Maniok (Linamarin maniok bi wex) ak Njaay abriko (Amygdalin/Laetrile) Lekk: Dafay yeexal dangar gi ci cyanure bu mbàq yi¶

Lekk ñambi bu wex buñu xooj bu baax wala buñu togguwul bu baax (Manihot esculenta, maniok/yuca)**, sàqami njariñu abriko yu wex, fosoŋu peche/sirisi/prune buñ fejar, wala amànd yu wex, wala wann yeneen garab "Vitamine B17" (amygdalin wala laetrile) suplement yi mën nañu indil nit fitna cyanure d'hydrogène buy yeexal mbàq yi (HCN) dangar. Woowal sa nimero urgence bi la gëna jege (911 ci Etats Unis ak Canada, 112 ci biir Union Européenne, 999 ci Royaume-Uni) wala nga seet sunu nimero paj mu jamp ci àdduna bi ci saasi, nga wax ki koy yóbbu ni malaad bi soxla Hydroxocobalamin (Cyanokit) wala Kit antidote cyanure (Sodium Thiosulfate / Sodium Nitrite). Balaa ngay xaar fajkat yi, méngaleel sa paj ci saasi ak sunu cyanure ak gaz industriel, wuutale deret bu xonk bu leer ci toxisite cyanure ak methemoglobinemie sokolaa-maron, nga waajal status epileptique convulsions yu yàgg wala CPR.

wuute na ak gaz cyanure hydrogène bi ñuy xëcci (biy waral daanu ci biir 10 to 60 seconds), wann glycosides cyanogènes, rawatina linamarin (ci ñambi bu wex, ñebbe lima, ak jiwwu lin) wala amygdalin / prunasin (ci kernels abriko yu wex, amànd yu wex, donji meññeefi Rosaceae, ak pepp bamboo),30-minute to 4-hour palanteer latency bu amul màndarga**. Ci diir bu noppi bi, enzyme yi ci gàñcax ak ci mbàq yi ak beta-glucosidase ak hydroxynitrile liyase dañuy hydrolyse glycosides yi ñu wann ci biir mbàq mu ndaw mi alkaline ak colon bi, daal di bàyyi cyanure d'hydrogène buy wéy di ray nit (HCN)** ci deret jiy jaar ci buntu bi. cyanure absorbé dafay lëkkaloo ak affinite bu rëy ak ferrique (Fe3+) atomu wen bu mitokondriye sitokrom c oksidaas (Complex IV), dafay taxawal respiration aerobic selulaire doonte arterie ak veine yu malaad bi dañuy wéy di fees dell ak oxygen (arterialization of venous blood). 100% oxygen buy yokk ci saasi, dekontaminaasioŋ bu mbàq yi, ak Hydroxocobalamin (5 grams IV) wala tiosulfaat de sodium (12.5 grams IV) + Nitrite de sodium (300 mg IV), ñi ci loru dañuy gaawa jeex ndax miir, waccu, ak tachypnea bu xóot (Kussmaul breathing) à réfractaire à gap anion haute asidose lactique (serum lactate > 8 to 10 mmol/L), convulsions generalisées, arrêt bradycardique, ak dee.

