Colchicine (Autumn Crocus) vs. Wild Garlic Mea'ai oona ma Vai Hemlock (Cicutoxin) vs. Poison Hemlock (Coniine) Triage¶

O le faaseseina o se laau vao mata'utia mo se tautotogo lanu meamata po'o se fualaau faisua a'a o se tasi lea o fa'alavelave fa'afuase'i fa'afoma'i fa'avavevave i fa'afiafiaga i fafo ma kuka a le fale. Afai e maua e se tasi le faafaufau, mu le gutu, niniva, faagesegese le tātā fatu, vaivai maso, po o le maʻi pe a uma ona ʻai le kalaka vao (ramps), kāloti vao, po'o parsnips vao, vala'au lau numera fa'alavelave fa'afuase'i (911 i le Iunaite Setete ma Kanata, 112 i le isi itu o le Iuni a Europa, 999 i le United Kingdom) pe fa'afeso'ota'i la matou fa'atonu numera fa'afuase'i fa'avaomalo vave. Aʻo faʻatali mo fomaʻi, toe iloilo le matou lautele mushroom vao ma la'au 'o'ona fa'atonuga o le taumafaina, saunia mo tulaga epilepticus faoa faaumiumi pe a 'aina Water Hemlock, ma sauni e amata toe fa'aolaina ile cardiopulmonary resuscitation (CPR) pe afai ole Poison Hemlock po'o le Autumn Crocus e mafua ai le manava po'o le fatu.

I le isi itu o Europa, Amerika i Matu, ma Asia taufetuli, e lua mailei mata'utia e foliga mai e pei o la'au o lo'o ta'uta'ua mo le tele o fa'ama'i oona o le vao mata'utia: 1. Le Laulau Lautele "Wild Garlic" Mailei: Fa'ato'a fa'aputuina e tagata fai mea'ai ** Wild Garlic / Ramsons (Allium ursinum)** po o Amerika i Matu Ramps (Allium tricoccum) i togavao susu o le tautotogo e selesele faafuaseʻi ai laulaau lanumeamata o loʻo tutupu mai Autumn Crocus / Meadow Saffron (Colchicum autumnale) po o le Sese Hellebore (Veratrum album / Veratrum viride), e ola fa'atasi i le eleele e tasi. A'o le Veratrum e fa'aoso vave pua'i, ogaoga bradycardia, ma le toto maualuga i totonu 30 to 120 minutes e matua tali atu i le atropine, Colchicum autumnale o lo'o i ai le mea oona o le mitotic spindle colchicine, lea e fa'ata'ita'ia ai le ma'i ma'i ma'i e le afaina mo 24 hours a'o le'i tu'uina atu le fa'aletonu tele o okeni, te'i cardiogenic, ma le ga'o o ponaivi e leai se vaifofo fa'asalalau lautele. 2. O le Umbelifer "Wild Carrot / Parsnip" Mailei: O tagata e seleseleina tagata o le aiga o karoti/pasili (Apiaceae) sese Water Hemlock (Cicuta maculata, Cicuta virosa, pe Oenanthe crocata) poʻo Oona Hemlock (Conium maculatum) mo karoti vao ( Queen Anne's lace), parsnip vao, angelica, po'o seleni vao. E ui lava o loʻo tauaveina uma le igoa "hemlock," o latou toxins e faʻafeagai ma falemaʻi: ** Water Hemlock ** o loʻo i ai ** cicutoxin ** (poʻo oenanthotoxin), o se GABA-O se faʻalavelave faʻalavelave faʻafuaseʻi e faʻaosoina le currictory **status epilepticus i totonu o le 15 i le 60 minute , ae o le ** Poison Hemlock ** o loʻo i ai le nicotinic alkaloid e pei o le alkaloid. ma'i le manava fa'afu'e a'o mataala atoatoa le tagata manu'a se'ia o'o i totonu le hypoxia.

