Colchicine Overdose le Gloriosa Lily Poisoning: Hobaneng ho Nka Lipilisi tse Eketsehileng tsa Gout bakeng sa Flare ho Bolaea¶

Colchicine (Colcrys, Mitigare, Gloperba) - alkaloid ea lilemo tse lekholo e khahlanong le ho ruruha e laetsoeng bakeng sa li-gout flares tse matla, feberu ea malapa ea Mediterranean (FMF), le pericarditis - e na le e 'ngoe ea lifensetere tse tšesaane, tse sa tšoareleng ka ho fetisisa meriana eohle ea bongaka. Ho fapana le ibuprofen kapa acetaminophen, moo mokuli a ka nkang ka phoso hore a ka noa lipilisi tse ngatanyana ha bohloko ba gout bo sa ntlafalang, **ho metsa matlapa a 10 ho isa ho a 20 a tloaelehileng a 0.6-milligram colchicine (kakaretso ea limiligrama tse 6 ho isa ho tse 12, kapa ho feta 0.15 k'hilograma e le 'ngoe e tloaelehileng ea letsatsi le letsatsi e sebelisana le lithibela-mafu) joalo ka clarithromycin - e baka chefo e nyarosang, ea biphasic ea litho tse ngata tse se nang pheko ea khoebo e fumanehang hohle **. Chefo e ts'oanang e bolaeang e etsahala ha li-forage kapa bana ba ja li-tubers, bulbs kapa makhasi a Flame Lily (Gloriosa superba) kapa Hoetla Crocus (Colchicum autumnale), kapa ha ho tsepamisitsoe podophyllin (podofilox) resin ea topical wart ea metsoa kapa e tšeloa libakeng tse sephara tsa letlalo. Haeba mang kapa mang a noa matlapa a fetang 3 a behiloeng (1.8 mg) a colchicine ka lihora tse 24, kapa a noa limela tsa Colchicum kapa Gloriosa, letsetsa sebaka sa heno. dinomoro tsa tshohanyetso hang-hang - **le haeba ba ikutloa ba phetse hantle lihora tse 'maloa tsa pele **. Bakeng sa maemo a tšohanyetso a amanang le toxicological le hematological, ikopanye ho ja li-mushroom tse hlaha le ho ja semela se chefo, neutropenic fever le khatello ea masapo, le chefo ea lijo, lefu la sethoathoa se matla, le ho felloa ke metsi 'meleng.

Chefo ea Colchicine ke chefo ea khale ** "nako e khutsitseng-bomo" chefo ** e ts'oanang le li-mushroom tsa amatoxin Death Cap le paraquat: ka mor'a ho lieha ho se nang matšoao a lihora tse 2 ho isa ho tse 12, Mokhahlelo oa 1 o otla ka letšollo le phatlohileng, le kang k'holera le tšollo ea hypovolemic, e lateloa ka lihora tse 24 ho isa ho tse 7. ho hloleha ho phefumoloha (ARDS), ho hloleha ha sebete / liphio, le aplasia e feletseng ea moko oa masapo (lisele tse tšoeu tsa mali le liplatelete tsa zero)**.

Etsa sena hona joale¶

1. Letsa nomoro ea hau ea ts'ohanyetso ea lehae le Taolo ea Chefo HANG-HANG haeba mang kapa mang a koenya matlapa a fetang 3 a colchicine (1.8 mg) ka letsatsi, kapa chelete EFE KA EFE ea Autumn Crocus / Gloriosa Lily. Letsetsa 911 United States le Canada (US Taolo ea Chefo klzzwxh:37, European Union ho pholletsa le European Union, 9 000 naheng ea Australia (Boitsebiso ba Chefo 13 11 26), kapa sheba bukana ea rona ea dinomoro tsa tshohanyetso. **Le ka mohla u se ke ua emela hore bohloko ba ka mpeng kapa ho hlatsa ho qale **; hang ha colchicine e monya ka maleng ’me e tlamella ka har’a lisele tsa ’mele, e ke ke ea ntšoa maling.
2. Potlakela lefapheng la maemo a tšohanyetso nakong ea lihora tse 1 ho isa ho tse peli bakeng sa mashala a ts'ohanyetso (Multidose Activated Charcoal). Hobane colchicine e feta enterohepatic recirculation (sebete se ntša colchicine ka har'a nyooko, e khutlelang ka maleng a manyenyane feela hore e boele e monye hape), sepetlele sa ho noa **mashala a sebetsang khafetsa lihora tse ling le tse ling tse peli ho isa ho tse 4 ** se tšoara colchicine ka tsela e atlehang ka ho fetisisa ho tloha maleng 'me e emisa lesapo le lesapo. moko.
3. KHAOTSA ho noa colchicine hang-hang haeba u laetsoe lithibela-mafu life kapa life tsa macrolide (clarithromycin kapa erythromycinantifungal),itraconazole, ketoconazole), sethethefatsi sa pelo (verapamil, diltiazem), kapa cyclosporine - kapa haeba u noa lero la grapefruit. Meriana ena e thibela CYP3A4 enzyme le P-glycoprotein efflux pump e hlakisang colchicine, e fetolang tekanyo e tloaelehileng ea gout ea lipilisi tse 2 hore e be tekano e feteletseng ea ka hare ea makhetlo a 10.
4. Haeba Mokhahlelo oa 1 oa ho hlatsa ho matla le lets'ollo le nang le metsi / mali a se a qalile, qala ka ho khutlisetsa mokelikeli o matla ha u ntse u emetse ambulense - 'me U SE KE UA fana ka litlhare tse thibelang letšollo (loperamide / Imodium). Colchicine e holofatsa karohano ea lisele lera la mala, e leng ho etsang hore lilithara tsa plasma le electrolyte li tsoe ka maleng (cholera-like gastroenteritis). Ho fana ka loperamide kapa bismuth subsalicylate ho tšoasa colchicine e sa monngoeng ka har'a mala hoo chefo e ngata e kenang maling.
5. **Haeba podophyllin (podofilox) wart liquid e ile ea qhalana ka phoso libakeng tse khōlō tsa letlalo kapa lera la mucous, hlatsoa letlalo hang-hang ka sesepa le metsi a phallang.
6. Tlisa botlolo ea pilisi ea colchicine (e le hore lingaka li tsebe ho bala lipilisi tse sieo le ho bala hantle mg/kg dose) kapa senepe/sampole sa tleloubu ea semela kapa palesa e jetsoeng. Ho tseba hore na mokuli o jele < 0.5 mg/kg, 0.5 to 0.8 mg/kg, kapa > 0.8 mg/kg hang-hang o bolella sehlopha sa tlhokomelo e matla boemo ba mokuli ba ho pholoha le litlhoko tsa ICU.

