Manioke (Linamarin Manioc kona) mo e 'Apilikoti Kernel (Amygdalin / Laetrile) 'Oku 'ai: Fakatoloi 'a e kona 'o e Gut Cyanide¶

Kai ta'etotonu 'a e fakamomoko pe 'oku 'ikai ke tunu manioke kona (Manihot esculenta, manioc/yuca), lamu ngaahi tengaʻi ʻēpilikoti kona, ngaahi luo ʻo e piisi/sieli/palamu kuo tuki, pe ʻalimoni kona, pe folo ʻa e faitoʻo kehe "Vitamini B17" (amygdalin pē laetrile) 'oku fakatupu 'e he ngaahi me'akai fakalahi 'a e fakatu'utamaki ki he mo'ui toloi 'a e gastrointestinal Hydrogen Cyanide (HCN) fakakonahi. Ta ki hoʻo fika fakavavevave fakalotofonuá (911 ʻi he ʻIunaiteti Siteití mo Kānata, 112 ʻi he kotoa ʻo e ʻIunioni ʻIulopé, 999 ʻi he Puleʻanga Fakatahatahá) pe vakai ki heʻemau . tohi fakahinohino fika fakavavevave fakavaha'apule'anga ‘i he taimi pē ko iá, pea tala ki he tokotaha ‘oku ‘ave ‘a e mahakí ‘oku fiema‘u ‘e he mahakí ‘a e Hydroxocobalamin (Cyanokit) pe ko e Kiti Fakafepaki‘i ‘o e Saianití (Sodium Thiosulfate / Sodium Nitrite). Lolotonga hoʻo tatali ki he kau toketā fakafaitoʻó, fakafeʻungaʻi hoʻo tokangaʻi vave mo ʻetau . cyanide mo e kasa fakangaue'anga inhalation 'uluaki tokoni fakahinohino, fakafaikehekehe‘i ‘a e toto kulokula ngingila ‘o e kona ‘o e cyanide mei he . methemokolopinemia sokoleti-lanumata, pea teuteu ki he . tu'unga epilepticus 'oku fuoloa 'a e puke pē CPR.

‘Oku ‘ikai ke hangē ia ko e kasa haitoloseni sainaite ‘oku mānava‘í (‘a ia ‘okú ne fakatupunga ‘a e holo ‘i loto ‘i he . 10 to 60 seconds), folo ** glycosides cyanogenic**, tautefito ki he linamarin (‘i he manioke kona, piini lima, mo e tenga‘i ‘akau flax) pe amygdalin / prunasin (‘i he ngaahi tenga‘i ‘ēpilikoti kona, ‘āmoni kona, ngaahi maka fua ‘o e Rosaceae, mo e ngaahi va‘a ‘o e ‘akau ko e ‘akaú), ‘oku ‘asi ai ha decept .30-minute to 4-hour faka'ilonga-ta'etotongi latency 'a e matapa**. Lolotonga e vaha'ataimi fakalongolongo ko 'eni, 'oku hydrolyze 'e he 'akau mo e 'enisaimi 'a e glycosides kuo folo 'i loto 'i he 'uto si'isi'i 'o e alkaline mo e kolona, 'o tukuange mai ha hokohoko atu, fakatupu mate 'o e ** haitoloseni cyanide (HCN)** ki he toto 'o e portal. 'Oku ha'i 'a e cyanide 'oku to'o 'aki 'a e affinity lahi ki he ferric (Fe3+) 'atomi ukamea 'o e maitokonitulia ** saitokolomu c 'okisiteisi (Complex IV)**, ‘o ta‘ofi faka‘aufuli ‘a e mānava ‘aerobic ‘a e selo neongo ‘oku kei fonu pē ‘a e ngaahi halanga totó mo e ngaahi veini ‘o e mahakí ‘i he ‘osikena (arterialization of venous blood). 'I he 'ikai ha pule'i vave 'o e 100% 'osikena fakalahi, faka'auha 'o e kete, mo e 'i he veini Hydroxocobalamin (5 grams IV) pe Sotiume Tiosulfeiti (12.5 grams IV) + Sotiume Naitalaiti (300 mg IV), 'oku vave 'a e fakalakalaka 'a e kau ma'ukovia mei he 'ohovale, lua, mo e tachypnea loloto 'o e hanu (Kussmaul breathing) ki he refractory ma'olunga-'onion-ava 'asitosi lactic (serum lactate > 8 to 10 mmol/L), ngaahi puke fakalūkufua, puke ‘a e bradycardic, mo e mate.

+-------------------------------------------------------------------------+
|       CYANOGENIC GLYCOSIDE DELAYED GUT CYANIDE TRIAGE TIMELINE          |
+-------------------------------------------------------------------------+
|  0 TO 60 MINUTES (THE SILENT ENZYMATIC HYDROLYSIS WINDOW):              |
|  * Victim eats bitter Apricot Kernels, Laetrile, or Bitter Cassava      |
|  * Plant beta-glucosidase (emulsin/linamarase) + Human gut microflora   |
|    cleave Amygdalin/Linamarin -> Mandelonitrile/Acetone Cyanohydrin     |
|    -> Lethal HYDROGEN CYANIDE (HCN) absorbed across intestinal wall     |
|  * Immediate Action: Call 911/112/999; give Activated Charcoal (< 1-2h) |
+-------------------------------------------------------------------------+
|  30 MINUTES TO 4 HOURS (ONSET OF CELLULAR HYPOXIA / HISTOTOXIC SHOCK):  |
|  * Early Signs: Headache, dizziness, anxiety, nausea/vomiting, cherry-  |
|    red flushed skin, tachycardia, and deep gasping hyperventilation     |
|  * Late Signs: Coma, tonic-clonic seizures, hypotension, bradycardia    |
|  * Lab Clues: Venous blood looks bright "cherry-red" (PvO2 > 50-60 mmHg)|
|    + Serum Lactate > 8 to 10 mmol/L (confirms acute cyanide poisoning)  |
+-------------------------------------------------------------------------+
|  DEFINITIVE HOSPITAL ANTIDOTAL RESCUE:                                  |
|  * Give 100% High-Flow Oxygen (ALWAYS safe & beneficial in cyanide)     |
|  * 1st Choice Antidote: IV Hydroxocobalamin (Cyanokit) 5 g (70 mg/kg)   |
|    + IV Sodium Thiosulfate 12.5 g (25% solution, 50 mL) for slow release|
|  * 2nd Choice Antidote: IV Sodium Nitrite (300 mg) + Sodium Thiosulfate |
+-------------------------------------------------------------------------+

