Tetrodotoxin le Saxitoxin Chefo: Pufferfish, Blue-Ringed Octopus, le Paralytic Shellfish.¶

Tetrodotoxin (TTX) le saxitoxin (STX) ke tse ling tsa li-neurotoxin tse se nang protheine tse matla ka ho fetisisa tlhahong, tse khonang ho baka ka potlako ho holofala ha methapo ea kutlo le ho tšoaroa ka ho felletseng ka phefumoloho nakong ea metsotso e 15 ho isa ho e 90 ea lijo tsa leoatleng kapa ho kopana le chefo. Ho ba le monyetla oa ho ja pufferfish e sa lokisoang hantle (fugu), ho longoa ho se bohloko ke octopus e nang le blue-ringed octopus (Hapalochlaena mefuta) sebakeng sa Indo-Pacific tide pool, kapa ho ja bivalve shellfish (mussels, clams, oyster, scallops, kapa geoducks) e nang le likokoana-hloko tse kotsi (PSP), mokhoa o behang bophelo kotsing o ts'oana: thibelo e tsoelang pele ea liteishene tsa sodium tse nang le voltage-gated methapong ea motlakase le mesifa ea marapo, e fellang ka ho holofala ha diaphragmatic le ho tšoaroa ha pelo ea hypoxic. Habohlokoa, hobane ha ho tetrodotoxin kapa saxitoxin e tšelang mokoallo oa mali-bokong a motho ka bongata bo boholo, ** motho ea shoeleng litho ka ho feletseng ea nang le bana ba tsitsitseng, ba phutholohileng le ho phefumoloha ho sa tloaelehang o lula a tseba, a falimehile, 'me a khona ho utloa le ho utloa ntho e' ngoe le e 'ngoe e mo potileng ka liperesente tse 100. Haeba mang kapa mang a e-ba le melomo kapa leleme ka mor'a ho ja lijo tsa leoatleng kapa ho sebetsana le bophelo ba leoatleng, letsetsa sebaka sa heno dinomoro tsa tshohanyetso hang-hang 'me u itokisetse ho phefumoloha ka mokhoa o tsoelang pele (CPR). Hape hlahloba litataiso tsa banab'eno ho botulism, ciguatera, scombroid, le chefo ea neurotoxin ea shellfish, ho chefo thuso ea pele, le ho kgaruma.

Ntho e tlang pele bophelong ba hau ke ho hlokomela hore ** bohatsu kapa lithapo le linale tsa molomo le leleme ka mor'a metsotso e seng mekae ea lijo tsa leoatleng kapa ho loma octopus ke tlhokomeliso e kholo ea ho holofala ha mesifa ea ho hema **, beha motho ea hlasetsoeng sebakeng sa ho hlaphoheloa ha a hlatsa kapa a rothisoa ke metsi, sebelisa khatello ea Australian Immobilization Bandage hang-hang, 'me hang-hang u fane ka octopus. **melomo-to-molomo e sa sitisoeng kapa phefumoloho e sa sitisoeng ea bag-valve-mask ** nako eo ho hema ho fetoha ho sa tebang kapa ho emisa.

Etsa sena hona joale¶

1. Letsa nomoro ea hau ea tšohanyetso ea sebakeng sa heno hang-hang ha u qala ho lla ka molomo, leleme, kapa menoana ka mor'a ho ja pufferfish, shellfish, kapa reef invertebrates, kapa ka mor'a ho tšoara octopus e nyenyane. dinomoro tsa tshohanyetso. Bolella motho ea romelang molaetsa ka ho hlaka: *"Ho belaelloang hore ke tetrodotoxin kapa chefo ea khetla ea paralytic, kotsi e kholo ea ho tšoaroa ka potlako ea hohema, tsela e tsoetseng pele ea moea le moea o kenang o hlokahalang hang-hang."*
2. *KHAOTSA ho ja lijo tsa leoatleng tse belaelloang hang-hang, lemosa e mong le e mong ea arolelaneng lijo, 'me u boloke sampole ea tlhapi e tala kapa e phehiloeng, likhofu, kapa mahlatsa ka sejaneng se tiisitsoeng bakeng sa ho hlahloba chefo ea sechaba. U se ke ua lahla lijo tse setseng; boitsebiso bo potlakileng ba laboratori ea tetrodotoxin kapa saxitoxin e tataisa tlhokomelo e matla ea sepetlele le ho thusa sechaba ho hopola maemo a tšohanyetso a libethe tsa likhofu tse silafetseng.
3. **Haeba ho pepeseha e le ho loma ho tswa ho octopus e ringed blue (kapa khofu) letsohong kapa leotong, tlola letlapa le tiileng la Pressure Immobilization (PIB) hang-hang 'me u qhekelle leoto le khutsitse. leoto lohle le thibane ha leqaqailaneng le thinyehileng (le tiile ka ho lekaneng hore le ka liehisa metsi a chefo ea lymphatic ntle le ho khaola methapo ea mali), le etsa hore leoto le se ke la sisinyeha ka khohlo e thata, 'me mokuli a lule a khutsitse ka ho feletseng.
4. *Le ka mohla u se ke ua etsa hore motho a hlatse, le ka mohla u se qobelle motho ea otselang kapa ea hlephang hore a noe metsi, lebese kapa mashala lapeng, ebe o etsa hore mokuli ea tenehileng a be lehlakoreng la hae.
5. Sheba botebo ba ho phefumoloha 'me u lekanye metsotsoana e meng le e meng e 60,' me u qale ho phefumoloha ka mokhoa o tsoelang pele (kapa CPR e feletseng haeba maqhubu a lahlehile) ho phefumoloha hang-hang ho fetoha ho sa tebang, butle, kapa ho khaotsa. Haeba mokuli a khaotsa ho phefumoloha, khutlisetsa hlooho morao, phahamisa selelu, tsitlella nko, 'me u fane ka phefumoloho e le 'ngoe ea pholoso metsotsoana e meng le e meng e 5 ho isa ho e 6 bakeng sa ho phahama ha motho e moholo ka metsotsoana e 10 ho isa ho e 1. Haeba o sa utloe ho otla ha carotid nakong ea metsotsoana e 10, qala ka botlalo CPR ka 30 sefubeng compressions ho 2 pholosa phefumoloho.
6. *Bua ka khutso, ka mokhoa o khothatsang, le ka mokhoa o sa khaotseng le mokuli ea shoeleng litho, ’me u lemose baoki le lingaka hore motho ea hlokofalitsoeng o falimehile haholo ka hare ho ’mele o shoeleng litho. Esita le haeba lehlatsipa la tetrodotoxin kapa saxitoxin le sitoa ho bula mahlo, ho bua, ho sisinya monoana, kapa ho hema, esita le haeba bana ba bona ba tsitsitse le ho phutholoha, lentsoe le leng le le leng le ka hare ho phaposi ea bona ea ho utloa le khona ho hema. le ho utloa mekhoa e bohloko ntle le haeba ho fanoa ka sedation e nepahetseng le analgesia nakong ea intubation.