Sefate sa liqeto: colchicine, Gloriosa lily, le triage ea chefo ea podophyllin¶

flowchart TD
    A["Ho belaelloang hore ho na le Overdose ea Colchicine, Gloriosa Lily / Autumn Crocus Engestion, kapa Podophyllin Exposure"] --> B{"Bala tekanyo ea Colchicine e kentsoeng (ka mg/kg ea boima ba 'mele) kapa hlahloba Tšebelisano ea Lithethefatsi"}
    B -->|"Tekanyetso e tloaelehileng ea gout + Clarithromycin / Verapamil / Cyclosporine + letšollo le lecha / ho hlatsa"| C["IATROGENIC COLCHICINE TOXICITY: Emisa lithethefatsi ka bobeli 'me u ee ho ER hang-hang"]
    B -->|"Ho feta tekano ho feta 0.5 mg/kg (mohlala, 7 ho 30 mg ho motho e moholo ea boima ba 70 kg)"| D["KOTSI E HOLIMO: Lipalangoang tsa hang-hang tsa EMS bakeng sa Gastric Lavage (haeba <1 hr) + Multidose Activated Charcoal"]
    B -->|"Ho feta tekano ho 0.5 ho isa ho 0.8 mg/kg (35 ho 56 mg ho batho ba baholo ba boima ba 70 kg)"| E["CHEFO E BOHLOKOA E KOPANANG BOPHELO: Lebella ho tšoha ho matla ha GI + Bone Marrow Aplasia (mafu a 10% ho isa ho 50%)"]
    B -->|"Ho feta tekano ho feta 0.8 mg/kg (> 56 mg ho batho ba baholo ba boima ba lik'hilograma tse 70) kapa tuber e feletseng ea Gloriosa"| F["FULMINANT LETHAL DOSE (E atamela 80% ho isa ho 100% ea batho ba shoang): Hang-hang ICU / ECMO Transfer"]
    C --> G["Mokhahlelo oa 1 (Lihora tsa 2 ho isa ho tse 24): Pheliso e matla ea IV ea Crystalloid bakeng sa Kolera-Joaloka Tahlehelo ea Mokelikeli oa GI"]
    D --> G
    E --> G
    F --> G
    G --> H["Mokhahlelo oa 2 (Matsatsi a 1 ho isa ho a 7): Tšehetso ea pelo ea ICU (Norepinephrine/VA-ECMO) + G-CSF (Filgrastim) bakeng sa Neutropenia"]

Kamoo colchicine le podophyllin li bolaeang lisele ka teng: ho notlela mitotic spindle¶

Ho utloisisa hore na ke hobane'ng ha chefo ea colchicine e shebahala joaloka chefo e matla ea lijo, ebe e tšoana le tlhaselo e matla ea pelo, 'me matsatsi a mahlano hamorao joalo ka lefu le matla la radiation kapa chefo ea chemotherapy ea leukemia, hlahloba hore na molek'hule e sebetsa joang ka har'a sele e 'ngoe le e 'ngoe ea motho.