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

Defal lii leegi¶

1. Woowal ci saasi serwiisu paj mu jamp ak ñiy saytu dangar yi, doonte nit ki dafa melni ku wér ba leegi. Woowal 911 (Etats Unis ak Canada), 112 (Union Européenne), 999 (Royaume-Uni), 000 (Australie), wala 111 (Nouvelle-Zélande). Wax ki koy yónnee substance bi nga wann (bitter apricot kernels, laetrile / amygdalin tablets, bitter cassava / manioc, wala bitter almonds), ñaata kernel wala gram lañu sàqami, ak waxtu bi ñu ko jëlee suko defee hopitaal bi koy jël mëna defar Hydroxocobalamin (Cyanokit) ak Tiosulfate de sodium ci barabu resuscitation balaa malaad bi di daanu.
2. Bul musa waccu, te bul musa def resuscitation gémmiñ-ci-gémmiñ te amul masku. Sudee malaad bi wann glycosides cyanogenic wala xorom cyanure waccu, asid gastrique dafay soppi cyanure bi nekk cyanure hydrogène (HCN) gaz (which smells weakly like bitter almonds to the 40% to 60% of people genetically able to detect the odor). Su malaad bi taxawee noyyi, jëfandikoo mask-valve-sac (BVM) wala masku CPR bu am oxygen bu bari te baña laal gémmiñ ak gémmiñ.
3. Jox 100% Oxygen bu bari bi fajkat yi yegsee. Doonte pulse oximetry (SpO2) dina lire 98% to 100% ndax selul yu am dangar mënu ñu dindi oxygen ci deret ji, joxe 100% Oxygen normobarique dafay yokk tension oxygen plasma biy seey, di joŋante ak cyanure ci barab yi sitokrom c oxidase di lëkkaloo, ba noppi gëna yokk sinersi antidotik bu thiosulfate de sodium ak hydroxocobalamin.
4. Bàyyi Vitamine C ci gémmiñ (Ascorbic Acid) suplement. Su amee ku jël pepp abriko wala oral laetrile, xool ndax jël nañu itam dose yu bari Vitamine C. Vitamine C bu bari> 1 to 3 grams) dafay gaawal soppi amygdalin ci biir mbàq yi mu nekk cyanure hydrogène ba noppi di jeexal dencukaayi cysteine yi enzyme biy dindi toxin yi ci xëtër gi soxla.
5. Denc kofre bi, saaku jiwwu yi, wala reenu ñambi bi des. Indaaleel récipient bi am kernel abriko, B17 butéelu suplement, wala tuber ñambi bu ñor ci bànxaasu paj mu jamp. Lim wala xayma limu kernel yi nga lekk: sàqami rek 5 to 10 bitter apricot kernels ci xale bu ndaw wala 20 to 60 bitter apricot kernels (0.5 to 3.5 mg/kg ci cyanure) ci mag mën na indi toxic cyanide bu mëna ray nit wala mu ray nit.

Garab dogal: Triage glycoside cyanogenic bu yeex ak tànneef antidote¶

flowchart TD
    A["Lekk ñambi bu wex, mboq abriko bu wex, fosoŋu meññeef, wala Laetrile (Amygdalin)"] --> B{"Luñu ko lekk ak naka?"}
    B -->|"1-3 fosoŋu sirise/prune/peche buñu raxasul wala ay jiwwu pomme yu néew"| C["Risk bu ndaw: Mantelu jiwwu bu amul benn sikk dafay tere Amygdalin génn; Seetal ci kër gi fileek sàqami"]
    B -->|"Kernels d'abricot amare, amande amare, tablettes de laetrile, ou manioc amare"| D["RISK BU YÀGG CI POISONING HCN BU YÀGG (Latency 30 simili ba 4 waxtu)"]
    D --> E["Woowal 911/112/999; Defal 100% Oxygen buy daw bu baax; Jox Charbon Actif (1 g/kg ba 50-100 g) sudee < 1-2 waxtu te yeewu"]
    E --> F["Komàndeel gasu deret jiy jaar ci deret ji (VBG), gasu deret jiy jaar ci arteri yi (ABG), lactate sérique, ak panelu metabolism bu yomb"]
    F --> G{"Dañu xool ni feebar bi di tardee ak lactate serum"}
    G -->|"Laktat < 3.0 mmol/L"| H["Seetlu ci ED / ICU ci diir bu gàtt 6 ba 12 waxtu (Hydrolyse bu yeex); Baamtu laktat q1-2h"]
    G -->|"Coppite ci nekkinu xel, konvulsioŋ, tension bu wàññeeku, tachypnée, wala lactate >= 8-10 mmol/L"| I["JOX ANTIDOTE YI CI SAASI (BUL xaar ni cyanure bi tollu ci lab bi)"]
    I --> J{"Ban antidote cyanide moo am ci saasi?"}
    J -->|"Hidroxocobalamin (cyanokit) disponible (1ère choix)"| K["Infuse hydroxocobalamin 5 g IV (70 mg/kg ci xale yi) lu weesu 15 simili + yokk tiosulfate de sodium 12,5 g IV ngir wéy di génne butit yi"]
    J -->|"Kit Nitrite + Tiosulfate kese moo am"| L["Jox nitrit de sodium 300 mg IV (10 ml ci 3%) ci diiru 2 ba 4 simili (ñu njëkka xool hemoglobine bi) -> topp ci thiosulfate de sodium 12,5 g IV"]

Patofisioloji: Ni glycoside yu gàncax yi di soppikoo ci Cyanure d'hydrogène (HCN) ci biir butit nit¶

Lu weesu 2,500 Xeetu gàñcax yi dañuy defar glycosides cyanogenic ngir jàppale seen bopp ci ñax yiy lekk ñax. Ci xob yi, reeni gàñcax yi, wala jiwwu yi, glycoside cyanogenic bi dañu koy denc ci biir vacuole selulaar yi, ñu tàqale ko ci enzyme hydrolytique yi koy yëngal (beta-glucosidase ak hydroxynitrile lyase), ñu nekk ci biir muru selul wala sitoplasma gàñcax.