Sefate sa liqeto: ho belaelloa hore ho na le neurotoxin ea metsing le tlhahlobo ea ho tšoaroa ha phefumoloho¶

flowchart TD
    A["Lijo tsa morao-rao tsa lijo tsa leoatleng tsa leoatleng kapa ho kopana le letamo la maqhubu"] --> B{"Mohloli oa pepesetso e ne e le ofe?"}
    B -->|Bite or handling of small octopus or cone snail| C["TTX ea 'mala o moputsoa oa octopus kapa khofu e bitsoang conotoxin"]
    B -->|Ate pufferfish, toadfish, globefish, or horseshoe crab eggs| D["Chefo e kentsoeng ea Tetrodotoxin (TTX)."]
    B -->|Ate mussels, clams, oysters, scallops, or whelks| E["Chefo ea Shellfish e Kenyelitsoeng ea Paralytic (Saxitoxin)"]
    C --> F["Kenya Pressure Immobilization Bandage + leoto le qhekellang hang-hang"]
    D --> G["Emisa lijo, boloka mohlala oa lijo, boloka mamello e ntse e le ka lehlakore"]
    E --> G
    F --> H{"Sheba tsela ea moea, ho koenya le ho phefumoloha metsotsoana e meng le e meng e 60"}
    G --> H
    H -->|Perioral tingling, slurred speech, drooling, weak cough| I["Bitsa EMS hang-hang: kotsi e kholo ea ho tšoaroa ke phefumoloho ka 15 ho 60 min"]
    H -->|Shallow breathing, cyanosis, or respiratory arrest| J["Qala ho phefumoloha hang-hang (phefumoloho e le 'ngoe ka metsotsoana e 5 ho isa ho e 6) kapa CPR e felletseng"]
    I --> K["Boloka NPO (ho se letho ka molomo), ho monya kapa ho ntša mathe sebakeng sa ho hlaphoheloa"]
    J --> L["Khothalletsa mokuli ka lentsoe le phahameng: ba lula ba elelloa 100% leha ba shoele litho"]
    K --> M["Sepetlele ICU: Endotracheal intubation le sedation + 24 ho 72 hr ventilation"]
    L --> M

Pathophysiology ea limolek'hule: kamoo Tetrodotoxin (TTX) le Saxitoxin (STX) li holofatsang 'mele¶

Ho utloisisa mokhoa oa cellular oa tetrodotoxin le saxitoxin ho hlalosa hore na ke hobane'ng ha lefu le hlaha ka potlako ntle le tšehetso ea moea le hore na ke hobane'ng ha ho fola ka ho feletseng haeba matšoafo a kene ka moea ho fihlela ho tlosoa ha renal.

1. Guanidinium cork blockade ea liteishene tsa sodium tse nang le voltage-gated¶

Ka bobeli tetrodotoxin (319 Daltons) le saxitoxin (299 Daltons) ke guanidinium alkaloids e qhibilihang ka metsing e tlamahanang le nanomolar affinity ho Sebaka sa 1 se bulang pore ea extracellular ea likanale tsa voltage-gated sodium (NaV) holim'a mesifa ea methapo ea kutlo, lera la motho.