Fai ʻeni he taimí ni .¶

1. Ta ki he ngaahi sevesi fakavavevave mo e Pule'i 'o e Kona 'i he taimi pe ko ia, neongo 'oku kei ongo'i 'oku angamaheni 'aupito 'a e tokotaha. Taila ki he 911 ('Amelika mo Kanata), 112 ('Iunioni 'Iulope), 999 (Pule'anga Fakatahataha), 000 ('Aositelelia), pe 111 (Nu'usila). Tala ki he tokotaha fakaʻiloá ʻa e meʻa pau naʻe folo (bitter apricot kernels, laetrile / amygdalin tablets, bitter cassava / manioc, pe . bitter almonds), ko e hā e lahi ʻo e ngaahi foʻi ʻakau pe kalami naʻe lamu, pea mo e taimi ʻo hono fakaʻaongaʻí koeʻuhí ke lava ʻe he falemahaki ʻoku tali ʻa e meʻakaí ʻo teuteuʻi ʻa e Hydroxocobalamin (Cyanokit) mo e Sotiume Tiosulfate 'i he feitu'u fakaakeake kimu'a pea toki tō 'a e mahaki.
2. 'Oua 'aupito na'a ke fakatupu 'a e lua, pea 'oua na'a teitei fakahoko 'a e fakaakeake 'o e ngutu ki he ngutu 'o 'ikai ha me'a fakapuli mata. Kapau 'oku lua ha taha mahaki na'a ne folo 'a e cyanogenic glycosides pe ngaahi masima cyanide, 'oku liliu 'e he 'esiti gastric 'a e cyanide ki he volatile hydrogen cyanide (HCN) kasa (which smells weakly like bitter almonds to the 40% to 60% of people genetically able to detect the odor). Kapau ‘oku tu‘u ‘a e mānava ‘a e mahakí, ngāue‘aki ha kato-valve-mask (BVM) pe ko ha me‘a fakapuli CPR ‘i he kato ‘oku ‘i ai ‘a e ‘osikena ‘oku tafe lahi kae ‘ikai ko e fetu‘utaki fakahangatonu ‘a e ngutu ki he ngutu.
3. Fakahoko 'a e tafe ma'olunga 100% 'Okisiseni 'i he taimi pe 'oku a'u mai ai 'a e kau toketaa. Neongo 'a e pulse oximetry (SpO2) ʻe lau . 98% to 100% koe‘uhi ‘oku ‘ikai lava ‘e he ngaahi sela kona ‘o to‘o ‘a e ‘osikena mei he totó, ‘o ‘oange ‘a e ** .100% normobaric 'osikena ** fakalahi 'a e 'osikena 'o e plasma 'oku fakamovetevete, fe'auhi mo e cyanide 'i he ngaahi feitu'u 'o e cytochrome c oxidase 'o e ha'i, pea fakalahi 'a e synergy 'o e sotiume thiosulfate mo e hydroxocobalamin.
4. Ta'ofi 'a e Vitamini C 'oku inu (Ascorbic Acid) ngaahi me‘a fakalahi. Kapau na‘e to‘o ‘e ha taha ‘a e ngaahi tenga‘i ‘ēpilikotí pe ngutu . laetrile, vakai'i pe na'a nau toe to'o foki 'a e Vitamin C 'oku lahi hono tu'unga. Vitamini C ‘oku lahi hono inu ‘i he ngutú (> 1 to 3 grams) fakavave'i 'a e liliu 'o e gastrointestinal 'o e amygdalin ki he haitoloseni cyanide pea fakasi'isi'i 'a e ngaahi falekoloa 'o e cysteine 'i loto 'oku fie ma'u 'e he 'enisaimi detoxifying rhodanese 'o e 'ate.
5. Tauhi 'a e kato, kato tenga'i 'akau, pe toenga 'o e aka manioke. 'Omi 'a e koniteina 'o e ngaahi tenga'i 'akau 'o e 'epilikoti, B17 hina fakalahi, pe ko e fo‘i manioke mata ki he potungāue fakavavevavé. Lau pe fakafuofua'i 'a e lahi totonu 'o e kernels 'oku kai: lamu pe ** .5 to 10 bitter apricot kernels 'i ha ki'i tamasi'i** pe ** .20 to 60 bitter apricot kernels (0.5 to 3.5 mg/kg ‘o e cyanide tatau) ‘i ha tokotaha lahi** ‘e lava ke ne fakatupu ‘a e kona ‘o e cyanide ‘oku fakatu‘utāmaki ki he mo‘uí pe fakatupu mate.

'Akau 'o e tu'utu'uni: Toloi 'a e gut cyanogenic glycoside triage mo e fili 'o e faito'o konatapu¶

flowchart TD
    A["Ko hono kai ‘o e Manioke Kona, Ngaahi Tenga‘i ‘Āpilikoti Kona, Ngaahi Luo Fua, pe Laetrile (Amygdalin)"] --> B{"Ko e Ha Na'e Ingested & Founga?"}
    B -->|"1-3 Ngaahi Luo Sieli/Plum/Peach 'oku te'eki ke tuki kakato pe ko ha ngaahi tenga'i 'akau 'o e 'Apele si'isi'i"| C["Fakatu'utamaki Ma'ulalo: 'Oku ta'ofi 'e he kote tenga'i 'akau 'oku kei hao 'a e tukuange 'o e Amygdalin; Fakatokanga'i 'i 'api tukukehe kapau 'oku lamu ."]
    B -->|"Lamu/Kelekele 'a e Ngaahi Tenga'i 'Apilikoti Kona, 'Amoni Kona, Laetrile Tablets, pe Manioke Kona"| D["FAKATU'UTAMAKI MA'OLUNGA KI HE TOLOI 'A E KONA 'O E GUT HCN (Latency 30 min ki he houa 'e 4)"]
    D --> E["Ta ki he 911/112/999; Faka'aonga'i 'a e 100% 'Okisiseni Ma'olunga-Tafe; 'Oange 'a e Malala Faka'aonga'i (1 g/kg 'o a'u ki he 50-100 g) kapau < 1-2 Houa pea 'Ā ."]
    E --> F["'Ota Stat Kasa Toto Veini (VBG), Kasa Toto 'o e 'Ati (ABG), Lactate 'o e toto, mo e Panel Metabolic Fakava'e"]
    F --> G{"Fakafuofua'i 'a e mamafa fakafaito'o & Serum Lactate"}
    G -->|"'Oku 'ikai ha faka'ilonga & Lakite < 3.0 mmol/L"| H["Fakatokanga'i 'i he ED/ICU ki he Houa 'e 6 ki he 12 Si'isi'i taha (Toloi 'a e Gut Hydrolysis); Toe fai 'a e Lakite q1-2h"]
    G -->|"Liliu 'a e Tu'unga Faka'atamai, Puke, Ma'ulalo 'a e toto, Tachypnea, PE Lactate >= 8-10 mmol/L"| I["TUKU VAVE 'A E ANTIDOTE ('OUA 'e tatali ki he ngaahi tu'unga 'o e lab cyanide)"]
    I --> J{"Ko e Fē ʻa e Faitoʻo Fakafaitoʻo ʻo e Cyanide ʻoku Maʻu Leva?"}
    J -->|"Haitolosokopalamini (Cyanokit) 'Oku ma'u (Fili 1)"| K["Fakahu 'a e Hydroxocobalamin 5 g IV (70 mg/kg 'i he fanau) 'i he 15 min + Tanaki atu 'a e sotiume Tiosulfate 12.5 g IV ki he hokohoko atu 'o e tukuange 'o e gut"]
    J -->|"Ko e Naitaliti pe + Tiosulfete Kit 'oku ma'u"| L["'Oange 'a e Sotiume Naitaliti 300 mg IV (10 mL 'o e 3%) 'i he 2-4 min (Siaki 'a e Hemokolopini 'uluaki) -> Muimui mo e Sotiume Tiosulfate 12.5 g IV"]

