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Colchicine Overdose uye Gloriosa Lily Poisoning: Sei Kutora Mapiritsi Ekuwedzera Gout kune Flare Inouraya

Nhamba dze emergency dzinosiyana nenyika. Iri peji rinoshandisa 911, nhamba yeUnited States neCanada. Dzimwe nyika dzakawanda dzinoshandisa 112, 999, kana imwe nhamba. Tsvaga nhamba yenyika yako.

Colchicine (Colcrys, Mitigare, Gloperba) - zana remakore rekare rinopesana nekuputika alkaloid yakarongedzerwa kune acute gout flares, mhuri yeMediterranean fever (FMF), uye pericarditis - ine imwe yemahwindo akamanikana, asingakanganwiri ekurapa mumishonga yese yekiriniki. Kusiyana neibuprofen kana acetaminophen, apo murwere angafungidzira zvisiri izvo kuti anogona kutora mamwe ane chitsama chemapiritsi kana kurwadziwa nezvigunwe zvikuru zvegout kuchitadza kuvandudzwa, **kungomedza 10 kusvika 20 mahwendefa e0.6-milligram colchicine (6 kusvika 12 milligrams, kana kupfuura 0.15 mamirigiramu anorwisa mabhakitiriya pazuva) senge clarithromycin - inokonzeresa inotyisa, biphasic multi-organ chepfu isina inowanika yakawanda yekutengeserana antidote **. Muchetura unouraya wakafanana unoitika kana maforoji kana vana vachidya machubhu, mababu, kana mashizha e Flame Lily (Gloriosa superba) ** kana ** Autumn Crocus (Colchicum autumnale), kana kuti yakanangidzirwa podophyllin (podofilox) topical wart resin inomedzwa kana kuiswa panzvimbo dzakafara dzeganda. Kana paine munhu akatora anopfuura mapiritsi matatu akatarwa (1.8 mg) ecolchicine mumaawa makumi maviri nemana, kana akadya zvirimwa zve Colchicum kana Gloriosa, fonera nhamba dze emergency nekukasira - **kunyangwe vachinzwa zvakanaka kwemaawa akati wandei ekutanga **. Nezve toxicological uye hematological emergency, bvunza howa hwemusango kutsvaga kudya uye kudyiwa kwechirimwa chine chepfu, neutropenic fever uye bone marrow kudzvinyirirwa,uye chepfu yechikafu, acute gastroenteritis, uye kupera mvura mumuviri.

Colchicine poisoning ndeyekare ** "yakanyarara nguva-bhomba" muchetura ** yakafanana neatoxin Death Cap howa uye paraquat: mushure mekunyengedza kwemaawa maviri kusvika ku12-awa pasina zviratidzo kunonoka, Chikamu chekutanga chinorova nekuputika, korera-kufanana neropa remanyoka uye hypovolemic shock, inoteverwa nemaawa ** * 24 kusvika 7 kuvhunduka, inoteverwa neawa * 24 kusvika ku7. kutadza kufema zvakanaka (ARDS), kukundikana kwechiropa/itsvo, uye aplasia yemwongo yakakwana (zero white blood cells and platelets)**.

Ita izvi ikozvino

  1. Fonera nhamba yako yekukurumidzira yekwaunogara uye Kudzora Chepfu PAMBERI kana paine akamedza anopfuura mapiritsi matatu ecolchicine (1.8 mg) pazuva, kana CHERO chiyero cheAutumn Crocus / Gloriosa Lily. Dhonza 911 muUnited States neCanada (US Poison Control 1-800-222-1222 1212 1229, European Union yose muEuropean Union), 000 muAustralia (Ruzivo rweChepfu 13 11 26), kana bvunza dhairekitori redu re nhamba dze emergency. **Usambofa wakamirira kurwadziwa nemudumbu kana kurutsa kunotanga **; kana colchicine yangotora kubva muura uye ichisunga mukati memasero emuviri, haigone kubviswa muropa.
  2. Kumhanyira kudhipatimendi rekukurumidzira mukati mekutanga 1 kusvika 2 maawa kune emergency Activated Charcoal (Multidose Activated Charcoal). Nokuti colchicine inopinda zvakanyanya enterohepatic recirculation (chiropa chinobudisa colchicine mu bile, iyo inodzokera mumatumbo maduku kuti idzoke zvakare zvakare), kunwa chipatara **activated charcoal kakawanda maawa maviri kusvika ku4 ** inoteya colchicine mumararamiro emvura uye inosvika pamapfupa emudumbu uye inosvika pamwoyo. mwongo.
  3. ** REGA kunwa colchicine nekukasira kana ukanyorerwa CHESE macrolide antibiotic (clarithromycin kana erythromycin), antifungal (itraconazole, ketoconazole), mushonga wemoyo (verapamil, diltiazem), kana cyclosporine - kana wanwa muto wegrapefruit.** Mishonga iyi inovhara CYP3A4 enzyme uye P-glycoprotein efflux pombi inojekesa colchicine, ichishandura yakajairwa 2-piritsi gout dosi kuita inouraya kakapetwa kagumi mukati.
  4. Kana Phase 1 kurutsa kwakanyanya uye manyoka ane mvura/aneropa atotanga, tanga kutsiva mvura ine hasha uchimirira amburenzi - uye USAMBOPA mishonga inorwisa manyoka (loperamide / Imodium). Colchicine inoremadza kupatsanurwa kwesero muchikamu chemukati, zvichiita kuti marita eplasma uye electrolyte abude muura (cholera-like gastroenteritis) Kupa loperamide kana bismuth subsalicylate kunoteya iyo isina kubvorwa colchicine mukati mehura saka huturu huzhinji hunopinda muropa.
  5. Kana podophyllin (podofilox) wart liquid yakadirwa netsaona panzvimbo hombe dzeganda kana mucous membranes, geza ganda nekukurumidza nesipo nemvura inoyerera. Concentrated podophyllin resin inotora nekukurumidza kuburikidza neganda rakasimba kana rakaputika uye rinokonzera zvakafanana mitotic-spindle poisoning, coma, peripheral marrowopathy, uye bone marrowopathy.
  6. *Unza nebhodhoro repiritsi recolchicine (kuitira kuti vanachiremba vaverenge mapiritsi asipo voverenga chaizvo mg/kg dose) kana pikicha/sample yegirobhu kana ruva rinenge ramedzwa. Kuziva kana murwere akamwisa < 0.5 mg/kg, 0.5 to 0.8 mg/kg, kana > 0.8 mg/kg pakarepo anoudza timu yevanorwara zvakanyanya mamiriro ehupenyu hwemurwere chaiwo uye zvinodiwa neICU.