1. Amygdalin ak 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)                                     |
+-------------------------------------------------------------------------+

• Lu tax oral Laetrile / Amygdalin lu ëpp toxic 40 yoon luñu koy dugal ci vesóo Laetrile: Njuuj njaajkat yiy fësal "Vitamine B17" dañu yàgg a wax ni laetrile amul benn loraange ndax pikiir yi ñuy def ci baayima yi duñu indi toxisite bu néew ci saasi. Suñu ko pikiiree ci deret ji, amygdalin bu amul doom dafay romb yooyu digestif bi daal di génn > 90% du soppiku ci saw bi ndax deretu nit ak tisu yi amul enzyme beta-glucosidase. Sudee dañu ko naan ci gémmiñ, bakteri colon yi ak mbàq yu ​​ndaw yi dañu am beta-glucosidase bu bari. Doonte nit ki dafay baxal peppu abriko ngir soppi peppu gàñcax bi emulsin enzyme, wala wann garab gu sell laetrile tablet yi, seeni bakteri mbàq ñooy xaaj glycoside bi 1 to 4 hours ginaaw ga ci ileum bi gëna suufe ak colon bi, di fees sidit bu portaal bi ak cyanure d'hydrogène (HCN).
• Li waral ñambi bu wex bi di dagg njaboot yi ci jamonoy bekkoor ak ñàkkum dundu: Xeetu ñambi yi ñu ngi leen xaaj ** ñambi yu "suukër"** (< 50 milligrams de HCN équivalent par kilogramme de racine fresh, que se trouve sur la peil extérieure) et "bitter" manioc (100 to > 500 milligrams de HCN ci kilogram bu nekk, ñu séddale ko ci yàpp wi am feculent). Su amee bekkoor yu metti, gàñcaxu ñambi dafay yokk limu linamarin lu tollu ci ñetti wala juróomi yoon. Sooy togg ñambi bu wex ci anam wu wóor, fàww nga xolli ko, dagg ko/dagg ko, ** xooj ko/fermenter ko ci ndox 3 ba 5 fan** (nga may endogene linamarase ngir soppi linamarin ci aseton siyanohidrin), ginaaw ga waw ci naaj wala toggu ci tàngoor wu metti ngir volatilise aseton siyanohidrin ak HCN gaz. Sudee famiy bu xiif, dafay togg reeni ñambi yu wex te duñu raxas, 20 minutes, wala lekk ñambi bu xaaj xooj ci biir 24 hours, tàngoor wi dafay soppi linamarase enzyme balaa linamarin bi di tas, bàyyi linamarin ak aseton siyanohidrin ci ñam wi. Buñu ko wannee, acetone cyanohydrin dafay seey ci boppam nekk letal HCN ci biir duodenum alkaline, bakteri yi ci biir butit yi dañuy hydrolyse linamarin bi des ci bi ci topp 2 to 6 hours.

Tegtale glycoside cyanogenic ci ñam ak toxisite clinique¶

Diagnostic ci wetu lall: Ni ñuy firndee dangar bu tar bu Cyanide balaa ñuy dellusi ci laboratuwaar yi¶

Test cyanure ci deret ji yépp dafay jël ay waxtu wala ay fan ci laboratoire yi te musul am ci jamono ngir tegtal resuscitation urgent. Doktër yi firndeelnañu ni daa am dangar bu metti ci cyanure ci wetu lall bi ci 5 minutes jëfandikoo ñetti emprent baraam ngir saytu feebar bi ci saasi:

1. "Arterialisation" de sang venous (Deret venous rouge cherry et narrow A-V O2 Gap)¶