Pathophysiology: Founga 'oku liliu ai 'a e glycosides 'o e 'akau ki he Haitoloseni Sainaiti (HCN) ‘i loto ‘i he kete ‘o e tangatá .¶

Laka hake he 2,500 'oku synthesize 'e he ngaahi fa'ahinga 'o e 'akau cyanogenic glycosides ko ha malu'i fakakemikale fakanatula ki he fanga manu kai 'akau. 'I he lau 'o e fu'u 'akau 'oku kei hao, aka, pe tenga'i 'akau, 'oku tanaki malu 'a e cyanogenic glycoside 'i loto 'i he vacuoles 'o e selo, 'oku mavahe fakatu'asino mei hono ngaahi 'enisaimi hydrolytic fakatupu (beta-glucosidase pea . hydroxynitrile lyase), ‘a ia ‘oku tangutu ‘i he ‘ā ‘o e sela ‘o e fu‘u ‘akaú pe ko e saitoplasma.

1. Ko e sitepu 'e ua 'o e 'enisaimi 'o e Amygdalin mo e Linamarin .¶

+-------------------------------------------------------------------------+
|       BIOCHEMICAL CONVERSION OF AMYGDALIN & LINAMARIN TO CYANIDE        |
+-------------------------------------------------------------------------+
|                                                                         |
|  PATHWAY 1: APRICOT KERNELS, BITTER ALMONDS, PEACH/CHERRY PITS, LAETRILE|
|  Amygdalin (D-mandelonitrile-beta-D-gentiobioside)                      |
|      |                                                                  |
|      |  Step 1: Beta-Glucosidase (Plant 'Emulsin' when chewed OR        |
|      |          Human intestinal microflora beta-glucosidase in gut)    |
|      v                                                                  |
|  Prunasin + Glucose  --->  Mandelonitrile + Glucose                     |
|                                  |                                      |
|                                  |  Step 2: Hydroxynitrile Lyase OR     |
|                                  |  Spontaneous dissociation in         |
|                                  |  alkaline duodenum (pH > 6.5)        |
|                                  v                                      |
|              Benzaldehyde  +  HYDROGEN CYANIDE (HCN)                    |
|              (Almond odor)    (Lethal Complex IV inhibitor)             |
|                                                                         |
+-------------------------------------------------------------------------+
|  PATHWAY 2: BITTER CASSAVA (MANIOC / YUCA), LIMA BEANS, BAMBOO SHOOTS   |
|  Linamarin (alpha-hydroxyisobutyronitrile-beta-D-glucopyranoside)       |
|      |                                                                  |
|      |  Step 1: Linamarase (plant beta-glucosidase) OR Gut bacteria     |
|      v                                                                  |
|  Acetone Cyanohydrin + Glucose                                          |
|      |                                                                  |
|      |  Step 2: Hydroxynitrile Lyase OR Spontaneous breakdown at pH > 5 |
|      v                                                                  |
|  Acetone  +  HYDROGEN CYANIDE (HCN)                                     |
+-------------------------------------------------------------------------+

• Ko e ha 'oku ngutu ai Laetrile / Amygdalin ‘oku liunga 40 ‘ene kona ‘i he huhu ‘i he uoua . Laetrile: Na'e pehe 'e he kau poupou kākā 'o e "Vitamin B17" 'i he hisitōlia na'e malu 'a e laetrile koe'uhi ko e ngaahi huhu 'i he ngaahi uoua 'i he fanga monumanu na'e fakatupu 'e he si'isi'i taha 'o e kona vave. ‘I hono huhu * ‘i he uoua *, ‘oku fakalaka ‘a e amygdalin ta‘e‘aonga ‘i he halanga me‘akai pea ‘oku tukuange ia . > 90% ‘oku ‘ikai ke liliu ‘i he mimi koe‘uhi ‘oku ‘ikai ha ‘enisaimi beta-glucosidase ‘i he toto mo e ngaahi tisiū ‘o e tangatá. 'I he taimi 'oku to'o ai 'i he ngutu, ka neongo ia, 'oku ma'u 'e he kolonia 'o e tangata mo e fanga ki'i-'initestinal 'a e 'ekitiviti lahi 'o e beta-glucosidase. Neongo kapau ‘e fakavela ‘e ha taha ‘a e ngaahi tenga‘i ‘ēpilikotí ke faka‘auha ‘a e ‘akau ‘o‘oná . emulsin enzyme, pe folo fakama'a 'a e faito'o . laetrile ngaahi fo‘i ‘akau, ko honau fanga ki‘i pekitilia ‘i he ‘utó tonu ‘oku nau motuhi ‘a e glycoside . 1 to 4 hours kimui ange ʻi he ileum mo e kolona ʻi laló, ʻo tafea ʻa e veini ʻo e matapaá ʻaki ʻa e hydrogen cyanide fakatupu mate (HCN).
• Ko e ha 'oku kona ai 'a e manioke kona 'a e ngaahi famili lolotonga 'a e la'ala'aa mo e nounou 'o e me'akai: 'Oku fakakalasi 'a e ngaahi fa'ahinga manioke ki he manioke "melie" (< 50 milligrams 'o e HCN tatau mo e kilokalami 'o e aka fo'ou, 'oku tu'u lahi taha 'i he kili 'i tu'a) mo e "kona" manioke (100 to > 500 milligrams 'o e HCN ki he kilokalami 'oku tufaki 'i he kotoa 'o e kakano'i manu starchy). Lolotonga e ngaahi la'ala'aa lahi, 'oku fakalahi 'e he ngaahi fu'u manioke 'enau linamarin 'o liunga tolu ki he nima. Ko e teuteu tukufakaholo malu 'o e manioke kona 'oku fie ma'u ke peeling, grating/faka'auha, fakamomoko/fakafefeka 'i he vai 'i he 'aho 'e 3 ki he 5 (faka'ata 'a e endogenous linamarase ke liliu 'a e linamarin ki he 'asitoni saianohaitini), pea toki la'a-fakamomoa pe tunu 'i he vela lahi ke volatilize 'a e 'asitoni saianohaitini mo e . HCN kasa. Kapau ‘e tunu ‘e ha fāmili fiekaia ‘a e ngaahi aka manioke kona ‘oku te‘eki ke fakamomoko ‘aki pē ‘a e 100. 20 minutes, pe kai manioke kuo vaeua hono fakamomokó ‘i loto ‘i he . 24 hours, ‘oku faka‘auha ‘e he velá ‘a e . linamarase 'enisaimi kimu'a pea toki movete 'a e linamarini, 'o tuku 'a e linamarini mo e 'asetoni saianohaitoloni 'i he me'akai. ‘I hono folo pē, ‘oku ‘au‘auha fakafokifā ‘e he ‘asetoni cyanohydrin ‘o hoko ko ha me‘a fakatupu mate . HCN ‘i loto ‘i he duodenum ‘ākaliní, lolotonga ia ‘oku faka‘auha ‘e he fanga ki‘i pekitilia ‘o e ‘utó ‘a e linamarin ‘oku toé ‘i he ‘aho hoko maí . 2 to 6 hours.