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

Fai nei loa¶

1. Valaau vave auaunaga mo faalavelave faafuase'i ma Puleaina oona. Valaau le 911 (US ma Kanata), 112 (Iuni a Europa), 999 (United Kingdom), 000 (Australia), po'o le 111 (Niu Sila). Aua le faatali mo ni faailoga e amata pe a iloa e se tasi ua na ona foloina le Autumn Crocus, Water Hemlock, Poison Hemlock, poʻo False Hellebore: colchicine e i ai le taufaasese. 2 to 12 hour le leoa vaega i le taimi o le vave fa'amama a le falema'i e na'o le pau lea o le avanoa e taofia ai le fa'aogaina o le telefoni feavea'i.
2. Aoina ma pue le ata o le laau e le'i atoa, e aofia ai ma le matauila/a'a, le faavae, ma laulaau. Tuu se faata'ita'iga e le'i velaina o laulaau, o'a, fugala'au, po'o matauila (fa'aopoopo i ai so'o totoe, pesto, po'o salati) i totonu o se taga pepa po'o se koneteina ma aumai ma le ma'i i le potu fa'afuase'i. O tagata su'esu'e fa'alavelave fa'afuase'i ma foma'i oona i luga o le telefoni latou te fa'aogaina potu a'a, poloka o la'au, venation lau, ma le manogi kalaka e iloa tonu ai le oona i totonu o minute.
3. Aua ne'i fa'aoso le pua'i i le fale. Aua le tu'uina atu le sua o le ipecac, vai masima, po'o le fa'atoto o tamatamai lima. Afai o le laau o Water Hemlock (Cicuta), e mafai ona faoa faamalosi i totonu 15 minutes o le taumafaina, e mafua ai le manava o le mama pe a pua'i le tagata.
4. Tu'u le tagata ma'i e taoto i lalo ma sauni mo le faoa po'o le le manava.
5. Afai na 'ai e le tagata se a'a po'o le fa'agogo i tafatafa o le alia po'o le taufusi (Water Hemlock), ave ese mea ma'ai ma fa'amoe o latou ulu e sauni ai mo fa'alavelave fa'afuase'i.
6. Afai na 'ai e le tagata se 'a'au o'o'o lanu viole po'o lau pei o le fern (Poison Hemlock), va'ai fa'atu i luga le fatafata: afai e lagona le mamafa o latou vae ma fa'apa'u pe taofi le manava, amata loa le ** manava lavea'i / taga-valve-mask ventilation** (po'o le CPR atoa pe a leai se fatu) vave.
7. Afai e lagona e le tagata le niniva ma le tata lemu i lalo 45 beats per minute pe a uma ona 'ai laula'au lanumeamata lapopoa (Sese Hellebore), fa'ata'oto ma fa'ae'e vae 30 centimeters (12 inches) e lagolago ai le toe fo'i atu o le toto i le fatu se'ia faia e foma'i le tui i totonu atropine.
8. Lapata'i tagata uma na fa'atasia le mea'ai i le taimi lava lena. Pesto garlic vao, supo ramp, ma salati fa'a'ai e masani ona fa'asoa i tagata o le aiga, malo o le 'aiga o le afiafi, po'o tagata tou te tolauapi. So'o se tagata e 'ai se laulaau po'o se sipuni fo'i o le sua kuka (colchicine ma veratrum alkaloids e mautu le vevela ma liu i le sua sua) e tatau ona alu loa i le falema'i tusa lava pe lelei.

Laau fa'ai'uga: Fa'ailoaina fa'ama'i ma le fa'ata'ita'iga o le toxsidrome fa'apitoa¶

flowchart TD
    A["Ma'i Tu'i po'o le 'aina pe a uma ona su'e La'au vao"] --> B{"O le a le Ituaiga o La'au Na seleseleina?"}
    B -->|"Lau'au lanumeamata lamolemole lautele (sese mo le kalaka vao / ramps)"| C{"Siaki Fa'ailoga Amata & Tatau o le fatu"}
    B -->|"La'au pei o Fern po'o Fugalaau Fa'amalu Pa'epa'e / A'a (Sese mo Karoti Vao / Parsnip)"| D{"Siaki le Pulea Neurological Sign"}
    C -->|"Vave Amata (30-120 min) + Tulaga Bradycardia (HR <45) + Ma'ilalo"| E["FALSE HELLEBORE (Veratrum album / viride) - Bezold-Jarisch Reflex"]
    C -->|"Fa'atuai ona amata (2-24 itula) + Mata'i pei o le Kolera + Tachycardia"| F["AUTUMN CROCUS (Colchicum autumnale) - Colchicine Mitotic Poisoning"]
    E --> G["Tu'u atu le malala (<1-2h); IV 0.9% Saline + IV Atropine (0.5-1.0 mg q3-5m) -> Dopamine/Phenylephrine pe a manaʻomia"]
    F --> H["Fa'asao Fa'atosina Fa'atele Fa'atosina (MDAC q4-6h) + Fa'asalaina Voloma'i ICU Muamua + G-CSF mo Pancytopenia"]
    D -->|"Fa'aleaga Tulaga Fa'alaua'itele Epilepticus i totonu ole 15-60 Minute"| I["WATER HEMLOCK (Cicuta maculata / virosa / Oenanthe crocata) - Cicutoxin"]
    D -->|"Muscle Fa'aa'e a'e & Fa'afana Manava ma le Mafaufau manino"| J["HEMLOCK OONA (Conium maculatum) - Coniine Nicotinic Blockade"]
    I --> K["Puipui le Ea; Tulaga maualuga IV Benzodiazepines -> Phenobarbital poʻo Propofol + Faʻamafanafanaga Faʻamalosi + Bicarbonate mo Rhabdomyolysis"]
    J --> L["Fa'ato'a Fa'agata Endotracheal & Fa'a'avevela Fa'ainisinia mo le 24-72 Itula (Aloese mai Succinylcholine) + Fa'agaoioi malala"]