• The molecular cork ka botlolong: Ha boko bo romela taelo tlase ho mothapo oa phrenic ho kontraka diaphragm, voltage-gated sodium channels (NaV 1.1, NaV 1.2, NaV 1.4, NaV 1.6, and NaV 1.7) bula ka axon ho phatlalatsa matla a tšebetso ea motlakase. The guanidinium moiety e chehiloeng hantle ea tetrodotoxin kapa saxitoxin e kenella ka har'a sefe e ka ntle ea khetho (Ring ea DEKA) ea pore ea sodium e kang cork e phunyeletsoeng molaleng oa botlolo.
• Ho khutsa ho felletseng ka motlakase: Li-ion tsa sodium li thibiloe ka 'mele ho kena axon. Methapo ea kutlo e khaotsa ho fetisa ho ama ka mor'a ho phatloha ha pele ho fosahetseng (paresthesias), 'me methapo ea motlakase le mesifa ea masapo ha e khone ho thunya bokhoni ba ho thunya, e leng se bakang tsoelo-pele e potlakileng ** ho holofala ha mesifa ea masapo **.

2. Ke hobane'ng ha pelo e batla e hanyetsa ho fihlela hypoxia e hlaha¶

Mesifa ea masapo a motho le methapo ea peripheral e hlalosa ** TTX-sensitive sodium channel ** (NaV 1.4 le NaV 1.6 / NaV 1.7), e koetsoeng ke likhahla tse nyenyane tsa nanomolar (1 ho 10 nanomolar) ea tetrodotoxin. Ka lehlakoreng le leng, mesifa ea pelo ea motho e hlalosa haholo ** cardiac sodium channel isoform NaV 1.5 **, moo phapang e le 'ngoe ea amino acid (cysteine ​​ho Domain I) e etsang hore mocha oa pelo ** 200 ho linako tse 1,000 li se ke tsa mamela tetrodotoxin **. Ka litekanyetso tse holofatsang ka ho feletseng diaphragm le maoto le matsoho, **pelo ea motho ea hlasetsoeng e tsoela pele ho otla ka boeona ** ho fihlela ho haelloa ke ho hema ho baka hypoxemia e matla ea arterial hypoxemia le asphyxial cardiac arrest (le hoja ho kenngoa ka matla Mothating oa 4 ho ka baka kutloelo-bohloko ea vasomotor blockade, hypotension, le bradycardia).

3. Hobaneng ha mohlaseluoa a lula a falimehile ka 100% 'me a hlaphohetsoe kelellong (Locked-In Pseudocoma)¶

Hobane tetrodotoxin le saxitoxin li nyane e qhibilihang ka metsing (hydrophilic), limolek'hule tsa polar li qosoa hantle ho pH ea 'mele (7.4), ** ha li tšele habonolo mokoallo oa boko ba motho o nang le lipid **.

• Esita le ha mesifa e 'ngoe le e' ngoe ea 'mele ea boithaopo e le karolo ea 100 lekholong e holofetseng le ho thibela parasympathetic ho baka ** barutoana ba tsitsitseng, ba atolositsoeng (mydriasis) ** le li-absent corneal reflexes, ** mokuli o falimehile ka ho feletseng 'me o khona ho utloa moqoqo o mong le o mong le ho utloa molamu o mong le o mong oa nale kapa lehare la intubation **.
• Batho ba pele ba arabelang ha baa lokela ho ** le ka mohla ** ho fana ka maikutlo a se nang tšepo haufi le mokuli, ba tlameha ho theipi kapa ho tlotsa mahlo, 'me lingaka tsa tšohanyetso li tlameha ho fana ka ** intravenous sedation le analgesia e feletseng ** (propofol, midazolam, kapa ketamine plus fentanyl) pele ho intubation le ho pholletsa le moea oa mechine.

4. Mocheso o feletseng le botsitso ba lik'hemik'hale¶

Ka bobeli tetrodotoxin le saxitoxin ** li tsitsitse mocheso ka botlalo ebile li na le asiti e tsitsitseng**. **Ho pheha, ho halika, ho baka, ho chesa, ho pheha ka khatello, ho halika ** (100 ho 200 likhato tsa Celsius, kapa 212 ho isa ho 392 degrees Fahrenheit), ** leqhoa le leqhoa ** (-20 ho ea ho -80 likhato Celsius, kapa -4 ho -112 likhato tsa Fahrenheit), kapa ** marinating ka asene kapa lero la limero le lero la lemone le nang le lero la limero, lero la lemone le ka hare ho motho. 1.5 ho isa ho 2.0) ha e li robe. Pufferfish kapa shellfish e silafetseng e shebahala, monko, le tatso **100 lekholong e tloaelehileng le e ncha **.

Matšoao a maholo a ho pepeseha: Pufferfish, Blue-Ringed Octopus, le Paralytic Shellfish¶

Pufferfish (Fugu) le non-fugu Tetrodotoxin ho kenngoa¶

Moo Tetrodotoxin e ipatang ka har'a tlhapi ea pufferfish le linthong tse ling tsa metsing¶

Pufferfish (lelapa la Tetraodontidae, le tsejoang e le fugu Japane, bok-eo Korea, hetun naheng ea China, le blowfish kapa toadfish libakeng tse buang Senyesemane) li fumana TTX ho tsoa ho libaktheria tsa leoatleng ka ketane ea lijo ebe li e tsepamisa ka har'a liprotheine tse tlamang ka har'a litho tsa bona.