Microtubule depolymerization le ho tšoaroa ha karohano ea lisele ho metaphase¶

Sele e 'ngoe le e 'ngoe e phelang 'meleng oa motho e na le skeleton ea ka hare ea skeleton le tsamaiso ea litsela tse kholo tse entsoeng ka li-protein tubes tse se nang letho tse bitsoang **microtubules **, tse bokelletsoeng ho tloha ho li-block tsa mohaho tse bitsoang **alpha-tubulin le beta-tubulin dimers **. Li-microtubules li etsa mesebetsi e 'meli ea bohlokoa:

1. ** Mitotic Spindle nakong ea karohano ea lisele (mitosis):** Neng kapa neng ha stem cell lera la mala a hao, mokong oa masapo kapa melomong ea moriri e arohana ho nkela lisele tsa khale sebaka, li-microtubules li etsa liropo tse nyenyane (mitotic spindle) tse hulang li-chromosome tse kopilitsoeng hore e be lisele tse peli tse ncha tsa morali.
2. ** Lipalangoang tsa intracellular le contractility ea myocardial ka har'a lisele tse sa arohaneng: ** Ka hare ho lisele tsa mesifa ea pelo (cardiomyocytes), li-axon tsa methapo, le lisele tsa sebete, li-microtubules li sebetsa e le mabanta a tsamaisang a tsamaisang mitochondria, likanale tsa calcium, le li-neurotransmitter vesicles ho pholletsa le sele.

Colchicine (hammoho le podophyllotoxin ho tsoa ho semela sa Mayapple / wart resin, le vinca alkaloids e sebelisoang kalafong ea mofetše) e tlama ka kamano e haufi le e ke keng ea khutlisoa ho li-soluble beta-tubulin dimers, e koala pheletso e ntseng e hola ea microtubule hore e phutholohe le ho qhibiliha (**microtubule de sol).

• **Ka har'a lisele tse arohaneng ka potlako (Gut mucosa le Bone marrow): ** Seleng e 'ngoe le e' ngoe e arohaneng ea stem e hoama ka ho sa feleng bohareng ba karohano ea lisele (metaphase arrest) ebe e shoa ka mokhoa o hlophisitsoeng.apoptosis). Hobane lisele tse ka har'a mala a hau a manyane li nka sebaka sa lihora tse ling le tse ling tse 24 ho isa ho tse 48, lesela lohle la mala le theoha ka Letsatsi la 1 (Lets'ollo le kang k'holera mohato oa 1). Hobane lisele tse tšoeu tsa mali le liplatelete mokong oa masapo a hao li nka sebaka sa matsatsi a mang le a mang a 3 ho isa ho a 5, tsamaiso eohle ea 'mele ea ho itšireletsa mafung le tsamaiso ea mali ea ho koala mali li nyamela ka Matsatsi a 3 ho isa ho a 7 (**Phase 2 pancytopenia le sepsis **).
• Ka har'a mesifa ea pelo le lisele tsa methapo ea kutlo: Ho qhala marang-rang a microtubule ka har'a lisele tsa mesifa ea pelo ho sitisa ho tšoara calcium ea sarcoplasmic le lipalangoang tsa matla a mitochondrial, ho baka ** ho tsieleha ha myocardial e tsotehang, refractory cardiogenic shock, heart block e feletseng, le asystole ea tšohanyetso ** ka lihora tse 24 ho isa ho tse 72.

Ke hobane'ng ha hemodialysis le hemoperfusion li SA khone ho tlosa colchicine 'meleng¶

Ho fapana le caffeine, lithium, kapa salicylates (aspirin), e lulang e qhibiliha ka har'a plasma ea metsi ea mali moo mochine oa dialysis o ka li hloekisang, colchicine e monya e tsoa ka mali nakong ea lihora tse 1 ho isa ho tse 3 ebe e notlela ka thata liprotheine tsa tubulin ** ka hare ho lisele tse tiileng tsa 'mele , ho etsa hore ho be le phallo e kholo.Vd = 2 to 12 L/kg, ho fihlela ho 21 L/kg ho overdose). Hobane karolo e ka tlaase ho 1 ho ea ho 2 lekholong ea colchicine ea 'mele e ntse e phaphametse maling, **hemodialysis, hemofiltration, le mashala a mashala ha a na thuso ho tlosa colchicine ** (le hoja dialysis e ntse e sebelisoa ho tšehetsa bakuli bao liphio tsa bona li hlōlehang ho Mokhahlelo oa 2). Ke ka lebaka lena ho hloekisoa ha mala pele ho nako ka Multidose Activated Charcoal pele le nakong ea ho tsosolosa enterohepatic ho leng bohlokoa haholo.

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

Ho toxicology ea bongaka (eo qalong e neng e thehiloe ke Bismuth, Baud, le basebetsi-'moho le Paris Poison Control Center), ho pholoha ha mokuli ka mor'a ho feta tekano ea colchicine ho boleloa esale pele ka ho nepahala ho makatsang ka ho bala lethal dose ea milligram e arotsoeng ka boima ba 'mele oa mokuli ka lik'hilograma.mg/kg):

Mekhahlelo e meraro e ikhethileng ea kliniki ea Colchicine le chefo ea Gloriosa Lily¶

Chefo ea Colchicine e tsamaea ka mekhahlelo e meraro e latellanang ea kliniki matsatsing a 10 ho isa ho a 14:

Mokhahlelo oa 1: Mokhahlelo oa Gastrointestinal & Hypovolemic (Lihora tse 2 ho isa ho tse 24 kamora ho jeoa)¶