Fa'atusatusaga fa'aleaganu'u ma falema'i o fa'ama'i fa'ama'i fa'ama'i e 4¶

Vaega 1: O le Kalaka Vao e foliga mai: Autumn Crocus (Colchicine) vs. False Hellebore (Veratrum)¶

O tautotogo uma i Europa, Peretania, ma Amerika i Matu, e faitau afe tagata e fafaga i vaomatua susu susu mo ** Wild Garlic (Allium ursinum)** po o Ramps (Allium tricoccum) e fai ai pesto kalaka vao, supo, po'o sauté greens. Ona o le kalaka vao e ola i kapeta mafiafia sa'o i vaega o ** Autumn Crocus (Colchicum autumnale)** ma ** False Hellebore (Veratrum album i Europa; Veratrum viride i Amerika i Matu)**, o le tasi luuga o laulaau e pu'eina e masani ona iai uma ituaiga e tolu. E le gata i lea, o le taimi lava e ufiufi ai tamatamailima o le tagata fai meaʻai i le sua o le kalaka vao, o latou lima e manogi pei o le kalaka, faʻavalea le "suʻega sogisogi" pe a latou asiasia lau mulimuli ane.

Ma'i 1A: Autumn Crocus (Colchicum autumnale) ma Glory Lily (Gloriosa superba): Colchicine Poisoning¶

O vaega uma o le Colchicum autumnale (lau, corm/bulb, fatu, ma fugala'au o le autumn) ma le vevela Gloriosa superba tubers o lo'o i ai le maualuga maualuga (0.1% to 0.6%) ole alkaloid colchicine. E sili atu nai lo 0.5 mg/kg o le colchicine (roughly 2 to 5 fresh leaves of Autumn Crocus mo se tagata matua, pe 1 leaf mo se tamaititi) e masani ona oti, ma o tui e sili atu 0.8 mg/kg mafua toeitiiti lava 100% maliu mai le cardiogenic te'i ma le tele o okeni faaletonu.

Pathophysiology ma le 3 vaega o falemaʻi o Colchicine oona¶

O le Colchicine o lo'o fusifusia e le mafai ona toe fa'afo'iina i totonu o le sela alpha- ma beta-tubulin dimers, e taofia ai i latou mai le fa'aputuina i totonu o le microtubules. A aunoa ma ni microtubules aoga, e le mafai e sela ona fausia se mitotic spindle e vaevae ai (pu'ea uma sela vavave vaevae i le metaphase), ma sela e le vaeluaina (e pei o myocytes cardiac ma neura peripheral) leiloa felauaiga vesicle intracellular ma contractility.