Sei kutora mamwe mapiritsi ecolchicine kana gout flare ichiri kurwadza iko kukanganisa kunouraya

Kusvikira muna 2009, mabhuku ezvokurapa echinyakare aidzidzisa chirongwa chekare chegout ("tora piritsi rimwe recolchicine awa imwe neimwe kusvika kurwadziwa kwegout kwamira kana kusvika waita manyoka nekurutsa"). Miedzo yakakura yekiriniki (the AGREE trial) yakaratidza kuti ** kutora mapiritsi anopfuura 3 akazara (mapiritsi maviri e0.6-mg ikozvino, achiteverwa neRIMWE 0.6-mg piritsi 1 awa gare gare = 1.8 mg yose) inopa ZERO yekuwedzera kurwadziwa kwegout, uku ichisundira murwere zvakananga mune inogona kuuraya colchicine poisoning **. Kana uchinge watora piritsi rako rechipiri (piritsi rimwe paawa-1 chiratidzo), haufanirwe **USAtora rimwe piritsi recolchicine kwemazuva matatu **.

Muti wesarudzo: colchicine, Gloriosa lily, uye podophyllin chepfu triage

flowchart TD
    A["Inofungidzirwa Colchicine Overdose, Gloriosa Lily / Autumn Crocus Ingestion, kana Podophyllin Exposure"] --> B{"Verenga kumedzwa Colchicine dose (mu mg/kg yehuremu hwemuviri) kana tarisa Kudyidzana Kwezvinodhaka"}
    B -->|"Normal gout dose + Clarithromycin / Verapamil / Cyclosporine + itsva manyoka / kurutsa"| C["IATROGENIC COLCHICINE TOXICITY: Misa zvese zvinodhaka uye enda kuER nekukurumidza"]
    B -->|"Acute overdose <0.5 mg/kg (semuenzaniso, 7 kusvika 30 mg mumunhu mukuru ane 70-kg)"| D["HURU RISK: Pakarepo EMS yekufambisa yeGastric Lavage (kana <1 hr) + Multidose Activated Charcoal"]
    B -->|"Acute overdose 0.5 kusvika 0.8 mg/kg (35 kusvika 56 mg mu70-kg mukuru)"| E["HAKAKOSHA HUPENYU HUNHU HUNOTYISA UTOXI: Tarisira yakanyanya GI kuvhunduka + Bone Marrow Aplasia (10% kusvika 50% kufa)"]
    B -->|"Acute overdose> 0.8 mg/kg (> 56 mg mu70-kg mukuru) kana Gloriosa tuber yose"| F["FULMINANT LETHAL DOSE (Inosvika 80% kusvika 100% kufa): Pakarepo ICU / ECMO Transfer"]
    C --> G["Chikamu 1 (Maawa 2 kusvika ku24): Aggressive IV Crystalloid Resuscitation yeCholera-Senge GI Fluid Loss"]
    D --> G
    E --> G
    F --> G
    G --> H["Chikamu 2 (Mazuva 1 kusvika ku7): ICU Cardiac Support (Norepinephrine/VA-ECMO) + G-CSF (Filgrastim) yeNeutropenia"]

Ko colchicine uye podophyllin inouraya sei maseru: kuvhara iyo mitotic spindle

Kuti unzwisise kuti sei colchicine chepfu ichitaridzika senge chepfu yechikafu chakanyanya, uye senge hosha yemoyo, uye mazuva mashanu gare gare senge acute radiation chirwere kana leukemia chemotherapy toxicity, tarisa kuti morekuru inoshanda sei mukati mesero remunhu wese.

Microtubule depolymerization uye kusungwa kwesero division mune metaphase

Sero rega rega ripenyu riri mumuviri wemunhu rine skeleton yemukati uye nzira huru yakagadzirwa nehollow protein tubes inonzi microtubules, yakaunganidzwa kubva mumatombo ekuvaka anonzi **alpha-tubulin uye beta-tubulin dimers **. Microtubules anoita mabasa maviri akakosha:

  1. ** Iyo Mitotic Spindle panguva yekuparadzaniswa kwesero (mitosis):** Pose panopatsanuka stem cell muura hwako, mwongo, kana kuti mvere dzotsiva masero ekare, tumatambo tuduku tuduku (mitotic spindle) tunodhonza makromosome akadhindwa achiparadzana kuva vanasikana vaviri vatsva.
  2. Intracellular transport uye myocardial contractility mukati memasero asina kupatsanura: Mukati memwoyo mhasuru masero (cardiomyocytes), maaxon etsinga, uye masero echiropa, mamicrotubules anoita semabhandi ekutakura anotakura mitochondria, nzira dzecalcium, uye neurotransmitter vesicles mhiri yesero.