Fakafehoanaki 'o e ngaahi ma'u'anga tokoni glycoside cyanogenic 'o e me'akai mo e kona fakafaito'o .¶

Fakatotolo 'i he tafa'aki mohenga: Founga ke fakapapau'i 'a e kona 'o e Cyanide 'o e Cyanide kimu'a pea toki foki mai 'a e ngaahi labs 'o e lave¶

Ko e sivi fakalukufua ‘o e cyanide ‘o e toto kakató ‘oku lau houa pe ‘aho ia ‘i he ngaahi fale fakatotolo fakakemi pea ‘oku ‘ikai ‘aupito ke ma‘u ia ‘i he taimi totonu ke tataki ‘aki ‘a e fakaakeake fakavavevavé. Fakapapau'i 'e he kau toketaa 'a e kona 'o e gut cyanide 'i he tafa'aki mohenga 'i he 2019. 5 minutes ʻo fakaʻaongaʻi ha ngaahi fakaʻilonga nima fakaʻilonga vave ʻe tolu:

1. "Arterialization" 'o e Toto Veini (Toto Veini Kulokula-Sieli mo e Fakapuliki A-V O2 Vahe)¶

• Founga: Koe'uhi 'oku loka'i 'e he cyanide 'a e mitochondrial saitokolomi c 'okisitesi (Complex IV) 'i hono oxidized ( ).Fe3+) tu‘unga, ‘oku ‘ikai lava ‘e he ngaahi tisiū ‘o e tafa‘akí ke to‘o ‘a e ‘osikena mei he ‘osihemokolopini ‘oku paasi.
• Faka'ilonga 'i he tafa'aki mohenga: 'I he taimi 'oku to'o ai 'e he neesi pe phlebotomist ha peripheral sipinga toto 'o e veini, 'oku 'asi 'a e toto 'o e veini ngingila "cherry-red" ('ikai lava ke fakafaikehekehe'i mei he toto 'o e 'alati) kae 'ikai ko e toto 'o e veini 'uli'uli-kulokula.
• Fakapapau'i 'o e kasa toto: Fakafehoanaki ha taimi tatau Kasa Toto 'o e Arterial (ABG) mo e lotoloto/fakakatakai Kasa Toto Veini (VBG):
• Lolotonga 'a e arterial . PaO2 mo e okisimeti ‘o e mafú (SpO2) kei angamaheni pē (97% to 100%) 'i he kamata'anga, 'a e saturation 'o e 'osikena 'o e veini (ScvO2 pē SvO2) laka hake ʻi he 85% to 90% mo e veini PvO2 laka hake 50 to 60 mmHg.
• Ko e kehekehe 'o e 'osikena arteriovenous (A-V O2 gradient) fakapuliki ki he si‘i hifo ‘i he . 1 to 2 vol%, fakamo‘oni‘i ‘a e hypoxia ‘o e selo histotoxic (shared only by cyanide, hydrogen sulfide, sodium azide, and high-oxygen resuscitation).
• Fakapapau'i 'e he fundoscopic: 'Oku fakahaa'i 'e he ophthalmoscopy fakahangatonu 'o e mata 'a e ngaahi veini 'o e mata 'oku lanu kulokula ngingila tatau tofu pe mo e ngaahi halanga toto 'o e mata.

2. Lakiteti 'o e toto >= 8 to 10 mmol/L (Ko e Fakaʻilonga Fakafetongi ʻo e Tuʻunga Koulá)¶

• Koe'uhi ko e aerobic . ATP 'oku tapuni 'a e synthesis (producing only 2 ATP molecules per glucose via anaerobic glycolysis instead of 36 ATP), 'oku liliu vave 'e he ngaahi selo 'a e pyruvate ki he 'esiti lactic.
• Na'e fokotu'u 'e he ngaahi ako fakafaito'o 'o e toxicology (Baud et al., Tohinoa 'o e faito'o 'o 'Ingilani Fo'ou) 'i ha mahaki kona 'oku 'ikai kohu-inhalation, ko ha plasma lactate 'o e . >= 8 mmol/L (72 mg/dL) (pe >= 10 mmol/L 'i he huhu kohu) kuo ** .> 90% ongo'ingofua mo e pau ki he kona 'o e cyanide 'o e 'uto lahi** (blood cyanide > 40 micromoles/L pē > 1.0 mg/L) pea correlates linearly mo e kavenga 'o e cyanide 'i loto 'i he selo.

3. Ko e Biphasic Hemodinamika mo e Kuva 'o e Mānava .¶

• Konga 1 (Faka'ai'ai 'o e Chemoreceptor 'i he kamata'anga, 30 to 90 minutes): 'Oku faka'ai'ai fakahangatonu 'e he saianaiti 'a e ngaahi kemikale 'o e sino 'o e carotid, 'o fakatupu ha fakafokifā "saianaiti gasp" pea muimui 'i he faka'ilonga'i hyperventilation / tachypnea (Kussmaul breathing), sinus tachycardia, toto ma'olunga, mamahi 'ulu, vertigo, puputu'u, mo e fulufulua.
• Konga 2 (Faka'auha 'o e Hypoxic Tuai, 1 to 4 hours): Hange ko e loto selo . ATP 'oku holo 'i he 'uto mo e myocardium, 'oku liliu fakafokifā 'a e mahaki ki he ** apnea / bradypnea **, ** bradycardia loloto 'o e sinus pe poloka AV **, ** hypotension lahi 'o e ngaahi halanga toto **, ngaahi puke fakalukufua 'o e tonic-clonic, tu'unga 'o e 'uto, mo e pulseless electri (PEA) pe ko e asistoli.

Fakasitepu-ki-he-sitepu 'a e Falemahaki 'o e Falemahaki mo e Polokalama Faka'auha 'o e 'uli¶

Koe'uhi 'oku hokohoko atu 'a e gut hydrolysis 'o e amygdalin mo e linamarin 'i he houa 'i loto 'i he 'uto ('ikai hange ko ha taimi 'e taha 'o e huhu 'o e . HCN kasa), faito'o 'o e fu'u 'akau cyanogenic glycoside kona 'oku fie ma'u fakatou'osi 'a e fakahaofi vave 'o e faito'o konatapu 'i he veini PEA hokohoko atu 'a e decontamination 'o e gastrointestinal + infusion 'o e sulfur-donor 'oku loloa.

