositaraliya): **
• ** Ikinyamakuru gishya cy’ubuvuzi cy’Ubwongereza (NEJM) Isubiramo ry’ubuvuzi (Kraut JA, Kurtz I; Brent J): ** * Inzoga zangiza inzoga: Ibiranga ivuriro, gusuzuma, no gucunga (Methylpyrazole Iperereza ry’inzoga zifite ubumara [META] Ikigeragezo) *.

Kuyobora¶

• Methanol, antifreeze ya Ethylene glycol, n'uburozi bwa alcool
• Ubusinzi bwa alcool, hangover, hamwe no gutwara neza
• Uburozi nuburozi guhura nubufasha bwambere
• Ibihe byihutirwa bya diyabete: hypoglycemia na ketoacidose ya diabete
• Imibare yihutirwa ukurikije igihugu