** Colchicine ** (pamwe ne ** podophyllotoxin ** kubva kuMayapple chirimwa / wart resin, uye vinca alkaloids inoshandiswa mukenza chemotherapy) inosunga nepedyo-isingadzokeki hukama kune inonyungudika beta-tubulin dimers, ichivharira magumo ekukura kweiyo microtubule kuti iburitse nekunyunguduka (**microtubule dereta).

  • ** Mukukurumidza kupatsanura matishu (Gut mucosa uye Bone marrow): ** Sero rega rega rinopatsanura stem rinomira zvachose pakati pesero kupatsanurwa (**metaphase kusungwa ) uye inofa yakarongwa sero.apoptosis) Nekuti maseru anonamira ura hwako hudiki anozvitsiva ega ega ega ega 24 kusvika 48 maawa, iyo yese intestinal lining inodzima paZuva 1 ( Phase 1 korera senge manyoka ). Nekuti masero machena eropa uye maplatelet ari mumwongo wako anozvitsiva iwo ega ega 3 kusvika 5 mazuva, yako yese immune system uye yeropa- clotting system inonyangarika paMazuva 3 kusvika 7 ( Phase 2 pancytopenia uye sepsis **).
  • Mumoyo tsandanyama uye masero etsinga: Kunyungudutsa microtubule network mukati memoyo tsandanyama masero kunokanganisa sarcoplasmic calcium kubata uye mitochondrial simba kutakura, zvichikonzera yakananga myocardial inoshamisa, refractory cardiogenic shock, heart block yakakwana, uye kamwe kamwe asystole pa24 kumaawa 72.

Chikonzero nei hemodialysis uye hemoperfusion HAIKONI kubvisa colchicine kubva mumuviri

Kusiyana necaffeine, lithium, kana salicylates (aspirin), iyo inoramba yakanyunguduka muplasma yemvura yeropa umo muchina wedialysis unokwanisa kuasefa, inotorwa colchicine inomhanya ichibuda muropa mukati meawa 1 kusvika ku3 uye inovharira zvakasimba pamapuroteni etubulin ** mukati memukati memuviri wakasimba , zvichigadzira kugovera kukuru ( ** kuwanda kwehuwandu.Vd = 2 to 12 L/kg, kusvika ku21 L/kg mukuwedzeredza). Nokuti pasi pe1 kusvika ku2 muzana ye colchicine yemuviri inoramba ichiyangarara muropa, ** hemodialysis, hemofiltration, uye charcoal hemoperfusion hazvibatsiri zvachose pakubvisa colchicine ** (kunyange dialysis ichiri kushandiswa kutsigira varwere vane itsvo dzinokundikana muChikamu 2). Ichi ndicho chikonzero **kutanga kusvibiswa kwematumbo neMultidose Activated Charcoal ** pamberi uye panguva yekudzokorodza enterohepatic kwakakosha.

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

Mukiriniki toxicology (yakatangwa neBismuth, Baud, uye vaaishanda navo kuParis Poison Control Center), kupona kwemurwere mushure mekunyanya kuwandisa kwecolchicine kunofanotaurwa nekukasira kunotyisa nekuverenga milligram yekumedza yakakamurwa nehuremu hwemurwere mumakirogiramu.mg/kg):

Ingested Colchicine Dose (mg/kg) Yakaenzana 0.6-mg Mahwendefa mune 70-kg (154-lb) Mukuru Clinical Course & Zvinotarisirwa Matambudziko Historical Mortality Rate
** isingasviki 0.5 mg/kg** Pasi pe35 mg (inenge 8 kusvika ku55 mapiritsi, kunyangwe kufa kwakataurwa pamadosi akaderera se 7 kusvika 12 mg [12 kusvika kumapiritsi makumi maviri] muvarwere vakura/renal kana kusangana kwezvinodhaka) Kurutsa kwakakomba Phase 1, manyoka ane mvura zhinji, kupera simba kwemvura, kuderera-kusvika-zvine mwero kudonha kwemasero machena eropa / maplatelet, uye kupera kwebvudzi kunonoka.alopecia) ** Yakaderera (0% kusvika 5%)** nekukurumidza kuchipatara IV mvura uye Multidose Activated Charcoal
0.5 kusvika 0.8 mg/kg 35 mg kusvika 56 mg (58 kusvika 93 mapiritsi) Severe Phase 1 hypovolemic shock, inoteverwa paMazuva 2 kusvika ku7 ne yakadzika bone marrow aplasia (agranulocytosis uye yakanyanya thrombocytopenia), coagulopathy, sepsis, uye kusashanda zvakanaka kwenhengo dzakawanda. **10% kusvika 50% kufa ** (inoda kutarisirwa kwakanyanya, G-CSF bone marrow kukurudzira, uye yakakura-spectrum antibiotics)
Kupfuura 0.8 mg/kg Kupfuura 56 mg (94+ mapiritsi, kana kudya kamwe chete Gloriosa superba tuber) Fulminant Phase 1 fluid kurasikirwa shanduko mukati me **24 kusvika 72 maawa kupinda isingachinjiki cardiogenic shock, refractory arrhythmias, ARDS, DIC, uye kusungwa kwemoyo ** **80% kusvika 100% kufa ** pasina kutanga Multidose Activated Charcoal uye mechanical circulatory support (VA-ECMO)