+-------------------------------------------------------------------------+
|       TWO COMPLEMENTARY ANTIDOTAL MECHANISMS FOR GUT CYANIDE            |
+-------------------------------------------------------------------------+
|  1. HYDROXOCOBALAMIN (CYANOKIT - VITAMIN B12a PRECURSOR):               |
|     Hydroxocobalamin (Co3+ - OH)  +  Cyanide (CN-)                      |
|                     |                                                   |
|                     v  (Direct equimolar chelation in blood & cells)    |
|     Cyanocobalamin (Vitamin B12 - Non-toxic, excreted in crimson urine) |
|     * Pros: Instant onset, does NOT lower blood pressure, does NOT form |
|       methemoglobin (safe in children, pregnancy, and anemia)           |
+-------------------------------------------------------------------------+
|  2. SODIUM THIOSULFATE (SULFUR DONOR FOR HEPATIC RHODANESE):            |
|     Thiosulfate (S2O3 2-) + Cyanide (CN-) ---[Rhodanese]---> Thiocyanate|
|     * Pros: Provides continuous sulfur substrate to detoxify ongoing    |
|       slow release of HCN from apricot kernels or cassava in the gut    |
|     * CRITICAL RULE: Infuse Hydroxocobalamin and Sodium Thiosulfate     |
|       through SEPARATE IV lines (or flush thoroughly between them)      |
+-------------------------------------------------------------------------+

Sitepu 1: Faka'auha 'o e kete (Activated Charcoal pea . Gastric Lavage)¶

• Neongo malala 'oku faka'aonga'i 'oku 'i ai ha kalama-ki-kalami 'oku ma'ulalo 'aupito 'a e malava ki he potasiume cyanide ma'a 'o e inorganic (1 gram of charcoal adsorbs -35 mg of KCN), ngaahi faito‘o anga-maheni ‘o e kakai lalahí (50 to 100 grams 'o e malala 'oku faka'aonga'i) faingofua adsorb 'a e lahi 'o e milikalami fakatupu mate 'o e ** 'ikai-hydrolyzed amygdalin, linamarin, pea fakatau'ataina'i . HCN** 'i he kete pea fakalakalaka lahi 'a e mo'ui 'i he ngaahi kona 'o e 'ahi'ahi mo e fakakiliniki.
• Kapau 'oku 'asi mai 'a e mahaki 'i loto ** .1 to 2 hours** 'o e ingesting 'a e ngaahi tenga'i 'akau 'o e 'epilikoti kona kuo tuki, ngaahi fo'i 'akau laetrile, pe manioke kona, malu'i 'a e halanga 'ea (intubate kapau 'oku obtunded) pea fakahoko gastric aspiration/lavage ke to'o fakasino 'a e ngaahi konga 'o e tenga'i 'akau 'oku kei toe, pea muimui atu 'i he taimi pe ko ia 'a e Malala 'oku faka'aonga'i (1 gram/kg, ʻo aʻu ki he 100. 50 to 100 grams).

Sitepu 2: ʻUluaki-Laine ʻo e Faitoʻo Fakafaitoʻo ʻi he Uoua: Hydroxocobalamin (Cyanokit)¶

Haitolosokopalamini (Cyanokit) ko e faito'o 'uluaki-laine 'oku manakoa 'e he mamani kotoa pe ki he kona 'o e cyanide 'i he kotoa 'o 'Amelika Tokelau, 'Iulope, Pilitania, mo 'Aositelelia koe'uhi he 'oku ne ha'i fakahangatonu 'a e cyanide 'i loto 'i he selo mo e intravascular ke fa'u 'a e cyanocobalamin (Vitamin B12) ‘o ‘ikai ke ne fakangaloku ‘a e hemokolopini ‘oku ‘ave ‘a e ‘osikena pe fakatupu ‘a e ‘ohovale vasoplegic ‘oku fakatupu ‘e he nitrites.

• Tu'unga 'o e kakai lalahi: Toe fakafoki 5 kalama (one 5 g vial pē two 2.5 g vials) 'o e Haitolosokopalamini 'i he 1990. 200 milliliters 'o e 0.9% sotiume kololaite pea fakahu 'i he veini 'i he 15 minutes (-15 mL/minute).
• Tu'unga 'o e fanau: Fakahu 70 milligrams per kilogram (70 mg/kg, ‘o a‘u ki ha tu‘unga ‘uluaki lahi taha ‘o e . 5 grams) 'i he veini 'i 'olunga 15 minutes.
• Fakahokohoko'i 'o e Toe Dosing ki he Toloi 'o e Gut Hydrolysis: 'I he 'epilikoti kernel, laetrile, pe kona 'o e manioke kona, 'oku fa'a a'usia 'e he kau mahaki ha rebound 'o e cyanide . 2 to 6 hours hili ‘a e ‘uluaki . 5 g Hydroxocobalamin faito'o 'i he hokohoko atu 'a e pekitilia 'o e intestine 'o e glycosides 'oku 'ikai ke 'i he kolona. Kapau ko e ‘asitosi lēkití (> 4 mmol/L), hypotension, pe koma ‘oku toe hoko pe ‘oku kei hokohoko atu, ‘ai ha sekoni . 5 gram (70 mg/kg fakafaitoʻo ʻo e fānaú) ʻo e tuʻunga ʻo e Haitolosokopalamini ʻo laka hake ʻi he 100. 15 minutes to 2 hours.
• Ngaahi nunu'a 'oku 'amanaki ke hoko (Chromaturia ta'efakatupu maumau & Fakalavea 'a e Lapi): Ko e Hydroxocobalamin ko ha lanu kulokula-kulokula malohi. ‘Okú ne liliu leva ‘a e kili ‘o e mahakí, lo‘imatá, fulufulu‘i‘akaú, plasma, mo e mimi ‘o loloto kulokula-kulokula (chromaturia) mo e 2 to 7 days (pea aʻu ki he 28 days ‘i he mimi). Fakatokanga ki he fale fakatotolo fakakemi 'oku fakalavea'i 'e he hydroxocobalamin 'a e ngaahi sivi lanu ki he creatinine, bilirubin, transaminases, magnesium, mo e carboxyhemoglobin/methemoglobin co-oximetry, to'o 'a e ngaahi paipa toto 'o e baseline kimu'a pe pea kamata 'a e huhu kulokula.

Sitepu 3: Co-Pule'i 'o e sotiume Thiosulfate 'i he 'uto (12.5 Grams)¶

Koe'uhi ko e 'enisaimi fakanatula 'o e sino 'oku ne faka'auha 'a e kona, ko e mitochondrial rhodanese (thiosulfate sulfurtransferase) 'i he 'ate mo e uoua 'o e hui, vave 'a e lele 'a e kau foaki 'o e sulfur endogenous lolotonga 'a e absorption 'o e glycoside 'o e gut 'oku fuoloa, 'oku ne fakahoko 'a e Sotiume Thiosulfate 'i he veini 'oku ne 'omi ha tokonaki ta'efakangatangata 'o e sulfane sulfur ke liliu 'a e cyanide ki he ta'efakatu'utamaki thiocyanate (SCN-), ‘a ia ‘oku tukuange mai ‘e he ngaahi fatú: * Tu'unga 'o e kakai lalahi: 12.5 grams (50 milliliters 'o ha 25% Sotiume Tiosulfate fakalelei'i) 'oku fakahu 'i he veini 'i he 10 to 30 minutes. * Tu'unga 'o e Fanau: 250 milligrams per kilogram (1.0 mL/kg 'o e 25% fakaleleiʻi, pe . 412.5 mg/kg [1.65 mL/kg] 'o fakatatau ki he hydration 'o e founga, 'o a'u ki he 100. 12.5 grams) 'i he veini 'o 'olunga 'i he . 10 to 30 minutes.