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

La'asaga ta'itasi le Falema'i Pulea ole Colchicine Poisoning¶

1. ** Fa'amama fa'anatinati fa'afuase'i ma fai fa'afia (Even if Presenting Late):** Talu ai ona o le colchicine e o'o i le tele o le enterohepatic recirculation (nanā i le ga'o ma toe fa'afo'i i totonu o le tootoo la'ititi) ma fa'agesegese ai le gaioi o le manava, fa'atonu le ** vave manava/lavage** (pe a i totonu. 1 to 2 hours 'ai laulaau) ma amata Multi-Dose Activated Charcoal (MDAC: 50 grams muamua, ona 25 grams uma 4 to 6 hours mo 24 to 48 hours). O malala fa'agaoioi e fusifusia mau ai le colchicine i totonu o le gut lumen ma o le fua tasi lea e sili ona aoga e fa'aitiitia ai le fa'aleagaina o le tino.
2. Aggressive Hemodynamic ma le ICU Resuscitation: Fa'asusu le tele o voluma tioata paleni i le Laasaga 1 e sui ai 5 to 10 liters o le kolela-pei o le GI gau vai. Fa'atino vave echocardiography i tafatafa o le moega: a'o fa'agasologa le Laasaga 1 o le fa'ate'ia o le hypovolemic i le Laasaga 2 sa'o le te'i cardiogenic (typically at 24 to 72 hours), fesuia'i mai vai e maualuga tele i inotropes (norepinephrine + dobutamine po'o epinephrine) ma mafaufau vave Veno-Arterial Extracorporeal Membrane Oxygenation (V-A ECMO) a'o le'i tupu le asystole.
3. Granulocyte Colony-Stimulating Factor (G-CSF / Filgrastim): Mataitu le faitau atoa o le toto faalua i aso taitasi. Le taimi o le sela pa'epa'e (WBC) faitau amata lona pa'u to'a (typically Day 3 to 4), amata le subcutaneous ** Filgrastim (G-CSF, 5 micrograms/kg/day)** ma tu'u le tagata ma'i i totonu o le puipuiga neutropenic fa'atasi ma vaila'au fa'ama'i fa'ama'i fa'ama'i ma tu'uina atu platelet ina ia sao mai le ponaivi aplasia nadir.
4. Aisea ua le manuia ai le fa'amama toto ma fasi meafaitino: Ona o le colchicine e vave ona ulu atu i sela ma e tele le tufaina atu (2 to 12 L/kg), hemodialysis ma le hemoperfusion e le aveese le colchicine (e ui lava CRRT e faʻaaogaina mo le faʻaleagaina o fatugaʻo ma le acidosis). Fa'ata'ita'iga colchicine-specific ovine Fab antibody fragments e matua suia ai le oona i su'esu'ega fa'afoma'i, e ui ina fa'atapula'a fa'atauga fa'apisinisi i le lalolagi atoa; fa'afeso'ota'i vave le Poison Control e siaki ai avanoa su'esu'e.

Ma'i 1B: Hellebore Sese (Veratrum album, Veratrum viride, Veratrum californicum): O le Bezold-Jarisch Bradycardia Syndrome¶

E le pei o le tuai o le oti o le Autumn Crocus, o le 'ai o le ** False Hellebore ** lau (po o le inuina o le gentian liqueur i le fale ua fa'aseseina i le Veratrum album a'a) e fa'atupu ai fa'ailoga mata'utia i totonu 30 minutes to 3 hours.

• Mechanism: Veratrum ituaiga o lo'o iai steroidal veratrum alkaloids (veratridine, protoveratrine A and B, germerine, ma jervine). O nei vaila'au e mafai ona so'oso'o i le lipid e fusifusia e tatala voltage-gated sodium (Na+) alavai i le neura vagus, carotid sinus baroreceptors, ma le left ventricular mechanoreceptors, e taofia ai le inactivation o le sodium channel. O le sasaina faifaipea o alava vagal sensory cardiac e faagaioi ai le Bezold-Jarisch reflex: e iloa e le fai'ai e matua'i fa'alolo le fatu ma tali atu e ala i le fa'aosoina tele o le parasympathetic vagal tone a'o tapuni le leo vascular alofa.
• Talosaga Fa'afoma'i: I totonu 30 to 120 minutes, o le tagata maʻi e atiaʻe le malosi o le mu i tua, puaʻi malosi, faʻalavelave ma tingling faataamilo i le gutu ma tamatamailima (paresthesia), fa'alavelave va'aia (xanthopsia), profound sinus bradycardia (heart rate 30 to 45 beats per minute), atrioventricular (AV) poloka o le fatu, ma tetele le toto maualuga (systolic BP < 60 to 70 mmHg).
• Togafitiga Fa'atatau:
• Aisa Fa'agaoioi ile fua e tasi (50 grams tautala pe afai i totonu 1 to 2 hours ma e saogalemu le ea) + antiemetics (ondansetron).
• ** Vave Fa'asuavai Bolus:** Fa'atonu 1 to 2 liters o 0.9% saline masani.
• Atropine i totonu ole toto (The Specific Physiologic Antagonist): Pulea Atropine 0.5 to 1.0 mg IV tulei uma 3 to 5 minutes(up to 3 mg total i tagata matutua; 0.02 mg/kg i tamaiti). O le atropine e poloka ai masini vagal muscarinic i luga ole sinoatrial ma atrioventricular nodes, vave faʻaliliuina le bradycardia ma le fatu poloka.
• Vasopressors for Persistent Hypotension: Talu ai o le Bezold-Jarisch reflex e mafua ai foi le aveese mai o le alofa (vasodilation peripheral) faatasi ma le bradycardia, e mafai ona tumau pea le maualalo o le toto e tusa lava pe a uma ona toe faafoi e le atropine se fatu masani; fa'aopoopo i ai se fa'alaiti ole phenylephrine, dopamine, po'o le norepinephrine mo 12 to 24 hours se'ia toe fa'aleleia atoatoa (virtually 100% of Veratrum patients recover fully within 24 to 48 hours with supportive care).