1. Litho tse Bolaeang (Sebete le Mahe a Mae): Mefuteng e mengata ea Takifugu e sebelisoang lijong tsa Majapane,** sebete (kimo)** le movary / mahe (roe) li na le metsoako e bolaeang ea tetrodotoxin, moo 1 ho ea ho 2 milligram ea crystalline tetrodotoxin ea motho. ** mala ** le letlalo le tsona li na le lintho tse bolaeang. Japane, ho sebeletsa sebete sa pufferfish (fugu kimo) ho thibetsoe ho tloha ka 1984, 'me ke baapehi ba nang le mangolo feela ba ka lokisang mefuta e amohelehang; hoo e ka bang lipolao tsohle tsa Majapane tsa fugu tsa sejoale-joale li etsahala ha batšoasi ba litlhapi ba sa tsebeng letho ba lokisetsa pufferfish hae kapa ba ja sebete se hanetsoeng.
2. Mefuta e Hlasehang le e Chefo ea Nama (Lagocephalus sceleratus le North American Puffers): Mehleng e mengata e ka ntle ho temo ea metsing e laoloang, mesifa e tšoeu ka boeona e na le metsoako e bolaeang ea tetrodotoxin kapa saxitoxin:
3. Toadfish e marameng a silevera (Lagocephalus sceleratus): Tlhapi e hlaselang ea Indo-Pacific e ileng ea falla ka Suez Canal ho ea Leoatleng la Mediterranean (Greece, Turkey, Cyprus, Israel, Lebanon, Egypt, Italy, Spain). E na le litekanyo tse kholo tsa tetrodotoxin ho **ma ea mesifa **, litho le letlalo, e baka chefo e bolaeang har'a li-anglers tsa Mediterranean.
4. (Gulf of Mexico)
5. Li-Non-Pufferfish Tetrodotoxin Vectors:
6. Mangrove Horseshoe Crab (Carcinoscorpius rotundicauda): E fumaneha Thailand, Vietnam, Cambodia, le Malaysia; e batla e ts'oana le khalala e jeoang ea coastal horseshoe (Tachypleus gigas) empa e na le tetrodotoxin e bolaeang le saxitoxin maheng a eona.
7. Likokoanyana tsa Marine Gastropods, Sea Slugs, and Newts: Likhofu tsa khoeli tse hlabang, likhofu tsa manaka a tlou, le likhetla tsa terompeta Asia le Europe li bokella TTX litšoeleseng tsa tsona tsa ho sila lijo le leoto la mesifa; the grey side-gilled sea slug (Pleurobranchaea maculata) e hohola New Zealand le mabopo a Australia a nang le TTX e bolaeang; le matlapa a macha (Taricha granulosa) a US Pacific Northwest le British Columbia a ntša tetrodotoxin e bolaeang letlalong la tsona la mokokotlo.

The Fukuda le Tani 4-Stage Clinical Grading System¶

Baoki ba beha tsoelo-pele ea tetrodotoxin ka ho sebelisa Methati e 4 ea Fukuda le Tani Grading Scale. Haeba Mothati oa 1 ho tsikinyeha ha molomo ho qala nakong ea metsotso e 10 ho isa ho e 20 ka mor'a ho ja, ho fetela Mothating oa 4 oa ho hema ho ka etsahala nakong ea metsotso e 30 ho isa ho e 60.

1. *
2. Kereiti ya 2 (Advancing Numbness and Early Motor/Bulbar Weakness): Bohatsu bo aparela sefahleho, molala, kutu le maoto le matsoho, ka maikutlo a hore mmele o phaphametse moyeng. Bofokoli ba pele ba motlakase bo baka bothata ba ho tsamaea (ataxia), matla a fokolang a ho tšoara, puo e hlabang (**dysarthria ), bothata ba ho metsa mathe ( dysphagia ), mahlo a mahlo a thellang ( ptosis **), le tahlehelo ea cornea reflex.
3. Kereiti ea 3 (Ho holofala ho Hoholo ha Flaccid le Ho Hloleha ho Haufi ha ho Phefumoloha): Ho se khone ho ema ka ho feletseng, ho lula, kapa ho phahamisa maoto le matsoho, ka tahlehelo ea li-tendon reflexes tse tebileng (areflexia) le ho lahleheloa ke lentsoe (aphonia). Ho holofala ha mesifa ea intercostal le ho fokola ha diaphragm ho baka ** phefumoloho e sa tebang (hypoventilation) **, dyspnea, ho se khone ho khohlela, ho theoha ha oxygen saturation (ka tlase ho karolo ea 90 lekholong), hypercapnia, cyanosis, le hypotension. Mokuli o lula a hlaphohetsoe ka ho feletseng.
4. Kereiti ya 4 (Tshwaro e Feletseng ya ho Phefumoloha, Ho se tsitse ha Cardiovascular, le Pseudocoma): Ho holofala ho felletseng ha diaphragmatic (apnea, ho phefumoloha ho se nang letho). Ntle le phefumoloho e potlakileng ea pholoso kapa moea o kenang ka mochini, ho ts'oaroa ha pelo ea hypoxic ho etsahala nakong ea 3 ho metsotso ea 5. Thibelo ea ciliary ganglion le methapo ea kutlo e baka ** barutoana ba tsitsitseng, ba atolositsoeng (mydriasis) ** le ho se be teng ha gag, khohlela, corneal, le oculocephalic reflexes, hammoho le arterial hypotension le sinus bradycardia. Ntle le haeba hypoxia ea boko e etsahala pele moea o qala, cortex ea boko e lula e falimehile 'me e khona ho utloa ka hare ho' mele o sa sisinyeheng.