• Fensetere e thetsang ea lihora tse 2 ho isa ho tse 12: Lihoreng tse 2 ho isa ho tse 6 tsa pele ka mor'a ho metsa lipilisi tsa colchicine tse feteletseng kapa ho ja li-bulbs tse phehiloeng tsa Gloriosa / Colchicum, mokuli o ikutloa a tloaelehile ka ho feletseng (ntle le ho chesa hanyenyane ka hanong le 'metsong ka limela tse tala). U se ke ua thetsoa ka ho lula hae ka fensetere ena e khutsitseng.
• Ho phatloha ha "K'holera-Joaloka" Gastroenteritis (Lihora tse 6 ho isa ho 24): Ha crypt mitosis ea mala e emisa 'me lisele tsa mucosal li fokotseha, mokuli o ba le ho nyekeloa ke pelo ho sa phekoleheng, ho hlatsa, mahlaba a ka mpeng a bohloko, le *metsi a mangata, a sa khaotseng, a nang le metsi a nang le mali a mangata.
• Hypovolemic Shock and Electrolyte Collapse: Tahlehelo ea metsi e tsoang maleng e ka feta lithara tse 5 ho isa ho tse 10 (lithara tse 1.3 ho isa ho tse 2.6) ka lihora tse 24, e leng ho bakang ho makala ho hoholo ha hypovolemic, kotsi ea prerenal acute liphio, lactic acidosis, hypokalemia, hyponatremia, hypokalemia, hyponatremia, hypokalemia, hypokalemia, hypokalemia, hypokalemia, hypocalemia, hypokalemia spike ea lisele tse tšoeu tsa mali ka holimo ho 20,000 / mcL pele moko oa masapo o senyeha).

Mokhahlelo oa 2: Ho hloleha ha Litho tse ngata, Cardiogenic Shock, le Bone Marrow Aplasia Phase (Matsatsi a 1 ho isa ho a 7)¶

Joalo ka ha ho hlatsa le letšollo li bonahala li fokotseha hora ea 24 ho isa ho 36, mokuli o kena mokhahlelong oa bobeli o bolaeang:

1. Refractory Cardiogenic Shock and Arrhythmias (Lihora tse 24 ho isa ho 72 - Lebaka le ka Sehloohong la Lefu):
2. Ho senyeha ha tubulin ka ho toba ka har'a myocyte ea pelo ho baka ho hloleha ha pelo ea biventricular (left ventricular ejection fraction dropping below 15% to 20%), hypotension e tebileng e khaotsang ho arabela ho metsi a IV le vasopressors, sinus bradycardia, "atrioventricular heart block" e feletseng, tachycardia ea ventricular, le ka tšohanyetso ** asystolic cardiac arrest **.
3. E Feletseng Bone Marrow Aplasia / Pancytopenia (Matsatsi a 3 ho isa ho a 7):
4. Pakeng tsa Letsatsi la 3 le Letsatsi la 7, palo e felletseng ea mokuli ea neutrophil e theohela ho zero (agranulocytosis) ’me liplatelete li theohela ka tlaase ho 10,000 ho isa ho 20,000/mcL (severe thrombocytopenia).
5. Hobane lera la mala le senyehileng le lahlehetsoe ke tšitiso ea lona khahlano le libaktheria tsa mala ka nako eona eo 'mele o nang le lisele tse tšoeu tsa mali, libaktheria tsa Gram-negative (E. coli, Klebsiella, Pseudomonas) tšela ka ho toba ho tloha ka maleng ho kena maling, ho baka fulminant neutropenic septic shock le Disseminated Intravascular Coagulation (DIC).
6. Acute Respiratory Distress Syndrome (ARDS), Rhabdomyolysis, le Ascending Paralysis:
7. Ho lutla ha capillary matšoafong ho baka edema e seng ea cardiogenic pulmonary edema (ARDS) ho hloka moea oa mochini.
8. Tšenyo e tobileng ea mesifa ea masapo le axonal microtubule e baka myoneuropathy e matla (bofokoli ba mesifa bo haufi bo etsisa lefu la Guillain-Barré, creatine kinase e phahameng). rhabdomyolysis, le ho lahleheloa ke kelello), hammoho le kotsi e mpe ea sebete, pancreatitis, le ileus e shoeleng litho.

Mokhahlelo oa 3: The Recovery & Total Alopecia Phase (Letsatsi la 7 ho isa Beke ea 3+)¶

Haeba mokuli a pholoha koluoa ​​ea pelo le septic ea Phase 2 ho ICU:

• Rebound Leukocytosis: Lisele tsa 'mele oa masapo li qala ho arohana ho pota Letsatsi la 7 ho isa ho la 10, e leng se etsang hore palo ea lisele tse tšoeu tsa mali e khutlele hape ka matla.
• Ho lahleheloa ke moriri ho felletseng, ho makatsang (Total Alopecia): Hoo e ka bang Letsatsi la 7 ho isa ho la 14, hobane lisele tsa matrix tsa moriri-follicle li arola ka potlako feela joaloka bakuli ba chemotherapy, **kaofela letlalo la hlooho, lintši le moriri oa 'mele li oela ka lihlopha ** (qetellong li hōla ka ho feletseng ho feta likhoeli tse 3 ho isa ho tse 6). Bofokoli ba Neuromyopathy bo ka nka libeke kapa likhoeli tsa ho hlaphoheloa 'meleng ho rarolla.