Iwo matatu akasiyana ekiriniki zvikamu zveColchicine uye Gloriosa Lily chepfu

Colchicine chepfu inofamba nemuzvikamu zvitatu zvakatevedzana zvekiriniki kwemazuva gumi kusvika gumi nemana:

Chikamu chekutanga: Iyo Gastrointestinal & Hypovolemic Phase (Maawa 2 kusvika 24 mushure mekudya)

  • Iyo inonyengera 2-to-12-hour latent window: Kwemaawa maviri kusvika matanhatu ekutanga mushure mekumedza kuwandisa kwemapiritsi ecolchicine kana kudya magirobhu eGloriosa / Colchicum akabikwa, murwere anonzwa zvakakwana (kunze kwekutsva apo neapo mumuromo nepahuro nemuriwo wakabikwa). Usanyengerwa kugara pamba panguva yakanyarara iyi.
  • ** Inoputika "Cholera-Se" Gastroenteritis (Maawa 6 kusvika 24):** Sezvo intestinal crypt mitosis inomira uye mucosal masero anoderera, murwere anotanga kuita zvechisimba, kusingagoneki kusvotwa, kurutsa, kurwadza kupararira mazamu emudumbu, uye ** yakakura, inoenderera, mvura ine mvura* uye ine ropa.
  • Hypovolemic Shock and Electrolyte Collapse: Kurasika kwemvura muura kunogona kudarika 5 kusvika ku10 litres (1.3 kusvika 2.6 magaloni) mumaawa makumi maviri nemana, zvichikonzera kuvhunduka kwakanyanya, prerenal acute itsvo kukuvara, metabolic lactic acidosis, hypokalemia, hyponatremia, hyponatremia uye hypocalcicociemia yepakutanga**, hypokalemia, hypokalemia, hypocalosis, hypocalcemia, hypokalemia, hypokalemia spike mumasero machena eropa kuverenga pamusoro pe20,000/mcL mwongo usati waputsika).

Chikamu Chechipiri: Iyo Multi-Organ Failure, Cardiogenic Shock, uye Bone Marrow Aplasia Phase (Mazuva 1 kusvika 7)

Sezvinongoita kurutsa uye manyoka zvichiratidzika kunonoka kusvika paAwa 24 kusvika 36, murwere anopinda muchikamu chechipiri chinouraya:

  1. Refractory Cardiogenic Shock uye Arrhythmias (Maawa 24 kusvika 72 - Chekutanga Chikonzero cheRufu):
  2. Kuparadza kwakananga tubulin mukati memoyo myocytes kunokonzera biventricular heart failure (left ventricular ejection fraction dropping below 15% to 20%), hypotension yakadzika inomira kupindura kune IV mvura uye vasopressors, sinus bradycardia, yakakwana atrioventricular heart block, ventricular tachycardia, uye kamwe kamwe ** asystolic cardiac arrest **.
  3. ** Yakazara Bone Marrow Aplasia / Pancytopenia (Mazuva 3 kusvika 7):**
  4. Pakati peZuva 3 neZuva rechinomwe, nhamba yemurwere yakakwana neutrophil inodonha yakananga zero (agranulocytosis) uye maplatelet anodonha pasi pe10,000 kusvika 20,000/mcL (severe thrombocytopenia)
  5. Nekuti iyo intestinal lining yakarasa chipingamupinyi chayo kurwisa mabhakitiriya emudumbu panguva imwecheteyo muviri uine zero masero machena eropa, Gram-negative bacteria (E. coli, Klebsiella, Pseudomonas) inodurura zvakananga kubva mudumbu kupinda muropa, zvichiita fulminant neutropenic septic shock uye Disseminated Intravascular Coagulation (DIC).
  6. Acute Respiratory Distress Syndrome (ARDS), Rhabdomyolysis, uye Ascending Paralysis:
  7. Capillary inodonha mumapapu inokonzera isiri-cardiogenic pulmonary edema (ARDS) inoda mechanical ventilation.
  8. Yakananga skeletal tsandanyama uye axonal microtubule kukuvara kunokonzera yakanyanya myoneuropathy (proximal tsandanyama kushaya simba kutevedzera Guillain-Barré syndrome, yakakwirira creatine kinase rhabdomyolysis, uye kurasikirwa nemafungiro), pamwe chete nekukuvara kwakanyanya kwechiropa, pancreatitis, uye paralytic ileus.

Chikamu 3: The Recovery & Total Alopecia Phase (Zuva 7 kusvika Vhiki 3+)

Kana murwere akapona padambudziko remoyo uye septic reChikamu 2 muICU:

  • Rebound Leukocytosis: Bone marrow stem cells anotangazve kupatsanurana kutenderera Zuva rechinomwe kusvika 10, zvichiita kuti masero machena eropa adzoke zvakanyanya.
  • ** Yakazara, inoshamisa kurasikirwa kwebvudzi (Total Alopecia):** Around Day 7 to 14, nekuti hair-follicle matrix masero anopatsanurwa nekukurumidza sezvakangoita varwere vechemotherapy, ** zvese zvemusoro, tsiye, uye vhudzi remuviri zvinowira kunze mu clumps ** (inozopedzisira yakura zvachose kupfuura 3 kusvika 6 mwedzi). Neuromyopathy kushaya simba kunogona kutora mavhiki kana mwedzi yekugadziriswa kwemuviri kugadzirisa.