Blue-Ringed Octopus (Hapalochlaena) e loma le Australian Pressure Immobilization¶

Ho elelloa sebupuoa le leraba la ho loma le khutsitseng¶

Octopus e nang le boputsoa e na le mefuta e mene e menyenyane ea leloko la Hapalochlaena (H. maculosa karolong e ka boroa ea Australia, H. lunulata ka leboea ho Australia le Indo-Pacific ho tloha Indonesia le Philippines ho ea Japane, H. fasciata haufi le Australia bochabela, le H. nierstraszi): - Boemo bo bonyenyane le pontsho ya temoso: Mmele o boholo ba bolo ya kolofo (disentimetara tse 4 ho isa ho tse 6, kapa 1.5 ho isa ho 2.5 inch), ka bophara ba letsoho ba disentimitara tse 10 ho isa ho tse 20 (4 ho isa ho 8 inches). Li ipata ka har'a libotlolo tse lahliloeng, makotikoti, likhetla tsa leoatleng le matangoaneng a majoe a sa tebang. Ha li phomotse, li bonahala li le sootho; ha feela li hukutsoa kapa li nkuoa moo li-chromatophore li benyang **50 ho isa ho 60 masale a boputsoa bo boputsoa bo boputsoa bo botala bo boputsoa bo boputsoa **. - Ho longoa ho khutsitseng le ente e potlakileng ea TTX ea mathe: Molomo oa chitinous o lutse ka tlas'a tepo ea matsoho. Ho loma ha eona ho nyane hoo **ba fetang halofo ea bahlaseluoa ba utloang bohloko bo le sieo kapa pinprick e fokolang feela **, ba hlokomela feela milimithara e 1 ho isa ho 2 (0.04 ho 0.08 inch) ea mali kapa ho phunya monoana kapa leoto. Libaktheria tsa Symbiotic ka har'a litšoelesa tse ka morao tsa mathe li etsa tetrodotoxin, e kentsoeng ka har'a li-capillaries le lymphatic, e baka ** ho tsieleha ha nako, ho bona lerootho, le ho ts'oaroa ha moea ka botlalo nakong ea metsotso e 5 ho isa ho e 15 **.

Mohato ka mohato Protocol ea Australian Pressure Immobilization Bandage (PIB).¶

Ho fapana le jellyfish stings kapa fish punctures, ho loma ka blue-ringed octopus sting (kapa cone snail sting) ke neurotoxic envenomation e hlokang hore hang-hang Pressure Immobilization Bandaging (PIB) ANZCOR Tataiso 9.4.8:

1. ** Boloka motho ea hlokofalitsoeng a khutsitse ka ho feletseng 'me u mo robatse fatše:** Ho tsamaea kapa ho sotha leoto ho etsa hore pompo ea mesifa ea skeletal e sebetse 'me e potlakisa ho monya ha lymphatic TTX.
2. O SE KE wa hlatswa, wa seha, wa anya kapa wa itlotsa ka sesebediswa: Le ka mohla o se ke wa kgaola phallo ya madi kapa wa senya nako ho hlatswa leqeba.
3. Beha letlapa la 1 holim'a ho loma 'me u tlamelle leoto lohle 2: Koaela lesela le sephara (lisenthimithara tse 10 ho isa ho tse 15 kapa bophara ba lisenthimithara tse 4 ho isa ho tse 6) ka thata holim'a ho loma, ebe u phuthela ho tloha menoaneng kapa menoaneng ho ea fihla lepheong kapa mokokotlong ka har'a tsitsipano e sebelisetsoang ho otla letsoho ho tloha ho 50 ho isa ho 500H. 70 mmHg leoto). Netefatsa ho tlatsoa hape ha capillary ka metsotsoana e 2 le li-pulse tsa distal.
4. Tlatsa lesela le thata 'me u tlohe sebakeng seo ho fihlela ICU e se e loketse moea oa moea: Tlama lehare le thata leotong, tšoaea moo ho lomang holim'a tlamisa, 'me **u se ke ua tlosa tlamisa ho fihlela mokuli a le ka har'a kou ea sepetlele ea ho khutlisa moea a e-na le thepa ea ho intubation e se e loketse **.

Paralytic Shellfish Poisoning (PSP) le Saxitoxin¶

Paralytic Shellfish Poisoning (PSP) e etsahala haufi le mabopo a Pacific le Atlantic a Amerika Leboea (Alaska, British Columbia, Washington, Oregon, California, Maine, Massachusetts, and Maritime Canada), Chile, Argentina, UK, Europe, South Africa, Japan, Philippines, New Zealand, le Australia.