• Mekanism: Ndax cyanure dafay tëj sitokrom c oxidase mitokondriye (Complex IV) ci oxidé (Fe3+) nekk, tisu periferik mënu génne oxygen ci oxyhemoglobine biy romb.
• Màndarga ci wetu lall bi: Su infirmiye bi wala phlebotomist bi jëlee echantillon deret ci vesóo yi, deret ji ci vesóo yi dafay nuru "xonk bu leer" (mënul wuute ak deretu arteriye) moo gën xonk bu violet bu lëndëm.
• Fàttaliku gasu deret: Teg benn yoon Gasu deret arteriel (ABG) ak digg/periferik Gasu deret venous (VBG):
• Arteriel PaO2 ak oximetri puls (SpO2) des normal (97% to 100%) teel, saturasioŋ oxygen venous (ScvO2 wala SvO2) ëpp 85% to 90% ak venous PvO2 ëpp 50 to 60 mmHg.
• différence oxygen artérioveineux (A-V O2 gradient) dafay gëna néew 1 to 2 vol%, di firndeel hypoxie selulaire histotoxique (shared only by cyanide, hydrogen sulfide, sodium azide, and high-oxygen resuscitation).
• Fàttaliku ci fundoscope: Ophtalmoscopie bu jub ci retine bi dafay wane sidit yu retine yi am melo xonk bu leer nàññ ak arteri retine yi.

2. Laktat sérum >= 8 to 10 mmol/L (Màrker surrogat standard wurus)¶

• Ndax aerobic ATP synthese bi dafa tëju (producing only 2 ATP molecules per glucose via anaerobic glycolysis instead of 36 ATP), selul yi dañuy soppi pyruvate ci saa si nekk asid lactic.
• Gëstu yiñ amal ci wàllu toxicologie (Baud ak ñeneen, Suralu Pajum Angleterre bu Bees) dañu wane ni ci malaad bu am dangar budul xëcci saxaar, laktate plasma bi dafay >= 8 mmol/L (72 mg/dL) (wala >= 10 mmol/L ci inhalasioŋ saxaar) amna > 90% sensitivite ak spesifisite ngir toxic cyanure bu metti (blood cyanide > 40 micromoles/L wala > 1.0 mg/L) te dafay méngoo bu baax ak yab cyanure bi ci biir selul yi.

3. Courbe hemodynamique ak respiratoire biphasique¶

• Fase 1 (Teela stimuler chimorecepteur, 30 to 90 minutes): Cyanide dafay yëngal ci saasi chimiorecepteurs yi ci yaram wi, mu indi "gasp cyanide" ci saasi, daal di topp ci hyperventilation / tachypnée (Kussmaul breathing), sinus takikardi, tension bu yéeg, bopp buy metti, miir, jaxasoo, ak xonk.
• Faas 2 (Dekompensaasioŋ Hypoxic bu yeex, 1 to 4 hours): Ni biir selul ATP Dafay daanu ci tronc yuur gi ak myocarde bi, malaad bi dafay jekki rek dem ci apnée/bradypnée, bradycardie sinus bu xóot wala bloke AV, hypotension artérielle bu tar, convulsions tonique-cloniques généralisées, posture decérébrée, et activité électrique sans pulse (PEA) wala asistole.

Protocolu antidote ak dekontaminaasioŋ bu hopitaal bi jéego par jéego¶

Ndax hydrolyse butit bu amygdalin ak linamarin dafay wéy lu tollu ci waxtu ci biir mbàq yi (bu wuute ak benn yoon inhalation HCN gaz), faj gàñcax cyanogenic glycoside toxic dafay laaj wallu antidote ci saasi ak dekontaminaasioŋ gastrointestinal buy wéy + infusion sulfur-donateur bu yàgg.

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

Jéego 1: Dekontaminasioŋ bu mbàq yi (Activated Charcoal ak Gastric Lavage)¶

• Doonte charbon activé amna kàttan bu néew ci gram-ci-gram ci cyanure de potassium inorganique bu sell (1 gram of charcoal adsorbs -35 mg of KCN), dose standard yu mag ñi (50 to 100 grams de charbon activé) absorbez facilement livres de miligrams letaux de amygdalin, linamarine non hydrolysée et libéré HCN** ci biir bi, te dafay yokk bu baax dundu gi ci toxication experimental ak clinique.
• Sudee malaad bi dafa am 1 to 2 hours di lekk kernels abriko yu wex yuñ fejar, tablet laetrile, wala ñambi bu wex, nga tëj yoonu respiraasioŋ bi (intubé su obtunded) nga def aspiration/lavage gastrique ngir dindi physiquement fragments seeds yi des, topp ci saasi Charbon Activé (1 gram/kg, ba 50 to 100 grams).