Lethal Drug Interactions: Sei yakajairika 2-piritsi gout dose inova inouraya overdose

Inopfuura **hafu yezvese zvinouraya zvakanyorerwa colchicine chepfu muzvipatara hazvibvi kubva kune nemaune mapiritsi overdose **; zvinoitika kune varwere vanotora mapiritsi avo e-0.6-mg colchicine avo panguva imwe chete vanopiwa mishonga inorwisa mabhakitiriya kana mapiritsi emwoyo, kana vane chirwere chisingaperi cheitsvo kana chiropa.

The CYP3A4 uye P-glycoprotein (P-gp) clearance trap

Kazhinji, masero emunhu anozvidzivirira kubva kucolchicine achishandisa mapombi maviri ehupenyu:

  1. ** P-glycoprotein (P-gp / ABCB1):** Iyo inoshanda serol efflux pombi pamusoro pemasero emudumbu, chiropa chebiliary canaliculi, uye tubules tweitsvo **inobuditsa colchicine kubva mumaseru ichienda pachituru uye weti **.
  2. Cytochrome P450 3A4 (CYP3A4): Enzayemu yechiropa inobvisa methylate uye kuita kuti colchicine isashande.
Kudyidzana Mushonga kana Mamiriro Mechanism of Interaction Clinical Result & Mandatory Safety Rule
** Clarithromycin (Biaxin), Erythromycin, Telithromycin** (Macrolide antibiotics ye sinus/chest infections) ** Kudzivirirwa kwakasimba kweZVIVIRI P-glycoprotein UYE CYP3A4** Inowedzera ropa nematishu colchicine mwero ne250% kusvika 400%+. Mazana ekufa kwakanyorwa kwakaitika mukati memazuva 3 kusvika ku7 kubva pakunyorera clarithromycin kune gout kana FMF murwere pacolchicine. ** NEVER kusanganisa; shandisa azithromycin kana imwe kirasi yemishonga inorwisa mabhakitiriya.**
** Cyclosporine (Neoral, Sandimmune), Tacrolimus** (Transplant / autoimmune drugs) **Kune simba P-gp uye CYP3A4 blockade + nephrotoxicity ** Triples colchicine mazinga uye inokonzera kukurumidza ** colchicine myoneuropathy, rhabdomyolysis, uye pancytopenia **. Yakanyatso contraindicated kana inoda kuderedzwa kwedosi.
** Verapamil, Diltiazem ** (Calcium channel blockers yeBP / atrial fibrillation) **Zviri pakati nepakati-kune-zvakasimba P-gp uye CYP3A4 inhibition ** Kaviri colchicine kuratidzwa; inoda kucheka colchicine dose ne50% kusvika 75% (uye kudzivisa zvachose kana itsvo dzisina simba).
Itraconazole, Ketoconazole, Posaconazole, Voriconazole, Ritonavir (Paxlovid / mishonga yeHIV) **Zvakanyanya CYP3A4 uye P-gp blockade ** Kutora ** Paxlovid (nirmatrelvir/ritonavir)** yeCOVID-19 kana antifungals uchienderera mberi necolchicine inokonzera acute inouraya colchicine toxicity. Bata colchicine zvachose mukati uye kwemazuva akati wandei mushure mePaxlovid.
** Statins (Atorvastatin, Simvastatin, Rosuvastatin) & Fibrates (Gemfibrozil, Fenofibrate)** Synergistic myotoxicity + CYP3A4 / OATP1B1 makwikwi Inokonzera acute myopathy uye rhabdomyolysis yakakura (kurwadziwa kwetsandanyama kwakanyanya, kupera simba, weti yakasvibira) kana yasanganiswa necolchicine, kunyanya muchirwere cheitsvo.
Kuwanda kwemuto weGrapefruit Inhibits intestinal CYP3A4 uye P-gp Zvinonyanya kusimudza oral colchicine bioavailability; dzivisa mazambiringa paunenge uchitora colchicine.

Botanical inoratidzika-yakafanana: Gloriosa Superba (Flame Lily) uye Colchicum Autumnale (Autumn Crocus)

Zvidyarwa zviviri zvakakura zvakarimwa zvekushongedza uye zvemusango zvine huwandu hwakakura hwechisikigo checolchicine uye zvinokonzeresa huwandu hwehupfu hunouraya gore rega rega pakati pevarimi vekumba, mhuka dzesango-gariki, uye vana:

1. Colchicum autumnale (Matsutso Crocus / Meadow Saffron / Vakashama Vakashama)

  • ** The Wild Garlic (Allium ursinum / Ramps) Musungo Wekudyara:** Muchirimo, Colchicum autumnale inotumira mashizha akasvibira, akasvibira akaita semhumhu kubva pasi pevhu magirobhu munzvimbo dzakanyorova dzeEurope neNorth America - dzinowanzokura ** padyo nepadyo nekudyiwa Wild Garlic (Allium ursinum / gariki yebere)** kana marambu. Maforoji anonhonga mashizha egoriki yemusango ye pesto kana muto netsaona anounganidza mashizha e Colchicum pamwe negariki.
  • Kuzvisiyanisa: Kupwanya shizha regariki yemusango inodyika kunoburitsa kunhuhwirira kwegarlic yemusango**, uye mashizha awo anokura padzinde rimwe nerimwe kubva mugirobhu; ** ine chepfu Colchicum autumnale mashizha ane ZERO garlic kunhuhwirira**, akaomarara, uye anoputira zvine mutsindo mumwe nemumwe musheath yakapfava pazasi. Kudya mashoma emashizha e Colchicum kana maruva kunopa mushonga unouraya wecolchicine. (Cherechedza: Colchicum autumnale zvakare yakasiyana zvachose neyechokwadi culinary spice Saffron [Crocus sativus], iyo ndeyemhuri yeiris Iridaceae uye ine stigmas 3, nepo Colchicum ine chepfu ndeye Colchicaceae uye ine 6 stamen).