• Tlhahiso ea Dinoflagellate: Algae e nang le sele e le 'ngoe ea metsing (Alexandrium catenella, Alexandrium tamarense, Gymnodinium catenatum, le Pyrodinium bahamense) synthesize saxitoxin (STX) le 50+ gonyautoxin analogue. Li-filter-feeding bivalves (mussels, butter clams, razor clams, littleneck clams, soft-shell clams, geoduck, oyster, scallops, le cockles) li tsepamisa saxitoxin ka har'a litšoelesa tsa tsona tsa ho sila lijo le li-siphons. Li-gastropods tse jang liphoofolo (whelks, likhofu tsa khoeli, abalone) le crustaceans (Dungeness crab, rock crab, le lobster hepatopancreas kapa tomalley) le tsona li bokella saxitoxin e bolaeang.
• Hobaneng ha litlhahlobo tsa metsi tse bonoang li sa atlehe: Shellfish e bokella saxitoxin e bolaeang (li-microgram tse fetang 80 ka ligrama tse 100 tsa nama) esita leha metsi a leoatle a bonahala a hlakile ka 100 lekholong. Pacific butter clam (Saxidomus gigantea) e boloka saxitoxin ka har'a siphon ea eona bakeng sa ho isa ho lilemo tse 1 ho isa ho tse 2 ka mor'a hore palesa ea algal e nyamele, 'me ho ja matlapa a feletseng kapa a roe-on ho tsoa metsing a se nang leihlo ho na le kotsi e feletseng ea lefu la PSP.

Tlhahlobo e fapaneng: TTX le Saxitoxin vs Ciguatera, Scombroid, Botulism, le Anaphylaxis¶

Prehospital le sepetlele resuscitation: mohato ka mohato protocol ea kliniki¶

1. Boemo ba hang-hang tseleng ea moea le ho phefumoloha ha pholoso (Mehato ea 1 ho isa ho ea 4)¶

• Etsa mokuli hore a se ke a hlatsa: Mokuli ea nang le bulbar palsy a ke ke a sireletsa trachea ea hae 'me o tla lakatsa metsi kapa a hlatse matšoafong a hae. Beha mokuli sebakeng sa **lateral recumbent (ho hlaphoheloa) ** haeba ho nyekeloa ke pelo kapa ho kopana ha mathe ho etsahala.
• Ho phefumoloha ho sa khaotseng ha pholoso le moea oa Bag-Valve-Mask (BVM): Qala moea o thusoang hang ha phefumoloho e fetoha e sa tebang, e makatsang, kapa butle (ka tlase ho 8 phefumoloho ka motsotso), kapa haeba mokuli a sa khone ho bala ho 5 ka moea o le mong. Beha motho ea hlokofalitsoeng mokokotlong oa bona, etsa ** hlooho-tilt / chin-lift **, penya nko, 'me u fane ka ** 1 phefumoloho ea pholoso metsotsoana e meng le e meng e 5 ho ea ho 6 (phefumoloho e 10 ho ea ho 12 ka motsotso) ** bakeng sa motho e moholo (kapa ** phefumoloho e le 'ngoe metsotsoana e meng le e meng ea 2 ho ea ho 3 ** bakeng sa ngoana), ho shebella ho phahama ha sefuba. Hlahloba hape lebelo la carotid metsotso e meng le e meng e 2; haeba pulse e lahlehile, qala ka ho tlala CPR (30 compressions ho 2 phefumoloho).

2. Taolo ea ICU ea sepetlele: ho intubation, sedation, le ho felisa renal¶

1. Intubation ea Pele ea Endotracheal e nang le Sedation e Tlamang: Hlahloba seriana Negative Inspiratory Force (NIF) le Bokhoni bo Bohlokoa bo Qobelitsoeng (FVC) hammoho le carbon dioxide e qetellang (EtCO2). Intubate ka boikhethelo haeba FVC e oela ka tlase ho 15 ho isa ho 20 mL/kg kapa NIF e fokolisa nakong e fetileng -25 ho -30 cmH2O, kapa hang-hang bakeng sa ho kopanya bulbar kapa hypoventilation. Hobane mokuli o elelloa ka ho feletseng ka har'a 'mele o shoeleng litho, fana ka sedative induction sedative (etomidate, ketamine, kapa propofol) pele ho laryngoscopy le ho boloka intravenous sedation le analgesia nakong eohle ea moea oa mechine.
2. Sehlahisoa sa Gastric Gastric Lavage le Mashala a Kentsoeng (Ka Metsotso e 60 Feela): Bakeng sa ho kenngoa ka molomo ho hlahisa nakong ea hora e le 1, **feela ka mor'a hore ho kenngoe endotracheal tube e kentsoeng **, baoki ba ka hlatsoa nasogastric hamonate 'me ba kenya **charcoalkg e kentsoeng, e fihlang ho 1 g, ho fihla ho 1g) tetrodotoxin le saxitoxin.
3. ** Tšehetso ea Hemodynamic le Renal Clearance: ** Phekola Grade 4 hypotension le bradycardia ka ** isotonic IV crystalloid boluses **, ** norepinephrine ** kapa ** phenylephrine ** infusions, le **IV atropine ** (0.5 ho 1.0 mg). Ha ho na antivenine ea motho ea khoebo e teng bakeng sa tetrodotoxin kapa saxitoxin (IV neostigmine 0.05 mg/kg e nang le atropine ka linako tse ling e sebelisoa e le tlatsetso, empa ha e nke sebaka sa moea). Chefo ka bobeli e ntšoa e sa fetohe ke liphio ka glomerular filtration (kapa e hlakoloa ke hemodialysis ka ho hloleha ha renal). Ho phefumoloha ho itlelang feela ho khutla ka hare ho **12 ho lihora tse 24 **, ho lumella extubation ka hare ho **24 ho lihora tse 72 ** ka tšenyo e sa feleng ea methapo ea kutlo.