Vaega 2: Le Karoti-Aiga (Apiaceae) Fa'atusa: Water Hemlock (Cicutoxin) vs. Poison Hemlock (Coniine)¶

Le aiga botani Apiaceae (Umbelliferae) e aofia ai meaʻai suamalie (kāloti, parsnips, seleni, pasili, fennel, dill, coriander) faʻatasi ma laau e lua e sili ona mataʻutia neurotoxic i le Itulagi i Matu: Water Hemlock (Cicuta ituaiga ma Oenanthe crocata) ma ** Oona Hemlock (Conium maculatum)**. O lo'o fa'aalia uma ia fuifui fugala'au pa'epa'e, fa'aamalu (compound umbels), o a'a fa'atasi o'o'o, ma lau fa'aputu māvaevae.

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

Ma'i 2A: Suavai Hemlock (Cicuta maculata, Cicuta virosa) ma Hemlock Water Dropwort (Oenanthe crocata): Cicutoxin Tulaga Epilepticus¶

Water Hemlock o lo'o ta'ua lautele o le la'au fa'ato'aga sili ona oona i Amerika i Matu ma Europa i matu. O a'a fa'a'a'a'ai suamalie, manogi o le parsnip ma potu pito i lalo o lo'o i ai se vai mafiafia, samasama, ga'o e tele i le cicutoxin (po'o le oenanthotoxin i le Oenanthe crocata, e taatele i Peretania ma Europa i Sisifo), o se aliphatic e le tumu. C17 ava malosi polyacetylenic. E tasi le u (2 to 3 centimeters) o se a'a Water Hemlock, po'o se tamaititi o lo'o fa'aaogaina le o'o'o'o'o e fai ma fa'ama'i po'o le fa'aili, e mafai ona tu'uina atu se fa'ama'i oti.

• Mechanism: O le Cicutoxin e sopoia vave le pa puipui o le toto-fai'ai ma fusifusia e le tauva i le picrotoxin site i luga o le fatugalemu o le GABA-A receptor-ionophore complexes, e poloka atoa ai le amio o le chloride channel. A aunoa ma le fa'asaina o le GABA, e fa'aauau pea ona fa'ateteleina neu o le cortical ma le fai'ai.
• Fa'aaliga Fa'afoma'i (15 to 60 minutes): I totonu 15 minutes o le foloina o le a'a, e maua e le tagata manua le faafaufau, fa'afefe tele, tiga o le epigastric, niniva, ma fa'atetele tamaiti (mydriasis), soso'o fa'afuase'i i le fa'asa, fa'atupu fa'atupu fa'ama'i fa'ama'i fa'atosina (status epilepticus). E matua malosi le tete'e e masani ona mafatia ai tagata mama'i i le motusia o laulaufaiva, opisthotonos, gau compression vertebral, soona ** hyperthermia (> 41 degrees Celsius)**, tele rhabdomyolysis (creatine kinase > 50,000 U/L), tuga maualuga-anion-gap lactic acidosis (pH < 6.9), myoglobinuric renal failure, ma le hypoxic cardiac arrest.
• ** Pulea Falema'i Fa'afuase'i:**
• ** Fa'atonuina le Va'alele ma le GABA-Agonist Seizure Control:** Aua le fa'amaimauina le taimi i le phenytoin (ineffective against GABA-A blockade). Tu'u i totonu o le toto benzodiazepines (lorazepam 4 mg IV pe diazepam 10 mg IV), fa'ateleina vave ile tui phenobarbital (15 to 20 mg/kg) po'o le fa'asolosolo fa'avavevave fa'atasi ma le fa'aauau pea o le propofol po'o le midazolam.
• Neuromuscular Blockade ma Active Cooling for Rhabdomyolysis: Afai e tumau pea le malosi o muscular ma le hyperthermia e ui lava ina loloto le GABA-agonist sedation, fa'atonu se le-depolarizing neuromuscular blocker (rocuronium pe vecuronium; aloese mai le succinylcholine ona o le lamatiaga o le hyperkalemia) i lalo o le mata'ituina pea o le EEG e taofi vave ai le fa'atupuina o le vevela o maso ma le myoglobin.
• Aggressive Sodium Bicarbonate and Fluid Diuresis: Infuse isotropic intravenous crystalloids ma ** intravenous sodium bicarbonate** e faasa'o ai metabolic acidosis matuia ma fa'alili le mimi (target urine pH > 6.5), puipuia le fa'auluina o le myoglobin i totonu o tubules fatugao. Fa'atino vave le hemodialysis pe a tupu le hyperkalemia refractory, acidosis, po'o le anuric renal failure.