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

  • Iyo Inotapira Mbatata / Yam / Ginger Tuber Trap: Gloriosa superba muzambiringa unoshamisa unokwira unopisa une murazvo wakafanana nemaruva matsvuku-uye-yero anoyevedza akakura akakura muAsia, Africa, Australia, uye sechirimwa chekushongedza mumba muUS neEurope. Pazasi pevhu, inokura yakaita seV kana L-yakafanana nenyama machubhu epasi anotaridzika zvinoshamisa sematape aitapira, mayam, mufarinya, kana ginger mudzi.
  • Kuuraya kwakanyanya: Tuber imwe ye20-to-50-gram Gloriosa superba ine 60 kusvika 150 milligrams ye pure colchicine negloriosine - inokwana kuuraya vanhu vakuru vaviri kusvika vatatu. Chero ani zvake anobika netsaona uye kudya Gloriosa tuber anoda kukurumidza kubviswa gastric muchipatara kunyange mudumbu musati watanga.

Podophyllin (Podofilox / Mayapple) Chepfu: the topical wart-resin ngozi

** Podophyllin ** isimbi yakaomeswa resin yakatorwa kubva kumidzi ye ** American Mayapple (Podophyllum peltatum)**, ine inoshanda microtubule poison podophyllotoxin (podofilox / Condylox). Inotarwa se 0.5% solution/gel kana kusanganiswa se 10% kusvika 25% benzoin tincture yekupisa kubva kunhengo dzakavandika.condyloma acuminata) uye plantar warts.

  • Muchetura unoitika sei: Kumedza netsaona kwebhodhoro rinobvisa wart nekamwana kadiki, kudya muchero usina kuibva Mayapple/midzi musango, kana **kuisa 10% kusvika 25% podophyllin resin kumativi makuru, mbishi, kubuda ropa kunhengo yesikarudzi kana perianal warts uye kutadza kuigeza kubva mushure meawa 1 kusvika ku4.
  • Unique neurological twist pamwe chete nekutadza kwemwongo webhonzo: Sezvakaita colchicine, podophyllin inokiya mitotic spindle uye inoita kuti Phase 1 yakanyanya kurutsa/manyoka inoteverwa nePhase 2 **bone marrow pancytopenia, kusashanda kwechiropa, uye kuvhunduka **. Pamusoro pezvo, podophyllin inoyambuka chipingamupinyi cheropa-uropi zvine hutsinye zvakanyanya kupfuura colchicine, zvichikonzera ** acute central nervous system encephalopathy (kuvhiringidzika, kuona kurongeka, kuneta, coma, kubatwa) mukati me6 kusvika maawa makumi maviri nemana **, inoteverwa neyakakomba, inogara kwenguva refu ** sensorimotor peripheral neuropathy / kudonha kwetsoka, kudonha uye kudonha kwetsoka, kudonha uye kudonha kwetsoka ileus.

Chipatara ICU manejimendi yeColchicine uye Podophyllin chepfu

  1. Pakarepo Gastric Lavage (mukati memaminitsi makumi matanhatu) uye Multidose Activated Charcoal (MDAC):
  2. Nokuti kufa kwepamusoro kwe0.5 kusvika ku0.8 mg / kg kwakakwirira uye dialysis inokundikana, vanachiremba vanoita kukurumidza nasogastric aspiration / lavage kana murwere akasvika mukati meawa 1 yekudya uye kutungamirira ** activated charcoal (50 g pakutanga, inoteverwa ne 25 g yega yega 2 kusvika kumaawa 4) ** pamwe chete neIV pa biliaryherotic pinda.
  3. ** Aggressive Early Hemodynamic Resuscitation uye VA-ECMO: **
  4. Massive crystalloid fluid kutsiva (0.9% normal saline kana Ringer's lactate) inotungamirirwa nemubhedha we echocardiography panguva yeChikamu 1, kuchinja nokukurumidza ku ** norepinephrine / epinephrine infusions ** uye kutanga ** Veno-Arterial Extracorporeal Membrane Oxygenation (VA-ECMO) ** kana refractory cardiogenic shock inokura muChikamu 2 (VA-ECMO yakachengetedza mg / microcardio yakawanda kusvika ku8 microcardial varwere vavo). kuvandudzwa 5 kusvika 7 mazuva gare gare).
  5. ** Yekutanga Granulocyte Colony-Inosimudzira Factor (G-CSF / Filgrastim) uye Neutropenic Sepsis Precautions: **
  6. Pamberi kana nokukurumidza apo masero machena eropa anotanga kudonha paZuva 2 kusvika ku3, hematologists uye toxicologists vanotora zuva nezuva subcutaneous kana intravenous ** filgrastim.G-CSF, 5 mcg/kg/zuva)** kukurudzira masero emapfupa emapfupa asara uye kupfupisa nguva yekuuraya neutropenia, yakasanganiswa nemishonga inorwisa mabhakitiriya yakafara-siyana (broad spectrum intravenous).cefepime, piperacillin-tazobactam, kana meropenem) uye kuwedzerwa ropa kweplatelet.
  7. Kuongorora Colchicine-Specific Fab Antibody Fragments: Mukusarudza nzvimbo dzekuEurope dze toxicology (France), kuyedza ** colchicine-specific ovine Fab zvidimbu** (yakaumbwa zvakafanana neDigibind/DigiFab inoshandiswa kudigoxin overdose) yakabudirira kuburitsa colchicine kubva mumatumbu uye kusanganisirwa muweti yekukatyamadza kunowanikwa mune weti yecardige. protocol.