Litšebelisano tsa Lithethefatsi tse Lethal: Joang tekanyo e tloaelehileng ea gout ea lipilisi tse 2 e fetohang ho feta tekano ho bolaeang¶

Ho feta **halofo ea chefo eohle e bolaeang ea colchicine lipetlele ha e tsoe ho overdose ea ka boomo **; li etsahala ho bakuli ba noang matlapa a bona a kamehla a 0.6-mg colchicine bao ka nako e le 'ngoe ba fuoang lithibela-mafu tse tloaelehileng kapa lipilisi tsa pelo, kapa ba nang le lefu le sa foleng la liphio kapa sebete.

The CYP3A4 le P-glycoprotein (P-gp) leraba la ho hlakola¶

Ka tloaelo, lisele tsa motho li itšireletsa ho colchicine li sebelisa lipompo tse peli tsa likokoana-hloko:

1. P-glycoprotein (P-gp / ABCB1):** Pompe e sebetsang ea cellular efflux e holim'a lisele tsa mala, sebete sa biliary canaliculi, le li-tubules tsa liphio tse **pompang ka mafolofolo colchicine ho tsoa liseleng ho ea setulong le moroto **.
2. Cytochrome P450 3A4 (CYP3A4): Ensaeme ea sebete e ntšang methylation le ho etsa hore colchicine e sebetse.

Litšobotsi tse tšoanang tsa limela: Gloriosa Superba (Flame Lily) le Colchicum Autumnale (Hoetla Crocus)¶

Limela tse peli tse lengoang haholo tse khabisang le tse hlaha li na le bongata ba tlhaho ba colchicine e hloekileng 'me li baka chefo e ngata e bolaeang selemo se seng le se seng har'a balemi ba lirapa ba malapeng, bajaki ba konofolo le bana:

1. Colchicum autumnale (Hoetla Crocus / Meadow Saffron / Naked Ladies)¶

• ** Konofolo e Hlaha (Allium ursinum / Ramps) Sefi sa ho Fulisa:** Nakong ea selemo, Colchicum autumnale e hlahisa makhasi a tlokomang, a botala bo benyang, a bopehileng joaloka lehare ho tsoa ho bulbs tse ka tlas'a lefatše makhulong a mongobo a Europe le Amerika Leboea - hangata e hola ** haufi le konofolo e jeoang.Allium ursinum / konofolo ea bere)** kapa marampe. Bajaki ba kha makhasi a konofolo e hlaha bakeng sa pesto kapa sopho ka phoso ba bokella makhasi a Colchicum hammoho le konofolo.
• Mokhoa oa ho li arola: Ho pshatla lekhasi le jeoang la konofolo e hlaha ho ntša monko o sa tsitsang oa konofolo e hlabang, 'me makhasi a eona a mela kutung e le 'ngoe ho tloha tleloubung; Makhasi a chefo a Colchicum autumnale a na le monko oa ZERO garlic, a sataletse, 'me a thatelana ka thata ka selateng se boreleli botlaaseng. Ho ja makhasi kapa lipalesa tse seng kae tsa Colchicum ho fana ka tekanyo e bolaeang ea colchicine. (Hlokomela: Colchicum autumnale e boetse e fapane ka ho feletseng le linoko tsa 'nete tsa culinary Safrone [Crocus sativus], ea lelapa la iris Iridaceae mme e na le sekhobo se 3, athe Colchicum e chefo ke ea Colchicaceae 'me e na le li-stamens tse 6).

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

• The Sweet Potato / Yam / Ginger Tuber Trap: Gloriosa superba ke sefate sa morara se khahlang sa tropike se nang le mahlaku a lipalesa a bokhubelu le bosehla a kang malakabe a melang ho pholletsa le Asia, Afrika, Australia, hape e le semela se setle sa lapeng US le Europe. Ka tlas'a mobu, e mela marope a ka tlas'a lefatše a bōpehileng joaloka V kapa a bōpehileng joaloka L a shebahalang ka mokhoa o tsotehang joaloka litapole tse monate, li-yam, cassava, kapa ginger root.
• Ho bolaea ho feteletseng: Tuber e le 'ngoe ea 20-to-50-gram Gloriosa superba e na le 60 ho isa ho 150 milligrams ea pure colchicine le gloriosine - e lekaneng ho bolaea batho ba baholo ba babeli ho isa ho ba bararo. Mang kapa mang ea phehang ka phoso 'me a ja Gloriosa tuber o hloka ho hloekisoa hang-hang ka mpeng ea sepetlele le pele sefuba sa pele se qala.

PodophyllinPodofilox / Mayapple) Ho chefo: kotsi ea topical wart-resin¶

Podophyllin ke resin ea semela e teteaneng e ntšitsoeng metsong ea Mayapple ea Amerika (Podophyllum peltatum), e nang le chefo e sebetsang ea microtubule podophyllotoxin (podofilox / Condylox). E laetsoe e le 0.5% tharollo/gel kapa e kopanngoe e le 10% ho isa ho 25% ea tincture ea benzoin ho chesa litho tsa botona kapa botšehali.condyloma acuminata) le li-warts tsa limela.