2ème étape: Antidote bi njëkk ci deret ji: Hydroxocobalamin (Cyanokit)¶

Hidroksokobalamin (Cyanokit) mooy garab giñ gëna bëgg ci àdduna bi ngir faj cyanure bu metti ci Amerique du Nord, Europe, UK, ak Australie ndax dafay lëkkale cyanure bi ci biir selul yi ak ci biir vesóo yi ngir sos cyanocobalamin bu amul benn loraange (Vitamin B12) te du yàq hemoglobine biy yóbbu oxygen wala indi choc vasoplegique bu bawoo ci nitrite.

• Dose mag ñi: Defaraat 5 garaam (one 5 g vial wala two 2.5 g vials) de Hidroxocobalamin 200 milliliters de 0.9% chlorure de sodium ak dugal ko ci vesóo yi ci kaw 15 minutes (-15 mL/minute).
• Dose xale yi: Infuse 70 milligrams per kilogram (70 mg/kg, ba ci dose bu njëkk bi gëna mag 5 grams) ci deret ci kaw 15 minutes.
• Dose yiñ wara baamtu ngir hydrolyse butit bu yeex: Ci kernel abriko, laetrile, wala ñambi bu wex, malaad yi dañuy faral di am rebond bu cyanure 2 to 6 hours ginaaw bu njëkk bi 5 g Dose hydroxocobalamin bi bakteri yi ci mbàq yi wéy di xaaj glycoside yi duñu xëcci ci biir butit bi. Sudee asidose laktik (> 4 mmol/L), tension bu wàññeeku, wala koma bu dellusi wala bu wéy, defal ko benn segond 5 gram (70 mg/kg xale) dose hidroxokobalamin 15 minutes to 2 hours.
• Njexital yi ñuy seentu (Kromaturi bu amul benn loraange ak jafe-jafe laboratwaar): Hydroxocobalamin pigment bu xonk bu dëgër la. Ci saasi der malaad bi, rangooñ yi, ñaq yi, plasma yi ak saw yi dañu xonk bu baax (chromaturia) ngir 2 to 7 days (ak ba 28 days ci saw). Àrtu labo bi ni hydroxocobalamin dafay tere test melo yi def ci kreatinine, bilirubine, transaminase, magnesium, ak karboksihemoglobine/methemoglobine.

3ème étape: Bokk boole thiosulfate de sodium ci vesóo yi (12.5 Grams)¶

Ndax enzyme biy dindi cyanure ci yaram wi, rodanese (thiosulfate sulfurtransferase) ci xëtër gi ak sidit yax yi, dafay gaaw jeex ci donatëri sulfur yi ci diir bi ñuy xëcci glycoside bu yàgg, joxe Thiosulfate de sodium ci deret ji dafay joxe sulfure sulfane bu dul jeex ngir soppi cyanure ci thiocyanate (SCN-), bi rein yi di bàyyi: * Dose mag ñi: 12.5 grams (50 milliliters de a 25% tiosulfate de sodium) infusé par veineux sur 10 to 30 minutes. * Dose xale: 250 milligrams per kilogram (1.0 mL/kg de 25% saafara, wala 412.5 mg/kg [1.65 mL/kg] liko aju ci ni formulation bi di doxee, ba 12.5 grams) ci deret ji 10 to 30 minutes.

4ème étape: Protocole antidote bu wuute (sudee hydroxocobalamin amul): Nitrite de sodium + Thiosulfate de sodium (Nithiodote) wala Edetat Dikobalt (Kelocyanor)¶