Nhamba dzenharaunda dzechimbichimbi uye zvirongwa zveagency

  • United States neCanada: Fonera 911 uye US Poison Control pa1-800-222-1222 (Canada: 1-844-POISON-X). The US Food and Drug Administration (FDA) Colcrys (Colchicine) Safety Labeling inorayira zvakasimba 1.8 mg maximum 3-tablet acute gout flare cap (1.2 mg ichiteverwa ne0.6 mg 1 awa gare gare) uye inotakura Black Box contraindications pakubata pamwe nekushandisa colchicine ne CYP3A4/P-gp inhibitors (clarithromycin, ritonavir/Paxlovid, cyclosporine) muvarwere vane renal kana hepatic impairment.
  • United Kingdom: Fonera 999 nekukurumidza kune chero anofungidzirwa colchicine kana Colchicum overdose. Iyo UK Mishonga uye Healthcare zvigadzirwa Regulatory Agency (MHRA) uye National Poisons Information Service (NPIS / TOXBASE) inoronga CHESE nemaune kana netsaona overdose yecolchicine senjodzi yekurapa inotyisidzira hupenyu inoda kukasika kuchipatara, Multidose Activated Charcoal, uye mashoma makumi maviri nemana-awa yemoyo / biosymptomatic.
  • ** European Union: ** Fonera ** 112 **. European Alliance of Associations for Rheumatology (EULAR) gout nhungamiro uye French Poison Control / European Association of Poisons Centers uye Clinical Toxicologists (EAPCCT) mapuroteni anotungamira yakaderera-dose colchicine kunyorerwa, yakasimba macrolide kudzivirira, uye yekutanga ICU/VA-ECMO kutumira kune kumwisa>= 0.5 mg/kg.
  • Australia neNew Zealand: Fonera 000 muAustralia (Ruzivo rwePoisons 13 11 26) kana 111 muNew Zealand (0800 764 766). Therapeutic Goods Administration (TGA) neMedsafe NZ inoyambira zvakasimba pamusoro pe "kutora kusvika manyoka" gout dosing.
  • India neAsia-Pacific: Fonera 112 muIndia, 995 muSingapore, 119 muJapan neSouth Korea, kana 999 muMalaysia neHong Kong. MuIndia neSri Lanka, Gloriosa superba (Karthigai Kilangu / Niyagala) tuber poisoning ndicho chikonzero chikuru chinozivikanwa cheacute toxic pancytopenia uye cardiogenic shock inoda kuendeswa kuchipatara chepamusoro. Tarisa dhairekitori redu re nhamba dzepasi rose dze emergency.

Mibvunzo inowanzo bvunzwa

Ndeupi huwandu hwakachengetedzeka hwemapiritsi ecolchicine kutora pakurwisa gout?

FDA yemazuva ano uye yepasi rose rheumatology nhungamiro (zvichienderana nechiratidzo chekiriniki yeAGREE) inoratidza kuti iyo yakanyanya kuchengetedzwa uye inoshanda dosi yeacute gout flare mumunhu mukuru ane itsvo dzakakwana uye chiropa mahwendefa maviri e0.6-milligram (1.2 mg) anotorwa pachiratidzo chekutanga chemoto, ichiteverwa neIMWE chete yekuwedzera 0.6-milligram piritsi (0.6-milligram piritsi paawa imwe chete 0.6 mg). Iwe unofanirwa kumira uye kumirira angangoita maawa makumi manomwe nemaviri usati watora imwe acute flare kosi. Kutora mapiritsi matanhatu, gumi, kana gumi nemashanu pazuva hakuite kuti kurwadziwa kwegout kubve nekukurumidza uye kunogona kukonzera kuuraya kune-multi-organ chepfu.

Nei vanachiremba munguva yakapfuura vaiudza varwere vegout kuti varambe vachitora colchicine awa imwe neimwe kusvikira vaita manyoka, uye nei izvozvo zvakamiswa?

Kwemakumi emakore pasati paitwa zvidzidzo zvemazuva ano zvemadorosi, varapi vakanga vasina nzira dzakachengeteka dzekurwisa kuzvimba uye vaivimba nemutemo wemuzana remakore rechi19 wekupa 1 colchicine piritsi awa imwe neimwe kusvikira murwere aita manyoka akanyanya uye kurutsa. Medical toxicologists pakupedzisira vakaziva kuti colchicine-induced manyoka hakusi kukuvadza divi mhedzisiro - ndicho chiratidzo chakananga kuti mushonga ane chepfu uye kuuraya kupatsanura stem masero ari mudumbu mako mudiki, uye kuti dose rinokonzera manyoka rinopindirana zvakananga nemupimo unokonzera mwongo kutadza uye kuuraya kunouraya moyo.