• Kamoo chefo e etsahalang ka teng: Ho koenya ka tsietsi ha botlolo e tlosang leqeba ke ngoana e monyane, ho ja tholoana e sa butsoang ea Mayapple/metso morung, kapa **ho sebelisa 10% ho isa ho 25% podophyllin resin ho pholletsa le li-warts tse kholo, tse tala, tse tsoang mali kapa perianal warts le ho hloleha ho li hlatsoa ka mor'a lihora tse 1 ho isa ho tse 4.
• Tlhaloso e ikhethang ea methapo ea kutlo hammoho le ho hloleha ha moko oa masapo: Joalo ka colchicine, podophyllin e notlela mokokotlo oa mitotic mme e baka ho hlatsa / lets'ollo le matla le Mokhahlelo oa 2 **bone marrow pancytopenia, ho hloleha ha sebete, le ho tšoha **. Ntle le moo, podophyllin e tšela mokoallo oa mali-bokong ka mokhoa o mabifi ho feta colchicine, e bakang ** acute central nervous system encephalopathy (pherekano, pono ea pono, lethargy, coma, seizures) nakong ea lihora tse 6 ho isa ho tse 24 **, e lateloa ke e matla, e tšoarellang nako e telele ** sensorimotor peripheral neuropathy / ho chesa ha maoto * le ho tepella maikutlong, ho fokola ha maoto le ho tepella maikutlo. ileus.

Tsamaiso ea sepetlele ea ICU ea Colchicine le Podophyllin toxicity¶

1. Ho Hlatsoa ha Gastric Hang-hang (ka nako ea metsotso e 60) le Multidose Activated Charcoal (MDAC):
2. Hobane lefu le ka holimo ho 0.5 ho 0.8 mg / kg le phahame haholo 'me dialysis e hlōleha, lingaka li etsa tlhahiso ea pele ea nasogastric aspiration / lavage haeba mokuli a fihla ka hare ho hora ea 1 ea ho kenngoa le ho fana ka mashala a sebetsang (50 g qalong, e lateloa ke 25 g lihora tse ling le tse ling tse peli ho isa ho tse 4) hammoho le IV ho kena-kenana le biliary
3. Resuscitation ea Pele ea Hemodynamic e Matla le VA-ECMO:
4. Phetoho e kholo ea mokelikeli oa crystalloid (0.9% normal saline kapa Ringer's lactate) ho tataisoa ke echocardiography ea bethe nakong ea Phase 1, ho fetela ka potlako ho ** norepinephrine / epinephrine infusions ** le mathoasong a **Veno-Arterial Extracorporeal Membrane Oxygenation (VA-ECMO) ** haeba refractory cardiogenic shock e tsoela pele Phase 2 (VA-ECMO e bolokile mg / microcardia ea bona e mengata ho fihlela bakuli ba bangata ba 80 ba bolokang microcardio ea bona. e nchafalitsoe ka mor'a matsatsi a 5 ho isa ho a 7).
5. Sehlopha sa Pele sa Granulocyte Colony-Stimulating (G-CSF / Filgrastim) le Litlhokomelo tsa Neutropenic Sepsis:
6. Pele kapa hang ha palo ea lisele tse tšoeu tsa mali e qala ho theoha ka Letsatsi la 2 ho isa ho la 3, litsebi tsa mali le litsebi tsa chefo li fana ka letsatsi le letsatsi ka subcutaneous kapa intravenous filgrastim.G-CSF, 5 mcg/kg/letsatsi) ho susumetsa lisele tse setseng tsa moko oa masapo le ho khutsufatsa nako ea lefu la neutropenia, hammoho le lithibela-mafu tse kenang ka har'a methapo e mengata.cefepime, piperacillin-tazobactam, kapa meropenem) le tšelo ea liplatelete.
7. Likaroloana tsa Patlisiso tsa Colchicine-Specific Fab Antibody: Litsing tse khethiloeng tsa Europe tsa toxicology (Fora), liteko maqetšoana a Fab a colchicine-specific ovine (e hlophisitsoeng ka ho tšoana le Digibind/DigiFab e sebelisetsoang ho feta tekano ea digoxin) e ntšitse ka katleho colchicine ka ntle ho lisele le lethapo la cardiogenic ha le fumanoa ka har'a moroto. melaoana.