Linomoro tsa libaka tsa tšohanyetso le liprothokholo tsa mekhatlo¶

• United States le Canada: Letsetsa 911 hang-hang bakeng sa ntho leha e le efe e belaelloang ea pufferfish, shellfish, kapa marine neurotoxin. Ikopanye le US Taolo ea Chefo ho 1-800-222-1222 kapa Setsi sa Poison sa Canadian sa profinse, 'me u tlalehe thekiso ea likhofu kapa litlhapi tse silafetseng ho Lefapha la Bophelo la Naha le FDA (1-888-SAFEFOOD).
• Australia le New Zealand: Letsetsa 000 Australia kapa 111 New Zealand. Etsa kopo Letlapa la ho Thibela Khatello (ANZCOR Tataiso 9.4.8) bakeng sa ho loma leha e le efe e pherese e putsoa kapa khofu, 'me u letsetse Setsi sa Boitsebiso sa Poisons sa Australia (13 11 26) kapa New Zealand National Poisons Center (0800 764 766).
• United Kingdom: Letsetsa 999 bakeng sa ambulense ea Sehlopha sa 1. Baoki ba buisana le NPIS / TOXBASE mme ba tsebise UKSA Health Security Agency (UKHSA) le Setsi sa Maemo a Lijo (FSA).
• European Union: Letsetsa 112 ho pholletsa le linaha tsohle tseo e leng litho tsa EU. Ha u le lebopong la leoatle la Mediterranean, tlaleha ho jeoa ha tlhapi e bitsoang silver-cheeked toadfish (Lagocephalus sceleratus) hang-hang hore lihlopha tsa ICU li itokisetse ho holofala ka potlako ha tetrodotoxin.
• Japan, Korea Boroa, le Asia-Pacific: Letsetsa 119 Japane le Korea Boroa, 995 Singapore, 999 Malaysia le Hong Kong, 1669 Thailand, kapa 112 / 108 India. Tlaleha tse belaelloang fugu (Takifugu), mangrove horseshoe crab (Carcinoscorpius), kapa chefo ea likhofu hang-hang.

Lipotso tse botsoang khafetsa¶

Ke hobane'ng ha motho ea chefo ea pufferfish kapa octopus e nang le blue-ringed octopus a ntse a utloa le ho utloa ntho e 'ngoe le e' ngoe le ha a shebahala a akhehile ka bana ba tsitsitseng?¶

Tetrodotoxin le saxitoxin ke limolek'hule tse nyenyane, tse nang le qoso e ntle, tse qhibilihang ka metsing tse thibelang liteishene tsa sodium tse nang le voltage-gated ho peripheral motor, sensory, le autonomic nerve ka ntle ho boko, li holofatsa mesifa e 'ngoe le e' ngoe ea masapo ho akarelletsa le diaphragm, lithapo tsa lentsoe, mahlo le mesifa ea iris e tlamang bana. Hobane limolek'hule tsena tsa polar ha li khone ho tšela mokoallo oa boko ba lipid, cerebral cortex e lula e falimehile. Hafeela phefumoloho ea pholoso kapa mochine o kenang ka mochine o boloka oksijene e phalla bokong, mokuli ea shoeleng litho o utloa lentsoe le leng le le leng ka kamoreng 'me o hloka kholiseho e feletseng le sedation ka methapo nakong ea ho intubation.

Na ho belisa, ho halika, ho hatsetsa, kapa ho marinating pufferfish kapa red-tide mussels ka lero la lemone li senya tetrodotoxin kapa saxitoxin?¶

Che. Ka bobeli tetrodotoxin le saxitoxin ke li-alkaloid tse tsitsitseng mocheso le acid e tsitsitseng. Ho belisa shellfish ka likhato tse 100 tsa Celsius (212 degrees Fahrenheit), ho halika ka botebo, ho apeha ka tlas’a khatello, ho hatsetsa, kapa ho ineloa ka aseneng kapa lero la lamunu ha ho senye kapa ho fokolisa chefo, ’me lijo tsa leoatleng tse silafetseng li shebahala, monko le tatso e tloaelehileng ka ho feletseng.