Ci gox yu bari yu néew doole yi, fu feebaru ñambi bu wex bi di am, wala ci klinik yu ndaw yi amul Cyanokit, doktër yi dañuy jëfandikoo regime bu am ñaari jéego Nitrite + Tiosulfate: 1. Nitrite d'amyl (pont inhalé balance d'accès IV): Dagg benn ampoule nitrite d'amyl (0.3 mL) ci gaze nga tëye ko ci suufu bakkanu malaad bi (wala ci kaw sac-valve-mask bi) ngir 15 to 30 seconds ci simili bu nekk bi ñuy taxawal IV access. 2. Nitrite de sodium de vein (3% saafara): * Mekanism: Dafay oxide 10% to 20% hemoglobine ferreux circulant (Fe2+) ci methémoglobine (Fe3+). Ndax cyanure amna affinite bu rëy ci Fe3+, methemoglobine dafay dindi cyanure ci sitokrom c oxidase bi ci mitokondriye ngir sos methemoglobine cyan. * Dose mag ñi: 300 milligrams (10 milliliters de 3% Nitrite de sodium) infusé ci vesóo ci kaw 2 to 4 minutes (xool bu baax tension bi, ndax nitrite yi dañuy indi vasodilatation bu am doole ak wàññi tension). * Dose xale (Must Adjust for Hemoglobin to Prevent Fatal Methemoglobinemia):6 to 10 mg/kg (0.2 to 0.33 mL/kg de 3% saafara, lu gëna mag 300 mg), dañu koy wàññi bu baax sudee xale bi daa am deret (hemoglobin < 10 g/dL). Saytu ni methemoglobine bi tollu ci 30 minutes ak tëye methemoglobine bi ci suuf 20% to 30%. 3. Tiosulfate de sodium ci deret (25% solution): Toppal ci saasi (after flushing the line) ak 12.5 grams (50 mL de 25% saafara; xale 1.0 to 1.65 mL/kg) ngir soppi cyanmethemoglobine ci tiocyanate ci sawukaay bi ba fàww. 4. **Edetat dikobalto (Kelocyanor - UK/Commonwealth: ** ñu ngi koy doxal ni 300 mg (20 mL) IV ci kaw 1 minute topp ci saasi 50 mL de 50% Dekstros. Ndax cobalt bu amul fey dafay indi arrhythmie cardiaque bu metti, ëdem facial/laryngeal, ak hypotension sudee amul cyanure ci deret ji, **Dicobalt Edetate dañu ko wara jox malaad yi am toxic cyanide bu metti (coma, apnée) wala, malaad yi.

Waajal bu wóor bu ñambi ak ay yamaleg yamale ci kernels abricot¶

• Ni ñuy dindee ñambi bu wex ci kër (OMS/FAO "Njàngalem tooyal"):
• Raxas wala nga xëcc reenu ñambi buñ xolli ci puré wala farine bu woyof (di xotti selul yi linamarase jokkookat yi linamarin).
• Sook / fermenter purée bi ci ndox ngir 3 to 5 days (wala sooy jëfandikoo farine ñambi bu waw te ba leegi mingi wex, jaxaseel farine bi ak ndox mu nekk pat bu tooy bu woyof nga diw ko ci lëndëm gu woyof ngir 5 hours ci 30 degrees Celsius kon residu linamarase linamarine bi dafay soppi nekk aseton siyanohidrin).
• Baxalal wala nga lakk ko bu baax ci céebi ubbeeku suko defee aseton cyanohydrin ak HCN gaz bi dafay evapore ci air bi, nga sànni ndox miy seey/di seey.
• Àrtu yiñ tëral ci wàllu Abricot bu wex:
• Bañkat bi yor kaaraange ñam ci Ëroop (EFSA) ak Kuréel gi yor sàrti ñam yi ci Grande Bretagne (FSA) dañu taxawal dosu royuwaay bu tar (ARfD) de 20 micrograms/kg ci cyanure, ñu jàpp ni lekk lu ëpp 1 wala 3 kernel abriko yu ndaw yu wex ci mag ñi (wala genn-wàllu benn kernel bu ndaw ci xale yu ndaw yi) dafa weesu li ñu wara am. EU (Regulation 2017/1237) ak UK tere nañu jaay kernels abriko yu wex yu ñor yi konsomatër yu ëpp 20 mg/kg de asid hydrocyanique, ak Australie/Nouvelle-Zélande ** tere nañu jaay mboq abriko bu ñor muy lekk**.
• Ci Etats Unis ak Canada, FDA bu Etats Unis dafa tere laetrile (amygdalin) muy luñu nanguwul, luy njuuj njaaj, ak lu am toxic bu rëy, te Wérgi-yaram Canada dafay tënk cyanure biñ mëna génne ci kernel abriko yuñ jaay ba 20 ppm di artu mag ñi ñu baña lekk kernel yu wex.