Linomoro tsa libaka tsa tšohanyetso le liprothokholo tsa mekhatlo¶

• United States le Canada: Letsetsa 911 le US Taolo ea Chefo ho 1-800-222-1222 (Canada: 1-844-POISON-X). US Food and Drug Administration (FDA) Colcrys (Colchicine) Safety Labeling e fana ka taelo e tiileng 1.8 mg maximum 3-tablet acute gout flare cap (1.2 mg e lateloe ke 0.6 mg 1 hora hamorao) mme e jara li-contraindications tsa Black Box khahlanong le tšebeliso e kopanetsoeng ea colchicine le CYP3A4/P-gp li-inhibitors (clarithromycin, ritonavir/Paxlovid, cyclosporine) ho bakuli ba nang le bothata ba ho renal kapa sebete.
• United Kingdom: Letsetsa 999 hang-hang bakeng sa leha e le efe eo ho belaelloang hore ke colchicine kapa Colchicum overdose. UK Medicines and Healthcare Products Regulatory Agency (MHRA) le National Poisons Information Service (NPIS / TOXBASE) li khetholla ho feta tekano ea colchicine ka boomo kapa ka phoso e le ts'ohanyetso ea bophelo bo botle e hlokang ho amoheloa sepetlele hang-hang, Multidose Activated Charcoal, le bonyane lihora tse 24 tsa pelo / biochemical observation.
• European Union: Letsetsa 112. European Alliance of Associations for Rheumatology (EULAR) ditataiso tsa gout le French Poison Control / European Association of Poisons Centers and Clinical Toxicologists (EAPCCT) protocols e lebisang tekanyetso e tlase ea colchicine, ho qoba macrolide ka thata, le ho fetisetsoa pele ho ICU/VA-ECMO bakeng sa ho noa >= 0.5 mg/kg.
• Australia le New Zealand: Letsetsa 000 naheng ea Australia (Boitsebiso ba Chefo 13 11 26) kapa 111 New Zealand (0800 764 766). Therapeutic Goods Administration (TGA) le Medsafe NZ li hlokomelisa ka matla khahlanong le "ho nka ho fihlela lets'ollo" dosing ea gout.
• India le Asia-Pacific: Letsetsa 112 India, 995 Singapore, 119 Japane le Korea Boroa, kapa 999 Malaysia le Hong Kong. India le Sri Lanka, Gloriosa superba (Karthigai Kilangu / Niyagala) chefo ea tuber ke sesosa se tsebahalang sa chefo e matla ea pancytopenia le cardiogenic shock e hlokang ho romelloa hanghang sepetleleng sa thuto e phahameng. Sheba bukana ea rona ea dinomoro tsa matjhaba tsa tshohanyetso.

Lipotso tse botsoang khafetsa¶

U ka noa lipilisi tsa colchicine tse kae bakeng sa tlhaselo e matla ea gout?¶

FDA ea sejoale-joale le litataiso tsa machaba tsa rheumatology (tse ipapisitseng le teko ea kliniki ea AGREE) li tiisa hore tekanyo e phahameng e bolokehileng le e sebetsang bakeng sa lefu la gout e matla ho motho e moholo ea nang le liphio tse tloaelehileng le sebete ke matlapa a mabeli a 0.6-milligram (1.2 mg) a nooang ka lets'oao la pele la ho tuka, 'me a lateloe ke E LE 'NGOE feela ea tlatsetso ea 0.6-milligrams (0.6-milligram tablet - 0.1 mg ka mor'a hora e le 'ngoe). U tlameha ho ema 'me u eme bonyane lihora tse 72 pele u nka thupelo e 'ngoe e matla ea ho phatloha. Ho noa lipilisi tse 6, 10, kapa tse 15 ka letsatsi ha ho etse hore bohloko ba gout bo fele kapele mme ho ka baka chefo e bolaeang ea litho tse ngata.

Ke hobane’ng ha nakong e fetileng lingaka li ile tsa bolella bakuli ba gout hore ba ’ne ba noe colchicine hora e ’ngoe le e ’ngoe ho fihlela ba e-ba le letšollo, hona ke hobane’ng ha seo se ile sa emisoa?¶

Ka lilemo tse mashome pele ho etsoa liphuputso tsa sejoale-joale tse mabapi le lethal dose, lingaka li ne li haelloa ke mekhoa e meng e sireletsehileng ea ho thibela ho ruruha 'me li ne li itšetlehile ka molao o matla oa lekholong la bo19 la lilemo oa ho fana ka letlapa le le leng la colchicine hora e' ngoe le e 'ngoe ho fihlela mokuli a e-ba le letšollo le ho hlatsa ho matla. Litsebi tsa toxicologists tsa bongaka li ile tsa qetella li hlokometse hore letšollo le bakoang ke colchicine ha se phello e mpe ea lehlakore - ke pontšo e tobileng ea hore moriana o chefo 'me o bolaile lisele tsa stem tse arolang mala a hao a manyenyane, le hore lethal dose le bakang letšollo le feta ka ho toba le lethal dose le bakang ho hlōleha ha moko oa masapo le lefu la pelo le bolaeang.

Hobaneng ho le kotsi hakaale ho nka lithibela-mafu clarithromycin kapa COVID-19 Paxlovid ha u ntse u nka colchicine ea letsatsi le letsatsi?¶

'Mele oa hau o itšetlehile ka pompo ea cellular e bitsoang P-glycoprotein le enzyme ea sebete e bitsoang CYP3A4 ho pompa colchicine ka ntle ho lisele tsa hau ka har'a bile le moroto e le hore e se ke ea haha. Clarithromycin (Biaxin), erythromycin, lithethefatsi tsa antifungal joalo ka itraconazole, le karolo ea ritonavir ea COVID-19 Paxlovid li koetse ka botlalo P-glycoprotein le CYP3A4. Haeba u lula u noa lipilisi tsa hao tse tloaelehileng tsa 1 kapa 2 tsa letsatsi le letsatsi tsa colchicine ha u ntse u noa clarithromycin kapa Paxlovid, colchicine e tšoasa ka hare ho pelo ea hao le moko oa masapo ka makhetlo a 3 ho isa ho a 4 a tloaelehileng, a baka chefo e bolaeang ka mor'a matsatsi.