Sitepu 4: Polokalama kehe 'o e faito'o fakafepaki ('I he taimi 'oku 'ikai ke ma'u ai 'a e Hydroxocobalamin): Sotiume Nitrite + Sotiume Thiosulfate (Nithiodote) pe ko e Tikopaleti ‘Eteti (Kelocyanor)¶

‘I he ngaahi vahefonua langalanga hake lahi ‘a ia ‘oku hoko ai ‘a e ngaahi mahaki manioke kona, pe ‘i he ngaahi kiliniki ‘i he tukui koló ‘oku ‘ikai ha . Cyanokit, 'oku faka'aonga'i 'e he kau toketaa 'a e kalasi 'o e sitepu 'e ua Nitrite + Thiosulfate founga: 1. Amili Naitaliti (Halafakakavakava 'oku huhu kimu'a pea toki hū ki he IV): Faka'auha ha ampoule 'o e amili naitaliti (0.3 mL) ‘i he gauze pea puke ia ‘i lalo ‘i he ihu ‘o e mahakí (pe ‘i ‘olunga ‘i he hū‘anga ‘o e kato-valve-mask) ki he . 15 to 30 seconds 'o e miniti kotoa pe lolotonga hono fokotu'u 'o e IV access. 2. Sotiume Naitalaiti 'i he veini (3% fakalelei): * Funga ngaue: Oxidizes 10% to 20% ‘o e hemokolopini ukamea ‘oku tafe holo (Fe2+) ki he methemokolopini ukamea (Fe3+). Koe'uhi 'oku 'i ai ha affinity ma'olunga 'a e cyanide ki he . Fe3+, 'oku to'o 'e he methemokolopini 'a e saianaite mei he mitokonilia 'o e saitokolome c 'okisitesi ke fa'u 'aki 'a e saianomethemokolopini. * Tu'unga 'o e kakai lalahi: 300 milligrams (10 milliliters 'o e 3% Sotiume Naitalaiti) 'oku fakahu 'i he veini 'i he 2 to 4 minutes (siofi ofi ‘a e toto mā‘olungá, he ‘oku fakatupu ‘e he nitrites ‘a e vasolation mālohi mo e holo ‘a e toto mā‘olungá). * Tu'unga Fakafaito'o 'o e Fānau (Must Adjust for Hemoglobin to Prevent Fatal Methemoglobinemia): 6 to 10 mg/kg (0.2 to 0.33 mL/kg 'o e 3% fakalelei'i, lahi taha 300 mg), fakasi‘isi‘i pau kapau ‘oku ‘anemia ‘a e ki‘i tamá (hemoglobin < 10 g/dL). Siviʻi ʻa e tuʻunga ʻo e methemokolopiní ʻi he . 30 minutes pea tauhi 'a e methemoglobin fakakatoa ke pau 'i lalo . 20% to 30%. 3. Sotiume Tiosulfate 'i he veini (25% solova'anga): Muimui leva (after flushing the line) mo e 12.5 grams (50 mL 'o e 25% fakaleleiʻi; fakafaitoʻo ʻo e fānaú 1.0 to 1.65 mL/kg) ke liliu tu'uma'u 'a e cyanmethemoglobin ki he tiocyanate 'o e mimi. 4. Ko e Tikopaleti ʻEteti (Kelocyanor - Sitoka Tukufakaholo 'a Pilitania/Komuniuelí): Pule'i ko e 300 mg (20 mL) IV 'i 'olunga 'i he . 1 minute muimui atu leva ‘i he . 50 mL 'o e 50% Tekitolosi. Koe'uhi 'oku fakatupu 'e he kopaleti ta'etotongi 'a e ngaahi mahaki lahi 'o e loto, 'ea 'o e fofonga/'o e ngutu, mo e hypotension kapau 'oku 'ikai ha cyanide 'i he toto, Kuo pau ke 'oatu PE 'a e Dicobalt Edetate ki he kau mahaki 'oku 'ikai ha veiveiua, kona fakafaito'o 'o e cyanide 'o hange ko e prophymla, pe kau mahaki.

Teuteu malu 'o e Manioke mo e ngaahi fakangatangata fakalao ki he Ngaahi Tenga'i 'Apilikoti .¶

• Founga ke detoxify 'a e Manioke Kona 'i 'api (Ko e WHO / FAO "Founga Fakamomoko"):
• Grate pe pauni 'a e aka 'o e manioke peeled ki ha mash lelei pe mahoa'a (rupturing 'a e ngaahi 'ā 'o e selo ko ia linamarase fetu'utaki linamarin).
• Fakamomoko / fakafefeka 'a e mash 'i he vai ki he . 3 to 5 days (pe kapau 'oku ke ngaue'aki 'a e mahoa'a manioke kuo 'osi fakamomoa 'oku kei ifo kona, fefiofi 'a e mahoa'a mo e vai ki ha fakapipiki manifinifi 'oku 'i ai 'a e vai pea fakamafola ia 'i ha la'i manifinifi 'i he malumalu ki he 5 hours ʻi he 30 degrees Celsius ko ia toenga linamarase 'oku ne faka'auha 'a e linamarin ki he 'asetoni 'oku 'ikai ke 'i ai ha 'uhinga).
• Vela pe tunu fakalelei 'i ha ipu 'oku fakaava ko ia 'oku kotoa 'a e 'asetoni cyanohydrin mo e . HCN 'oku 'alu 'a e kasa ki he 'ea, pea li'aki 'a e vai 'oku fakamomoko/fakavela.
• Ngaahi fakatokanga fakalao ki he Ngaahi Tenga'i 'Apilikoti Kona:
• Na'e fokotu'u 'e he Ma'u Mafai ki he Malu 'o e Me'akai 'a 'Iulope (EFSA) mo e Potungaue Tu'unga 'o e Me'akai 'a Pilitania (FSA) ha Tu'unga Fakafekau'aki Fakatu'utamaki (ARfD) ʻo 20 micrograms/kg ‘o e cyanide, ‘o faka‘osi‘aki ko e kai lahi ange ‘i he 1 ki he 3 ‘o e fanga ki‘i tenga‘i ‘ēpiliko kona ‘i he kakai lalahí (pe ko e vaeua ‘o e ki‘i tenga‘i ‘akau ‘e taha ‘i he fānau valevalé) ‘oku lahi ange ia ‘i he tu‘unga malu. Fakatou'osi 'a e EU (Regulation 2017/1237) pea tapui ‘e Pilitānia ‘a hono fakatau atu ‘o e ngaahi tenga‘i ‘ēpiliko kona mata ki he kau fakatau ‘oku laka hake ‘i he 100. 20 mg/kg ‘o e hydrocyanic acid, pea ‘oku tapui ‘e ‘Aositelelia/Nu’usila ‘a hono fakatau fakalukufua ‘o e ngaahi tenga’i ‘ēpilikoti mata ko e me’akai faka’aufuli**.
• 'I he 'Iunaiteti Siteiti mo Kanata, 'oku tapui 'e he FDA 'Amelika 'a e laetrile (amygdalin) ko ha me'a ta'efakangofua, kākā, mo kona lahi, pea Mo'ui 'a Kanata fakangatangata 'a e cyanide fakakatoa 'oku lava ke to'o 'i he fakatau atu 'o e ngaahi tenga'i 'akau 'o e 'epilikoti ki he 100. 20 ppm lolotonga ia ‘oku fakatokanga ki he kakai lalahí ke ‘oua ‘aupito na‘a nau kai ‘a e ngaahi tenga‘i ‘akau kona.