Fa'a'ai 2B: Poison Hemlock (Conium maculatum): Coniine Ascending Respiratory Paralysis¶

** Oona Hemlock (Conium maculatum)**, ta'uta'ua i tala fa'asolopito o le fa'ama'i oona a le faifilosofia o Socrates i 399 BCE, o lo'o i ai le valu piperidine alkaloids, e sili le coniine ma le gamma-coniceine. Talu ai ona o lona lacy, pei o le fern e foliga foliga tutusa ma lau pasili, chervil, poʻo le lau o karoti vao (ma o lona aʻa paʻepaʻe e pei o le parsnip), e masani ona 'ai e le au faimalaga ma le au fai togalaau ile mea sese.

• Mechanism (Biphasic Nicotinic Blockade): O le Coniine e iai lona fausaga fa'ama'i ma gaioiga fa'afoma'i e tutusa lelei ma le nikotine ma le curare. E galue i ni vaega eseese se lua i ganglia autonomic ma le ** skeletal muscle neuromuscular junction (nicotinic acetylcholine receptors [nAChR])**:
• Vaega 1 (Amataina le Nicotinic Stimulation, 15 to 60 minutes): O lagona mu i le gutu ma le fa'a'i, tele fa'avauvau, faufau, pua'i, manava manava, tachycardia, toto maualuga, fa'ateteleina tamaiti, ma maso ma'ale'ale/tetetete.
• Vaega 2 (Fa'ato'a/E le'o fa'apalapala le Neuromuscular Blockade, 1 to 4 hours): O le fusifusiga faifaipea e fa'avaivaia ma poloka ai le nicotinic acetylcholine receptors i le afi fa'ai'u, fa'atupuina ai se ma'i pipili masani a'e pei o le curare e pei o le pipili.
• ** O le "Socrates Sign" (Ascending Paralysis with Clear Consciousness):** O le supa e amata i vae ma vae (e mafua ai ona tautevateva ataxia ma le mafai ona tu), alu aʻe ma le mausali i luga o ogavae, ogalaau, ma lima, ma iu ai ina pe le ** maso intercostal ma diaphragm **, aʻo ** faʻasaoina le fatugalemu o le tino ** Se'ia o'o ina oso mai le hypoxia ogaoga mai le manava, o le tagata ma'i e tumau pea le ala, malamalama, ma fefe, le mafai ona gaioi pe manava. Coniine e mafai foi ona mafua ai le rhabdomyolysis tuusaʻo ma le necrosis tubular acute.
• ** Pulea Falema'i Fa'afuase'i:**
• Ave Endotracheal Intubation ma Mechanical Ventilation (The Definitive Cure): E leai se vailaʻau faʻamaʻi mo coniine (ma ** anticholinesterases pei o neostigmine poʻo physostigmine e le tatau ona tuʻuina**, aua e mafai ona faʻateteleina le faʻaleagaina o le nicotinic poloka ma faʻatupu ai le faʻalavelave cholinergic). Nai lo lena, o le ea fa'ainisinia e 100% fa'aola ola. Tu'u vave le tagata ma'i i le taimi lava e fa'avaivaia ai le malosi o le manava fa'amalosi po'o le malosi o le manava (avoid succinylcholine), tu'u le fa'ama'i talafeagai (propofol/midazolam o le mea lea e le ala ai le tagata ma'i ma'i ma'i ma'i matala i luga o le ventilator), fa'atonu le ** malala fa'agaoioi** e ala i le fa'aau fau nasogastric, ma fa'alili mo 24 to 72 hours. O le taimi lava e fa'afefeteina ai le ate ma mama ma fa'ate'a le coniine, e toe fa'afo'i atoatoa le malosi o le neuromuscular e aunoa ma se fa'aletonu tumau.