Haeba motho a ile a koenya lipilisi tse eketsehileng tsa colchicine lihora tse 3 tse fetileng mme a ntse a ikutloa a tloaelehile ka 100%, na ba tsoile kotsing?¶

Che - fensetere eo e se nang matšoao ke leraba le kotsi ka ho fetisisa la chefo ea colchicine. Colchicine e nka lihora tse 2 ho isa ho tse 12 ho senya li-spindles tsa microtubule ka har'a lisele tsa mala tse arohaneng, kahoo mokuli e mong le e mong o ikutloa a phetse hantle lihora tse 'maloa tsa pele ka mor'a ho metsa tekanyo e bolaeang. Ho ema lapeng ho fihlela ho hlatsa ho matla le letšollo le nang le mali ho qala ho bolela hore chefo e se e tsoile maleng 'me e notleletsoe ka mokhoa o ke keng oa khutlisoa ka har'a mesifa ea pelo le moko oa masapo, moo dialysis e ke keng ea fihla ho eona. Ho ea kamoreng ea maemo a tšohanyetso nakong ea lihora tse 1 ho isa ho tse peli tse khutsitseng bakeng sa mashala a kentsoeng ho ka pholosa bophelo ba mokuli.

Ke joang batho ba kenang chefo ka phoso ke limela tsa Autumn Crocus kapa Gloriosa Lily?¶

Nakong ea selemo, makhasi a chefo a Autumn Crocus (Colchicum autumnale) a mela makhulong a mongobo haufi le konofolo ea naha e jeoang (Allium ursinum / ramps); Li-forage tse sa nkhang lekhasi le leng le le leng bakeng sa monko oa konofolo ka phoso li kopanya makhasi a Colchicum ho pesto kapa sopho ea konofolo. Libakeng tsa tropike le tsa tropike (le malapeng a nang le likhahla tse khabisang), li-tubers tse ka tlas'a lefatše tsa Flame Lily (Gloriosa superba) li shebahala joalo ka litapole tse nyane, li-yam, kapa motso oa ginger, 'me ho ja le halofo ea tuber ho fana ka tekanyo e kholo, e bolaeang ea colchicine.

Mehloli le tataiso ea semmuso¶

• ** Tsamaiso ea Lijo le Lithethefatsi tsa US (FDA, United States):** Ho Hlalosa Tlhahisoleseding le Tataiso ea Meriana bakeng sa Matlapa a Colcrys (Colchicine, USP) le *FDA Puisano ea Tšireletseho ea Lithethefatsi: Likamano tse Bolaeang tsa Lithethefatsi Pakeng tsa Colchicine le P-Glycoprotein / Strong CYP3A4 Inhibitors (Clarithromyrine, Cyclospos)
• Terkeltaub RA et al. (Arthritis & Rheumatism, The AGREE Trial): *High Versus Low Dosing of Oral Colchicine for Early Acute Gout Flare: Mashome a Mashome a Metso a Metso ea Metso ea Lihora tsa Sephetho sa Pele sa Multicenter, Randomized, Double-Blind, Placebo-Controlled, Parallel-Group, Collel-Group, Collal-Group.
• Finkelstein Y, Aks SE, Hutson JR, Juurlink DN, Baud FJ et al. (Clinical Toxicology): Colchicine Poisoning: Lehlakore Le Lefifi la Sethethefatsi sa Boholo-holo (Bismuth/Baud-based weight-based mg/kg lefu la stratification, tsoelo-pele ea kliniki ea 3-mohato, ho tsosolosoa ha enterohepatic, Multidose Activated Charcoal, le tlhokomelo e matla ea G-CSF / VA-ECMO).
• Meriana le Lihlahisoa tsa Bophelo bo Botle Regulatory Agency (MHRA) & National Poisons Information Service (NPIS, United Kingdom): Ntlafatso ea Tšireletseho ea Lithethefatsi: Colchicine - Intremely Narrow Therapeutic Index le Kotsi ea ho Fatal Overdose.
• Mokhatlo oa Lefatše oa Bophelo (WHO) & Tataiso ea Litsi tsa Chefo: Taolo ea Kliniki ea Chefo ea Semela: Colchicum autumnale (Autumn Crocus), Gloriosa superba (Flame Lily), le Podophyllum peltatum (Podophyllin Resin).

Litataiso tse amanang¶

• Ho ja li-mushroom tse hlaha, amatoxin le ho ja limela tse chefo
• Neutropenic fever, tšoaetso ea chemotherapy, le maemo a tšohanyetso a bongaka a oncologic
• Kotsi e mpe ea liphio, rhabdomyolysis, le tlhahlobo ea moroto o lefifi
• Chefo ea lijo, lefu la sethoathoa se matla, le ho felloa ke metsi 'meleng
• Thuso ea pele e chefo le ho pepesehela chefo