I-Colchicine Overdose kunye neGloriosa Lily Poisoning: Kutheni ukuthatha iiPilisi zeGout ezongezelelweyo zeFlare kubulala¶

Colchicine (Colcrys, Mitigare, Gloperba) - i-alkaloid yenkulungwane yeminyaka echasene nokudumba emiselwe i-gout flares ebukhali, i-familial Mediterranean fever (FMF), kunye ne-pericarditis - ineyona festile incinci, engaxoleliyo yonyango kuwo onke amayeza ekliniki. Ngokungafaniyo ne-ibuprofen okanye i-acetaminophen, apho isigulana sinokuthi ngempazamo sicinge ukuba sinokuthatha isandla esongezelelweyo seepilisi xa intlungu yegout ebuhlungu ingakwazi ukuphucuka, ** ukuginya nje i-10 ukuya kuma-20 amacwecwe e-colchicine e-0.6-milligram (i-6 ukuya kwi-12 milligrams iyonke, okanye ngaphezulu kwe-0.15 ye-antibiotics yemihla ngemihla ithatha i-dose yesiqhelo okanye i-0.15 ye-dose eqhelekileyo ngosuku). njenge-clarithromycin - yenza ityhefu eyoyikekayo, ene-biphasic multi-organ kunye ne-antidote yorhwebo efumanekayo ngokubanzi**. Ityhefu efanayo ebulalayo yenzeke xa iiforoji okanye abantwana besitya iibhubhu, ibhalbhu, okanye amagqabi e-Flame Lily (Gloriosa superba)* okanye Ukwindla Crocus (Colchicum autumnale), okanye xa igxininiswe podophyllin (podofilox) intsumpa intlaka iyaginywa okanye igalelwe kwiindawo ezibanzi zolusu. Ukuba nabani na uthatha ngaphezu kweepilisi ezi-3 ezimiselweyo (1.8 mg) ze-colchicine kwiiyure ezingama-24, okanye utya izityalo ze-Colchicum okanye i-Gloriosa, fowunela indawo ohlala kuyo. amanani kaxakeka ngokukhawuleza - **nokuba baziva bephilile ngokupheleleyo kwiiyure ezininzi zokuqala **. Malunga neemeko ezingxamisekileyo ze-toxicological kunye ne-hematological, dibana ukutya amakhowa asendle kunye nokutyiwa kwezityalo ezinetyhefu, umkhuhlane we-neutropenic kunye nokunciphisa umongo wethambo, kwaye ityhefu yokutya, i-gastroenteritis ebukhali, kunye nokuphelelwa ngamanzi emzimbeni.

I-Colchicine poisoning i-classic ** "i-silent time-bomb" i-toxin ** efana ne-amatoxin Death Cap mushrooms kunye ne-paraquat: emva kokukhohlisa ukulibaziseka kwe-2-to-12-symptom-free-symptom-free, iSigaba 1 sibetha ngokuqhushumba, isifo sohudo olufana ne-cholera kunye nokutshatyalaliswa kwe-hypovolemic, kulandelwa kwi-**24 ukuya kwi-24 ye-cardiogenic shock, i-hypovolemic shock. ukungaphumeleli kokuphefumula (ARDS), ukungaphumeleli kwesibindi / izintso, kunye ne-aplasia yomongo opheleleyo (i-zero iiseli zegazi ezimhlophe kunye neeplatelet) **.