Ngaahi polokalama fakavavevave fakavahefonua mo e ma'u 'o e faito'o konatapu¶

• 'Iunaiteti Siteiti mo Kanata: Ta ki he 911 he taimi pe ko ia pea taila ki he 1-800-222-1222 (Tokoni Kona 'a 'Amelika) pe 1-844-KONA-X (1-844-764-7669 ʻi Kānata). Poupou moʻui fakalakalaka (ALS) ngaahi me'alele fakahaofimo'ui mo e ngaahi potungaue fakavavevave 'o e falemahaki 'i he kotoa 'o 'Amelika Tokelau 'oku nau sitoka Hydroxocobalamin (Cyanokit, 5 g ngaahi hina) mo e Nitiotioti (Sodium Nitrite + Sodium Thiosulfate).
• Pule'anga Fakatahataha mo e 'Iunioni 'a 'Iulope: Ta mai ki he 999 (UK) pe 112 (EU). 'Oku fetu'utaki 'a e kau toketaa ki he NPIS / TOXBASE (Pilitānia) pe ngaahi senitā kona fakafonua 'o e EU (CAPTV, Giftnotruf). 'I Pilitania mo e EU, 'oku sitoka 'e he ngaahi potungaue fakavavevave Hydroxocobalamin (Cyanokit) mo e Sotiume Thiosulfate 'i he kato 'o e faito'o fakafepaki'i 'o e fakaakeake vave (Category A Antidotes required immediately at every acute hospital).
• Aositelelia mo Nu'usila: Ta ki he 000 ('Aositelelia) pe 111 (Nu'usila), pea fetu'utaki ki he Senitā Fakamatala ki he Ngaahi Kona (13 11 26 ʻi ʻAositelēlia; 0800 764 766 ‘i Nu‘u Sila) mo e vave . Cyanokit pea . Sodium Thiosulfate fakahinohino.
• Saute-Sahala 'o 'Afilika, 'Amelika Tonga, mo e Tonga-hahake 'o 'Esia: 'I he ngaahi vahefonua 'oku lahi ai 'a e manioke (Democratic Republic of the Congo, Mozambique, Tanzania, Nigeria, Brazil, Indonesia, Philippines), ʻa ia . Cyanokit ‘e ‘ikai lava ke fakatoka ‘i he ngaahi kiliniki ‘i he tukui koló, ‘oange vave ‘a e 100% ‘Okisiseni + Mahoa‘a Faka‘aonga‘i + Sotiume Thiosulfate ‘i he veini (25%, 50 mL IV) + Sotiume Paikaponate 'i he veini (ke fakatonutonu 'a e lactic acidosis lahi) 'oku fakahaofi mo'ui pea 'oku lahi hono fakatoka.

Ngaahi fehu'i 'oku toutou 'eke .¶

Ko e ha 'oku houa 'e 1 ki he 4 'a e kamata 'a e kona 'o e cyanide mei he tenga'i 'epilikoti pe manioke kona?¶

‘I he ‘ikai hangē ko e kasa haitoloseni saianaiti ‘oku mānava‘í (‘a ia ‘oku hū ki he ma‘ama‘á mo e totó ‘i ha ngaahi sekoni), ‘oku ‘i he ngaahi tenga‘i ‘ēpilikotí mo e manioke koná ‘a e ngaahi me‘a suka ‘o e ‘akaú ‘oku ha‘i ‘oku ui ko e cyanogenic glycosides (amygdalin mo e linamarin). Ko e ngaahi me‘a ko ení ‘oku ‘ikai ha maumau ia kae ‘oua kuo snip māmālie ‘e he ngaahi ‘enisaimi ‘o e ‘akaú (‘oku faka‘aonga‘i ‘aki ‘a e lamu) mo e fanga ki‘i pekitilia ‘o e ‘uto ‘o e tangatá ‘a e ngaahi molekula suka ‘i loto ‘i he ‘uto si‘isi‘i ‘o e alkaline mo e kolona, ‘o tukuange mai ‘a e kasa haitoloseni cyanide ta‘etotongi ki he totó ‘i he miniti ‘e 30 ki he houa ‘e 4 hili ‘a e kaí.

Ko e ha 'oku fu'u mate ange ai 'a e to'o 'o e "Vitamin B17" (Laetrile) 'i he ngutu 'i he huhu 'i he veini?¶

'Oku 'ikai ke ma'u 'e he toto mo e ngaahi 'okani 'o e tangata 'a e 'enisaimi beta-glucosidase 'oku fie ma'u ke motuhi 'a e amygdalin ki lalo ki he cyanide, ko ia 'i he taimi 'oku huhu ai 'a e laetrile ki ha veini, 'oku laka hake 'i he 90% 'o ia 'oku 'ikai ke liliu 'i he mimi. Kae kehe, ‘i hono folo ‘e he ngutú, ko e ngaahi pekitilia fakanatula ‘e laui tiliona ‘oku nau nofo ‘i loto ‘i he ki‘i ‘inisēkite mo e kolona ‘o e tangatá ‘oku nau fakatupu ‘a e ngaahi ‘enisaimi lahi ‘o e beta-glucosidase ‘a ia ‘oku nau vahevahe hangatonu ‘a e laetrile ngutú ki he hydrogen cyanide fakatupu mate, ‘o ‘ai ai ‘a e ngaahi fo‘i‘akau ngutú ke liunga 40 nai ‘a e kona ‘i he ngaahi faito‘o ‘oku ‘ai ‘i he uoua ‘o e sinó.

Ko e hā ʻe hoko kapau ʻe folo fakatuʻupakē ʻe ha kiʻi tamasiʻi ha luo sieli kakato pe maka pīsi ʻo ʻikai ke ne lamu ia?¶

Kapau 'oku folo kakato ha luo sieli, luo palamu, maka piisi, pe tenga'i 'apele mo hono 'anga'anga fefeka 'akau 'i tu'a 'oku 'ikai ke motuhi, 'oku nofo 'a e amygdalin 'o loka'i malu 'i loto 'i he kote 'o e tenga'i 'akau pea 'oku paasi ta'efakatu'utamaki 'a e luo ki tu'a 'i he stool 'i he 'aho 'e 1 ki he 3. Ko e kona ‘o e saianití ‘oku toki hoko ia ‘i he taimi ‘oku lamu, tuki, tuki, fefiofi, pe mafesifesi ‘a e ngaahi tenga‘i ‘akaú pe ngaahi luó ki mu‘a ke folo.