Ke hobane'ng ha u phuthela Bandage ea Pressure Immobilization ka ho loma octopus e boputsoa, ​​ha u sa lokela ho phuthela e le 'ngoe holim'a jellyfish sting?¶

Octopus e nang le 'mala o moputsoa e kenya tetrodotoxin e qhibilihang metsing ka molomo oa eona ka har'a lisele tse ka tlase ho letlalo, moo chefo e tsamaeang ka methapo ea mali ho ea bohareng ba mali ho holofatsa diaphragm ka mor'a metsotso e seng mekae. Ho kenya lesela le tiileng la Pressure Immobilization Bandage holim'a ho loma le holimo leoto le arohaneng ho theola lymphatic e ka holimo le ho liehisa ho holofala ha tsamaiso ho fihlela lisebelisoa tsa sefofane sa sepetlele li fihla. Ka lehlakoreng le leng, li-jellyfish nematocysts li lula holim'a letlalo, moo ho phuthela letlapa la khatello ho pshatla li-capsules tse hlabang tse sa chesoang ebe ho kenya chefo e eketsehileng letlalong.

A na ho na le antivenom kapa antidote bakeng sa pufferfish tetrodotoxin, ho loma octopus e boputsoa, ​​kapa chefo ea likhetla tsa paralytic?¶

Ha ho antivenom ea khoebo kapa antidote ea lik'hemik'hale e lumelletsoeng ho sebelisoa ke batho khahlanong le tetrodotoxin kapa saxitoxin. Ho e-na le hoo, phekolo e nepahetseng e pholosang bophelo ke ea hang-hang, e sa sitisoeng ea moea oa maiketsetso, ho qala ka ho phefumoloha ha molomo ho ea molomong kapa mokotla-valve-mask ea pholoso sebakeng sa ketsahalo le ho fetela ho endotracheal intubation le mochine oa moea o kenang ka har'a ICU bakeng sa lihora tse 24 ho isa ho tse 72 ha liphio ka tlhaho li sefa ka har'a metsi a qhibilihang.

Matšoao a qala kapele hakae ka mor'a ho ja pufferfish e chefo kapa likhetla tse shoeleng litho, 'me u tsoa kotsing neng?¶

Ho hlohlona le ho tsieleha ha molomo, leleme le marenene hangata ho qala ka mor'a metsotso e 5 ho isa ho e 45 ka mor'a ho ja lijo tsa leoatleng tse silafetseng (kapa ka mor'a metsotso e 5 ho isa ho e 15 ka mor'a ho longoa ke octopus e putsoa). Haeba ho thothomela ho qala ka mor'a metsotso e 20, ho hema ka botlalo ho ka hlaha nakong ea metsotso e 30 ho isa ho e 90. Haeba motho a phela lihora tse 24 tsa pele a e-na le moea o lekaneng, ho fola ho batla ho phethehile hohle ka matsatsi a 1 ho isa ho a 3 a latelang ho se na tšenyo ea methapo e sa feleng.

Ke hobane'ng ha ho le kotsi ho ja tomalley e tala kapa e sootho (mosetareta) ka har'a makhala kapa li-lobster nakong ea keletso ea shellfish?¶

Makhala le makhala a ja li-clam le li-mussels tse fepelang fatše holim'a leoatle. Ha li-bivalves li na le saxitoxin e tsoang lithunthung tsa dinoflagellate, khala e tsepamisa saxitoxin ka har'a hepatopancreas ea eona, setho sa tšilo sa lijo se botala bo botala kapa sootho se tsejoang e le tomalley kapa crab mustard. Le hoja nama ea leoto la makhala e tšoeu e lula e le chefo e fokolang, ho ja hepatopancreas ho ka fana ka tekanyo e matla, e ka bang kotsi ea chefo ea likhetla tse shoeleng litho.

Mehloli le tataiso ea semmuso¶

• Litsi tsa Taolo le Thibelo ea Mafu (CDC, United States): CDC Yellow Book: Poisoning ea Lijo ho Tsoa Chefo ea Marine (Tetrodotoxin, Paralytic Shellfish Poisoning / Saxitoxin, Ciguatera, and Scombroid) le MMWR Clinical Case Reports on Pufferfish and Saxitoxin Poisoning.
• Australian Resuscitation Council (ANZCOR, Australia le New Zealand): ANZCOR Tataiso 9.4.8: Envenomation, Pressure Immobilisation Technique le Tataiso 9.4.5: Envenomation, Blue-Ringed Octopus le Cone Shell.
• Mokhatlo oa Lefatše oa Bophelo (WHO) le Mokhatlo oa Lijo le Temo (FAO): Likokoana-hloko tsa Leoatleng (FAO Food and Nutrition Paper 80: Paralytic Shellfish Poisoning / Saxitoxin le Tetrodotoxin Clinical Management).
• US Administration Food and Drug Administration (FDA, United States): Bad Bug Book: Foodborne Pathogenic Microorganisms and Natural Toxins, Saxitoxin (Paralytic Shellfish Poisoning) le Tetrodotoxin.
• Lekala la Bophelo bo Botle, Mosebetsi le Boiketlo (MHLW, Japane): Litaelo tsa Bophelo bo Botle ba Bongaka le Sechaba ka Pufferfish (Fugu) Tetrodotoxin Poisoning le Fukuda-Tani Staging.

Litataiso tse amanang¶

• Botulism, ciguatera, scombroid le shellfish neurotoxin chefo
• CPR le phefumoloho ea pholoso bakeng sa batho ba baholo
• CPR ya bana le masea le ho kgama
• Thuso ea pele ea chefo le tlhahlobo ea taolo ea chefo
• Linomoro tsa maemo a tshohanyetso ho ea ka linaha