Fa'aitulagi fa'alavelave fa'afuase'i ma fa'atonuga fa'atonutonuina oona¶

• United States ma Kanata: Valaau loa 911 ma vili le 1-800-222-1222 (Fesoasoani US Poison) po'o le 1-844-POISON-X (1-844-764-7669 i Kanata). I Amerika i Matu, Water Hemlock (Cicuta maculata ma Cicuta douglasii), Oona Hemlock (Conium maculatum), ma le False Hellebore / Corn Lily (Veratrum viride ma Veratrum californicum) ua salalau solo i eleele taufusi, vao mauga, ma autafa o auala; Fa'aitulagi Poison Centers tausia 24/7 fa'akomepiuta su'esu'ega feso'ota'iga fa'atasi ai ma le fa'atalanoaina o toxicologists ma botanists e fa'ailoa mai ata fa'ata'ita'iga o la'au na lafo mai potu fa'alavelave.
• United Kingdom ma Europa Iuni: Valaau 999 (UK) poʻo 112 (EU). I le isi itu o Siamani, Ausetalia, Suitiselani, Farani, Italia, Slovenia, ma Peretania, e tupu ai le fenumiai i le va o Bärlauch / Ramsons (Allium ursinum) ma Herbstzeitlose (Colchicum autumnale) po o Weißer Germer (Veratrum album) e mafua ai le tele o le ulufale ma maliu ile ICU ia Aperila ma Me. I Peretania ma le talafatai i sisifo o Europa, Hemlock Water Dropwort (Oenanthe crocata, "Tama'ilima o le Tagata Maliu") o fugala'au e fufulu i auvai ma matafaga e mafua ai le vave o le oenanthotoxin status epilepticus e tutusa ma le Cicuta. E tatau i foma'i ona fa'afeso'ota'i le NPIS / TOXBASE (UK) po'o nofoaga o'ona a le atunu'u a le EU (Giftnotruf / Tox Info Suisse / CAPTV) vave.
• Ausetalia ma Niu Sila: Valaau 000 (Ausetalia) po o 111 (Niu Sila), ma faafesootai le Poisons Information Center (13 11 26 i Ausetalia; 0800 764 766 i Niu Sila). Fa'ailoa mai ** Poison Hemlock (Conium maculatum)** ma mea teuteu Gloriosa Lily (Gloriosa superba, mauoa i le colchicine) o mafua'aga taua ia o le 'ona o la'au i atunu'u uma e lua.
• Asia ma Itulagi Teropika: I Initia, Sri Lanka, ma Asia i Sautesasae, fatu o le Flame Lily / Glory Lily (Gloriosa superba) ose mafua'aga tele o le tele o le colchicine poisoning (fa'afuase'i ma le fa'amoemoeina), fa'afoeina i le Multi-Dose Activated Charcoal, ICU hemodynamic, ma le G-CSF protocol na fa'aogaina mo le Colchicum autumnale.

Fesili e fai soo¶

E fa'afefea ona fenumia'i e tagata le Autumn Crocus po'o le Hellebore Sese ma le Garlic Wild e mafai ona 'aina?¶

I le amataga o le tautotogo a'o le'i totogo mai fugala'au, e mafai ona 'aina e le Garlic Wild (Allium ursinum) ma Ramps (Allium tricoccum) la'au lapopoa, lanumeamata, pei o le tao i eleele susu o le vaomatua i tafatafa tonu o laulaau lanumeamata o le Autumn Crocus (Colchicum autumnale) ma False Hellebore (Veratrum album po o viride). A pu'e e se tagata sua ni laulaau vao vao i le taimi e tasi, e faigofie ona latou tauina se laulaau Autumn Crocus po o False Hellebore o loo ola i le ogatotonu o le fasiga, ma talu ai ua uma ona ufiufi o latou lima i le suauu kalaka, o lau oona e leai se manogi e foliga mai e manogi foi e pei o le kaliki.

E fa'afefea ona iloa e se foma'i pe 'ai e se kalaka vao ma'i le Autumn Crocus po'o False Hellebore?¶

O le taimi ma le tātā o le fatu e tuueseese vave ai ia mea e lua: False Hellebore (Veratrum) e saosaoa i totonu o le 30 minute i le 3 itula, e mafua ai le pua'i malosi e fetaui ma le telegese o le fatu (sinus bradycardia ogaoga i lalo ole 45 bpm) ma le maualalo o le toto e vave liliu i le atropine intravenous. Autumn Crocus (colchicine) e 2 i le 24 itula le tuai o le fa'asesega a'o le'i fa'atupu le ma'i tachycardia pei o le kolera ma le saoasaoa o le fatu (tachycardia), fa'asolosolo i luga o Aso 2 i le 7 i le fa'ate'ia cardiogenic mata'utia ma le ga'o o ponaivi.

O le a le eseesega i le va o le Water Hemlock (Cicuta) ma le Poison Hemlock (Conium)?¶

E ui lava o tagata uma e lua o le aiga kāloti e iai fugalaau faamalu paʻepaʻe ma oʻaʻaʻa, latou te osofaʻia le neura i auala faʻafeagai. Water Hemlock (Cicuta species) e tupu a'e i vao susu, ei ai a'a oozing samasama suau'u, ma o lo'o i ai le cicutoxin, lea e poloka ai le fai'ai GABA-A receptors e mafua ai le pa, fa'aauau tulaga epilepticus faoa i totonu ole 15 i le 60 minute. Oona Hemlock (Conium maculatum) e ola i luga o le eleele matutu, e iai ona ogalaau lanu viole, ma o loʻo i ai le coniine, lea e poloka ai musele pito i totonu e mafua ai le oso aʻe o le manava faʻafefe aʻo nofo le tagata maʻi.