Nei zvine njodzi zvakanyanya kutora antibiotic clarithromycin kana COVID-19 Paxlovid uchitora mazuva ese colchicine?

Muviri wako unovimba nepombi yemaserura inonzi P-glycoprotein uye enzyme yechiropa inonzi CYP3A4 kupomba colchicine kubva mumasero ako kupinda mubile uye weti kuti isavake. Clarithromycin (Biaxin), erythromycin, antifungal zvinodhaka se itraconazole, uye ritonavir chikamu cheCOVID-19 Paxlovid yakavhara zvachose zvese P-glycoprotein uye CYP3A4. Kana ukaramba uchitora mapiritsi ako e1 kana maviri emazuva ese ecolchicine uchitora clarithromycin kana Paxlovid, colchicine inoteya mukati memoyo wako nemwongo wepfupa pa3 kusvika ku4 nguva dzakajairika, zvichikonzera chepfu inouraya mukati memazuva.

Kana mumwe munhu akamedza mamwe mapiritsi ecolchicine maawa matatu apfuura uye achiri kunzwa 100% zvakajairika, vabuda munjodzi here?

Kwete - iyo hwindo isina-chiratidzo ndiyo musungo une njodzi muchepfu yecolchicine. Colchicine inotora maawa maviri kusvika gumi nemaviri kukanganisa microtubule spindles mukati mekuparadzanisa maseru emukati, saka murwere wese anonzwa zvakakwana kwemaawa akawanda ekutanga mushure mekumedza chirwere chinouraya. Kumirira kumba kusvika pakurutsa zvakanyanya uye manyoka ane ropa atanga zvinoreva kuti chepfu yatobuda muura uye yakavharika zvisingadzoke mukati memhasuru yemwoyo nemumwongo webhonzo, uko dialysis isingaisvike. Kuenda kukamuri yekukurumidzira panguva yekunyarara kwekutanga kwe1 kusvika kuawa ye2 yemarasha akabatidzwa kunogona kuponesa hupenyu hwemurwere.

Vanhu vanowana sei chepfu netsaona neAutumn Crocus kana Gloriosa Lily zvinomera?

Muchirimo, Autumn Crocus ine chepfu (Colchicum autumnale) inosiya inomera munzvimbo dzakanyorova padivi pegoriki yemusango inodyiwa (Allium ursinum / ramps); maforoji asinganhuhwi shizha rega rega rekunhuhwirira kwegariki vanosanganisa netsaona mashizha eColchicum kuita yemusango-gariki pesto kana muto. Munzvimbo dzinopisa uye dzinopisa (uye mudzimba dzine maruva anokwira), machubhu epasi pevhu eFlame Lily (Gloriosa superba) anotaridzika kunge mbatatisi diki, mayam, kana mudzi weginger, uye kudya kunyange hafu yetuber inopa hombe, inouraya dosi yecolchicine.

Nzvimbo uye nhungamiro yepamutemo

  • US Food and Drug Administration (FDA, United States): Kunyora Ruzivo uye Nhungamidzo yeMishonga yeColcrys (Colchicine, USP) Mahwendefa uye *FDA Drug Safety Kukurukurirana: Zvinouraya Zvinodhaka Kudyidzana Pakati peColchicine neP-Glycoprotein / Yakasimba CYP3A4 Inhibitors (Clarithromyrine, Cyclonaspovir)
  • Terkeltaub RA et al. (Arthritis & Rheumatism, The AGREE Trial): *High Versus Low Dosing of Oral Colchicine for Early Acute Gout Flare: Makumi maviri nemana-Maawa Mugumisiro Wekutanga Multicenter, Randomized, Double-Blind, Placebo-Controlled, Parallel-Group, Dose-Dose-Comparison.
  • Finkelstein Y, Aks SE, Hutson JR, Juurlink DN, Baud FJ et al. (Clinical Toxicology): Colchicine Poisoning: The Dark Side of Ancient Drug (Bismuth/Baud weight-based mg/kg kufa stratification, 3-chikamu chekiriniki kufambira mberi, enterohepatic recirculation, Multidose Activated Charcoal, uye G-CSF / VA-ECMO intensive care).
  • Mishonga neHealthcare products Regulatory Agency (MHRA) & National Poisons Information Service (NPIS, United Kingdom): Drug Safety Update: Colchicine - Yakanyanya Narrow Therapeutic Index uye Ngozi yeFatal Overdose.
  • World Health Organization (WHO) & Poison Centers Guidelines: Clinical Management of Plant Poisonings: Colchicum autumnale (Autumn Crocus), Gloriosa superba (Flame Lily), uye Podophyllum peltatum (Podophyllin Resin).

Tora kosi yerubatsiro rwekutanga yakasimbiswa uye bvunza nyanzvi

Gwaro iri rinopa ruzivo rwechimbichimbi uye dzidziso yerubatsiro rwekutanga yecolchicine, Gloriosa lily, uye podophyllin chepfu uye haitsivire toxicology yekurapa nekukurumidza uye kurapwa kwakanyanya. Kuti udzidze kuziva kuvhunduka, kubata chepfu yekukurumidzira, uye kuita CPR, tora kosi yerubatsiro rwekutanga yakasimbiswa kuburikidza neRed Cross, St John Ambulance, kana mupi anotenderwa wemuno.

Mazano anoenderana