Protocolu am jafe-jafe ak antidote ci diwaan yi¶

• Etats Unis ak Canada: Woowal 911 ci saasi nga woo 1-800-222-1222 (Ndimbalu DANGAR ci Etats Unis) wala 1-844-DANGAR-X (1-844-764-7669 ci Kanada). Support de vie avancé (ALS) ambulans yi ak bànxaasi yi yor paj mu jamp ci hopitaal yi ci Amerique du NordCyanokit, 5 g fiol)** ak nitiodot (Sodium Nitrite + Sodium Thiosulfate).
• Royaume-Uni ak Mbootaayu Ëroop: Wootal 999 (Royaume-Uni) wala 112 (UE). Doktër yi dañuy seeti NPIS/TOXBASE (Royaume-Uni) wala santar yu mag yi ci EU (CAPTV, Giftnotruf). Ci UK ak EU, departemaa yi yor paj mu jamp dañuy denc Hydroxocobalamin (Cyanokit) ak Thiosulfate de sodium ci biir armuwar antidote biy dundal ci saasi (Category A Antidotes required immediately at every acute hospital).
• Ostralie ak Nouvelle-Zélande: Woowal 000 (Ostralie) wala 111 (Nouvelle-Zélande), nga laaj Santar biy joxe leeral ci dangar yi (13 11 26 ci Australie; 0800 764 766 ci Nouvelle-Zélande) ngir ci saasi Cyanokit ak Sodium Thiosulfate tegtal.
• Afrique Sub-Saharienne, Amérique du Sud, ak Asie Sud-est: Ci gox yi ñambi gëna bari (Democratic Republic of the Congo, Mozambique, Tanzania, Nigeria, Brazil, Indonesia, Philippines), fu Cyanokit mën nañu ko denc ci klinik yi ci àll bi, ñu jox ko ci saasi 100% Oxygen + Charbon Actif + Thiosulfate de Sodium (25%, 50 mL IV) + Bicarbonate de sodium bi ñuy dugal ci deret ji (ngir saafara asidose lactique bu metti) dafay muccal nit te barina luñu ko denc.

Laaj yi ñuy faral di laaj¶

Lan moo waral dangaru cyanure bu bawoo ci kernel abriko wala ñambi bu wex di jël 1 ba 4 waxtu ngir tàmbali?¶

Gaz cyanure d'hydrogène bi ñuy xëcci (biy dugg ci poumon yi ak deret ji ci ay segond) wuute nañu ak mboq abriko yi ak ñambi yu wex yi, ndax dañuy am suukër buñ boole ci gàncax, ñu koy woowe glycosides cyanogène (amygdalin ak linamarine). Composé yooyu amul benn loraange ba keroog enzyme gàñcax yi (ñuy tàmbali sàqami) ak bakteri yi ci mbàq nit ñi dañuy dagg ndànk molecule suukër yi ci biir mbàq yu ndaw yi ak colon bi, bàyyi gaz cyanure hydrogène ci deret ji 30 simili ba 4 waxtu ginaaw bu ñu lekkee.

Lan moo waral naan "Vitamine B17" (Laetrile) ci gémmiñ moo gëna faat bakkan ci pikiir yi?¶

Deretu nit ak cër yi amul enzyme beta-glucosidase biy soxla ngir dagg amygdalin mu nekk cyanure, kon suñu pikiiree laetrile ci sidit, lu ëpp 90% ci laetrile dafay génn ci saw bi te du soppiku. Waaye suñu ko wannee ci gémmiñ, ay trillioŋu bakteri yu nekk ci biir mbàq yu ndaw yi ak colon yi dañuy defar enzyme beta-glucosidase yu bari yuy xaaj laetrile bi ñuy jël ci gémmiñ mu nekk cyanure hydrogène buy ray nit, moo tax tablet yi ñuy jël ci gémmiñ di gëna toxic lu tollu ci 40 yoon dose yi ñuy jël ci vesóo yi.

Lan mooy xew sudee xale bi daa wann benn fosoŋu cerise wala xeer peche te sàqamiwul?¶

Sudee benn fosoŋu cerise, fosoŋu prune, xeer peche, wala jiwwu pomme dañu ko wann lëmm ak lëfam bu dëgër bi nekk ci biti, amygdalin dafay des tëju bu baax ci biir mantoo jiwwu yi, fosoŋ bi dafay jaar ci biir tabu bi ci diiru 1 ba 3 fan te du am benn loraange. Dangar ci cyanure dafay am sudee jiwwu yi wala pax yi dañu sàqami, dagg leen, gën leen, jaxase leen, wala ñu xar leen balaa ñu leen di wann.

Ci 5 simili, naka la doktër yiy jàppale ci paj mu jamp mënee xam ndax cyanure bi dafay jël ay fan?¶

Doktër yi dañuy seet ñaari màndarga yu leer ci wetu lall biy wane ni jëfandikoo oxygen selulaar bi dafa tëju: bu njëkk bi mooy deret jiy génn ci loxo bi dafay nuru "xonk bu leer" (ni deretu arteri) ak saturation oxygen ci vein bi ëpp 85% ba 90% ndax mitochondria yi mënu ñu génne oxygen ci deret ji; ak ñaareel ba mooy lactate bi ci deret ji dafay yéeg ba weesu 8 ba 10 mmol/L ndax metabolism biy gaawa jeex.