‘Oku anga fēfē hono ‘ilo‘i ‘e he kau toketā fakavavevavé ‘a e kona ‘o e cyanide ‘i ha miniti ‘e 5 kapau ‘oku ‘aho lahi ‘a e sivi ‘o ​​e cyanide ‘i he totó?¶

'Oku kumi 'e he kau toketaa 'a e ongo faka'ilonga ta'efakahalaia'i 'i he tafa'aki mohenga 'o e poloka 'o e faka'aonga'i 'o e 'osikena 'o e selo: 'uluaki, toto 'o e veini peripheral 'oku to'o mei he nima 'oku sio ngingila "sili-kulokula" (hange pe ko e toto 'o e ngaahi halanga toto) mo ha saturation 'o e 'osikena veini 'i 'olunga 'i he 85% ki he 90% koe'uhi ko e mitochondria kona extraodoxygent cannot; pea ko hono ua, 'oku 'alu hake 'a e tu'unga 'o e lactate 'i he toto 'i 'olunga 'i he 8 ki he 10 mmol/L koe'uhi ko e metabolism fakafokifā 'o e anaerobic.

Ko e hā ʻoku ʻoange ai ʻe he kau toketaá ʻa e Hydroxocobalamin (Cyanokit) mo e Sotiume Tiosulfate fakatouʻosi ki he kona ʻo e tengaʻi ʻēpilikotí?¶

Ko ha tu‘unga kalami ‘e 5 ‘e taha ‘o e Hydroxocobalamin (Cyanokit) ‘okú ne faka‘auha leva ‘a e cyanide ‘oku lolotonga tafe ‘i he totó mo e ngaahi ‘ōkaní ki he Vitamini B12 ta‘efakatu‘utāmaki, ‘o fakahaofi ai ‘a e lotó mo e ‘utó ‘i ha ngaahi miniti si‘i pē. Ka neongo ia, koe'uhi ko e ngaahi tenga'i 'akau 'o e 'epilikoti kuo holoki pe manioke kona 'oku hokohoko atu 'a e tangutu 'i he ngaahi 'uto pea tukuange 'a e cyanide fo'ou 'i ha toe houa 'e 4 ki he 12, tanaki atu 'a e Sotiume Abgut Thiosulfate 'i he veini ('o fakafou 'i ha laine IV kehekehe pe 'oku fufulu) 'oku ne 'omi 'a e 'enisaimi rhodanese 'o e 'ate mo e hokohoko atu 'a e cyanide sulfur ki he neupyan sulfur.

Ko e ha e "Konzo" pea 'oku fehokotaki fefe ia mo e manioke kona?¶

Ko e Konzo ko ha mahaki fakatupu maumau, ta‘ealafakafoki ‘o e ongo va‘é fakatou‘osi (spastic paraparesis) ‘a ia ‘oku ne taa‘i ‘a e fānaú mo e kakai fefine ‘i he ta‘u fā‘elé ‘i he tukui kolo ‘o e Saute Sahala ‘o ‘Afiliká lolotonga ‘a e pāká mo e hongé. ‘Oku hoko ia ‘i he taimi ‘oku fakamālohi‘i ai ‘a e ngaahi fāmilí ke nau kai ‘a e manioke kona ‘oku ‘ikai ke fakamomoko totonu ‘i he uike ki he uike lolotonga ia ‘oku nau faingata‘a‘ia ‘i he si‘isi‘i lahi ‘o e polotini ‘i he me‘akaí (‘ikai ha ‘ēsiti ‘amino ‘oku ‘i ai ‘a e sulfur ko e methionine mo e cysteine ​​‘oku fiema‘u ‘e he ‘até ke faka‘auha ‘a e cyanide ki he thiocyanate).

Ke tokangaʻi lelei ʻa e ngaahi meʻa fakatuʻupakē ʻi he kona, halanga ʻea, mo e loto, fakakaukau ke fakakakato ha ako tokoni ʻuluaki mo e CPR mei he Kolosi Kulokulá, St John Ambulance, pe ko ha kautaha ako fakalotofonua kuo fakamoʻoniʻi.

Ngaahi fakahinohino fekau'aki¶

• Cyanide, Haitoloseni Sulifite, mo e Kasa Fakangaue'anga 'o e 'Uluaki Tokoni
• Ko e Methemoglobinemia (Toto Sokoleti-Lanu-Lanu), Ko e Kona ‘o e Penisokaini, mo e Kona ‘o e Naiteleiti
• Ko e Kumi Me‘akai ‘a e Mushroom Vao (Amatoxin) mo e Ingestion ‘o e Ngaahi ‘Akau Kona
• Status Epilepticus, Ngaahi Puke Fuoloa, mo e Ngaahi Faitoʻo Fakahaofi
• Fakakonahi Fakalukufua Tokoni 'Uluaki mo e Faka'auha 'o e 'uli

Ngaahi ma'u'anga fakamatala mo e fakahinohino faka'ofisiale .¶

• Kautaha Mo'ui 'a Mamani (WHO) & Kautaha Me'atokoni mo e Ngoue (FAO): Tohi Sivi Fakavaha'apule'anga Fakanounou 'o e Kemikale 61: Haitoloseni Saieni mo e Saiani: Ngaahi Tafa'aki Mo'ui 'a e Tangata; Ko e ngaahi Glycosides Saianoseni 'i he Manioke mo e Ngaahi Va'a 'o e Bamboo (Sene).
• Panel 'a e Ma'u Mafai ki he Malu 'o e Me'akai 'a 'Iulope (EFSA) ki he Ngaahi Me'a 'oku 'Uli'i 'i he Food Chain: Ngaahi fakatu'utamaki lahi ki he mo'ui lelei 'oku fekau'aki mo e 'i ai 'a e cyanogenic glycosides 'i he ngaahi tenga'i 'epilikoti mata mo e ngaahi koloa 'oku ma'u mei he ngaahi tenga'i 'epilikoti mata (EFSA Journal).
• KIMAUTOLU. Senita ki hono Pule'i mo e Ta'ofi 'o e Mahaki (CDC) / ATSDR: Ngaahi Fakahinohino ki hono Pule'i Fakafaito'o 'o e Haitoloseni Saiani, Sotiume Saiani, mo e Ngaahi Me'a Fakatahataha'i 'o e Saiano ('Iunaiteti Siteiti).
• Sevesi Fakamatala ki he Ngaahi Kona Fakafonua 'a Pilitania (NPIS) / TOXBASE & Kolisi Fakatu'i 'o e Faito'o Fakavavevave: Ngaahi Fakahinohino ki he Faito'o Fakafaito'o: Hydroxocobalamin (Cyanokit), Sotiume Tiosulfate, mo e Sotiume Nitrite 'i he Kona 'o e Cyanide mo e Cyanogenic Glycoside (Pule'anga Fakatahataha).
• Baud FJ, Palioti P, Tofisi V, mo e ni'ihi kehe. / Hall AH, Rumack BH: Ma'olunga 'a e ngaahi me'a 'i he toto 'o e saianaite mo e plasma lactate 'i he kona 'o e saianaite 'o e 'uto; Laetrile (Amygdalin) mo e kona 'o e 'akau 'o e 'Apilikoti (Tohinoa 'o e Faito'o 'o 'Ingilani Fo'ou / Ngaahi fakamatala 'o e Faito'o Fakavavevave).