Aisea e taua tele ai le vave Multi-Dose Activated Charcoal pe a 'ai se tasi i le Autumn Crocus?¶

O le taimi lava e ulu atu ai le colchicine i maso o le fatu ma sela o ga'o ponaivi ma loka i luga o le tubulin intracellular, e le mafai e le hemodialysis ona aveese ma e leai se vaifofo masani e maua lautele. Ae ui i lea, o le colchicine o loʻo faʻaauau pea ona natia e le ate i totonu o le gaʻo ma toe faʻafoʻi i totonu o le tootoo laiti; tu'uina atu o tui fa'asolosolo o le malala Fa'agaoioi i le ta'i 4 i le 6 itula e maileia ai le colchicine i le gut lumen, fa'alavelaveina le toe fa'aaogaina o le biliary, ma e mafai ona taofia ai se fa'alavelave mata'utia o le Laasaga 2 o le pu'eina o le fatu.

E mafai ona ola se tasi i le Poison Hemlock (Conium maculatum) pe a taofi lana manava?¶

Ioe, faatasi ai ma le tausiga faʻafuaseʻi faʻaonaponei, o le ola mai le Poison Hemlock e toetoe lava 100% pe afai e amata le manava laveai ma le faʻaogaina o le falemaʻi aʻo leʻi tupu le faʻaleagaina o le faiʻai hypoxic. Talu ai ona o le coniine e le faʻaleagaina tumau le faiʻai poʻo neura, o le tuʻuina o le tagata maʻi i luga o se masini faʻamalo ma le faʻamaʻi mo le 24 i le 72 itula e mafai ai e le tino ona faʻaogaina ma faʻamalo le toxin seia toe foʻi mai le malosi atoa.

O le fa'apuna pe kukaina o meamata vao e fa'aumatia ai mea oona i le Autumn Crocus po'o le Hemlock?¶

Leai, o le kuka, faapuna, falai, pe fa'agogo e le fa'aumatia ai le colchicine, veratrum alkaloids, po'o le cicutoxin. O le mea moni, o le faapunaina o lau o le Autumn Crocus poʻo le False Hellebore i le supa poʻo le vai pasta e aveese saʻo ai vailaʻau faʻafefe vai i totonu o le vai kuka, faʻaona ai soʻo se tasi e taumafaina le susu.

Ina ia nofo saogalemu i taimi o tafaoga i fafo ma faʻalavelave faʻafuaseʻi i le vao, mafaufau e ave se fesoasoani muamua ma le CPR mai le Koluse Mumu, St John Ambulance, poʻo se tausi vailaʻau faʻamaonia.

Taiala fa'atatau¶

• Fa'a'aiga Mushroom Vao (Amatoxin) ma La'au 'Oona
• Tulaga Epilepticus, Faoa Fa'aumi, ma Vailaau Laveai
• CPR: La'asaga ta'i La'asaga Fa'aola Fa'asa'o
• Oona o Mea'ai, Ma'i Gastroenteritis, ma le Fa'agata
• Oona Lautele Fesoasoani Muamua ma le Fa'amama

Punavai ma ta'iala aloa'ia¶

• U.S. Nofoaga Autu mo le Pulea ma le Puipuia o Fa'ama'i (CDC): Lipoti o Vaiaso Ta'itasi o Manu'a ma Maliu Mai Ai (MMWR): Water Hemlock (Cicuta maculata), Poison Hemlock (Conium maculatum), ma False Hellebore (Veratrum viride) Poisonings Associated with Foraging (United States).
• German Federal Institute for Risk Assessment (BfR) & Swiss Toxicological Information Center (Tox Info Suisse): Consumer Warning and Clinical Guidance on Confusing Wild Garlic (Allium ursinum) with Autumn Crocus (Colchicum autumnale) and White Hellebore (Veratrum album) (European Union and Switzerland).
• ** UK National Poisons Information Service (NPIS) / TOXBASE:** Clinical Management of Colchicum autumnale (Colchicine), Oenanthe crocata (Hemlock Water Dropwort), and Conium maculatum Ingestion (United Kingdom).
• Finkelstein Y, Aks SE, Hutson JR, Juurlink DN, et al.: * Colchicine poisoning: o le itu pogisa o se vailaau anamua * (Clinical Toxicology).
• Schep LJ, Slaughter RJ, Becket G, Beasley DM: Oona ona o vai hemlock (Cicuta species) ma poison hemlock (Conium maculatum) (Clinical Toxicology / New Zealand National Poisons Centre).