Lan moo waral doktër yi di jox hidroxokobalamin (cyanokit) ak thiosulfate de sodium ngir daŋar ci kernel abriko?¶

Benn dosu 5 garaam ci Hydroxocobalamin (Cyanokit) dafay soppi ci saasi cyanure biy daw ci deret ji ak cër yi, mu nekk Vitamine B12 bu amul benn loraange, muy muccal xol bi ak yuur gi ci ay simili yu néew. Waaye, ginaaw kernel abriko buñ fejar wala ñambi bu wex dañuy wéy di toog ci biir mbàq yi, di bàyyi cyanure bu bees ci diiru 4 ba 12 waxtu, yokk Sodium Thiosulfate ci deret ji (jaaraleko ci ligne IV buñ tàqale wala buñ xooj) dafay joxe enzyme rhodanese bu xëtër bi ak cyanure sulfur buy wéy di neutraliyan.

Luy "Konzo" ak naka lay lëkkaloo ak ñambi bu wex?¶

Konzo feebar bu metti la, bu mënul dellu ginaaw ci ñaari tànk yi (paraparesis spastique) di dal xale yi ak jigéen ñi tollu ci at yu mëna am doom ci àll bi ci Afrique Sub-Saharienne ci jamonoy bekkoor ak xiif. Dafay am su famiy yi di forse ñu lekk ñambi bu wex buñu raxas bu baax ayu-bis bu nekk, fekk ñu ngi am jafe-jafe ñàkkum protein ci seeni lekk (amul asid amino methionine ak cysteine ​​yu am sulfur yi xëtër bi soxla ngir dindi cyanide ci thiocyanate).

Ngir mëna xeex feebaru dangar, yooni respiraasioŋ, ak jafe-jafe xol, fexeel def njàngum paj mu njëkk ak CPR ci Croix Rouge, St John Ambulance, wala kuréel gu am sertifikaa di tàggat nit ñi ci dëkk bi.

Gid yu jëm ci loolu¶

• Cyanure, Sulfure d'hydrogène, ak paj mu njëkk ci inhalation usine
• Methemoglobinemie (Deret bu sokolaa-maroŋ), spray benzocaine, ak dangar nitrate
• Champignon de àll (Amatoxin) ak lekk garab yu am dangaar
• Status epilepticus, kriis yu yàgg, ak garabi mucc
• Toxinement général Secours premier ak décontamination

Boroom yi ak tegtali ofisel¶

• Mbootayu Wérgi-yaram ci Àdduna bi (OMS) & Mbootayu Lekk ak Bayyima (FAO): Kàddu bu gàtt buy jàngat Chimik yu Àdduna yi 61: Hydrogen Cyanide ak Cyanides: Mbiru Wérgi-yaramu Nit; Glycosides cyanogéniques dans la manioc et les brots de bambou (Genève).
• Baŋxaasu Europe biy saytu kaaraange ñam (EFSA) ci wàllu mbir yuy wàlle ci ñam yi: Risk yu metti yi ci wérgi-yaram yu aju ci nekkinu glycosides cyanogenic ci kernel abricot yu ñor ak produit yu bawoo ci kernel abricot yu ñor (EFSA Journal).
• NU. Centre yiy saytu ak fàggu feebar yi (CDC) / ATSDR: Njàngale ci wàllu pajum cyanure hydrogène, cyanure de sodium, ak composés cyanogènes (Etats Unis).
• **Serwiisu xibaar ci dangar yi ci réewum Grande Bretagne (NPIS) / TOXBASE & Daara bu kawe bu pajum paj mu jamp: ** Njàngalem antidote: Hydroxocobalamin (cyanokit), thiosulfate de sodium, ak nitrite de sodium ci dangaar bu tar ci cyanure ak glycogène (Royaume-Uni).
• *Baud FJ, Barriot P, Toffis V, ak ñeneen. / Hall AH, Rumack BH: ** Yokkateg deret ci cyanure ak lactate ci plasma ci toxic cyanure bu metti; Laetrile (Amygdalin) ak Toxisite bu Njàngalem Abriko (Suralu Pajum Angleterre bu Bees / Jaar-jaaru Pajum Jafe-jafe).