Yenza oku ngoku¶

1. Fowunela inombolo yakho kaxakeka yasekuhlaleni kunye noLawulo lwePoison NGOKUNGOKO ukuba nabani na uginya ngaphezu kwe-3 tablets ye-colchicine (1.8 mg) ngosuku, okanye NAYIPHI na isixa se-Autumn Crocus / Gloriosa Lily. Dial 911 e-United States naseKhanada (US Control Poison klzzwxh:36, i-European Union kwi-United Kingdom, kwi-European Union 000 eOstreliya (Poisons Information 13 11 26**), okanye jonga uluhlu lwethu lwe amanani kaxakeka. *ngaze ulinde ukuba isisu siqaqanjelwe okanye ukugabha kuqale**; yakube i-colchicine ifunxa emathunjini ize ibopheleleke ngaphakathi kwiiseli zomzimba, ayinakucocwa ngaphandle kwegazi.
2. Balekela kwisebe likaxakeka ngaphakathi kwe-1 yokuqala ukuya kwiiyure ze-2 kwi-imergency Activated Charcoal (Multidose Activated Charcoal). Because colchicine undergoes extensive enterohepatic recirculation (the liver excretes absorbed colchicine into the bile, which dumps back into the small intestine only to be reabsorbed all over again), drinking hospital activated charcoal repeatedly every 2 to 4 hours traps colchicine in the gut and is the single most effective way to stop a lethal dose from reaching the heart and bone umongo.
3. YEKA ukuthatha i-colchicine ngoko nangoko ukuba uyalelwe nasiphi na isithinteli-ntsholongwane semacrolide (clarithromycin okanye erythromycin, antifungal (itraconazole, ketoconazole), iyeza lentliziyo (verapamil, diltiazem), okanye cyclosporine - okanye ukuba usele ijusi yegrapefruit. La mayeza athintela CYP3A4 enzyme kunye P-glycoprotein impompo ye-efflux ecacileyo i-colchicine, ijika i-dose ye-gout yepilisi eqhelekileyo ye-2 ibe yi-10-fold overdose yangaphakathi ebulalayo.
4. Ukuba iSigaba soku-1 sokugabha kakhulu kunye norhudo olunamanzi/negazi sele luqalile, qalisa ukubuyisela ulwelo olunamandla ngelixa ulindele i-ambulensi - kwaye UNGAZE unike amachiza okulwa norhudo (loperamide / Imodium). I-Colchicine iphazamisa ukwahlukana kweeseli kulwelwe lwamathumbu, ibangela ukuba iilitha zeplasma neeelectrolyte ziphume emathunjini (cholera-like gastroenteritis). Ukunika i-loperamide okanye i-bismuth subsalicylate ibamba i-colchicine engafutywanga ngaphakathi emathunjini ukuze ityhefu engakumbi ifunxa egazini.
5. Ukuba i-podophyllin (podofilox) wart liquid ichithelwe ngempazamo kwiindawo ezinkulu zolusu okanye kwiinwebu, hlamba ulusu ngokukhawuleza kwaye ngokucokisekileyo ngesepha kunye namanzi abalekayo. I-podophyllin resin egxininisiweyo ifunxa ngokukhawuleza ngolusu olungaguqukiyo okanye olugqabhukileyo kwaye ibangele ityhefu efanayo ye-mitotic-spindle, coma, peripheral marrowopathy, neuropathy yethambo.
6. Yiza nebhotile yepilisi yecolchicine (ukuze oogqirha bakwazi ukubala iipilisi ezingekhoyo kwaye babale ngokuthe ngqo mg/kg ithamo) okanye ifoto/isampulu yeglowubhu yesityalo etyiweyo okanye intyatyambo. Ukwazi ukuba isigulana sityile na < 0.5 mg/kg, 0.5 to 0.8 mg/kg, okanye > 0.8 mg/kg ngoko nangoko uxelela iqela labagula kakhulu ngemeko yokusinda kwesigulana kunye neemfuno ze-ICU.

Umthi wesigqibo: i-colchicine, i-Gloriosa lily, kunye ne-podophyllin poisoning triage¶

flowchart TD
    A["Ukugqithiswa kweColchicine okukrokrelwayo, iGloriosa Lily / i-Autumn Crocus ingestion, okanye i-Podophyllin Exposure"] --> B{"Bala idosi yeColchicine etyiweyo (nge-mg/kg yobunzima bomzimba) okanye ujonge i-Drug Interactions"}
    B -->|"Idosi yegout eqhelekileyo + Clarithromycin / Verapamil / Cyclosporine + utyatyazo olutsha / ukugabha"| C["IATROGENIC COLCHICINE TOXICITY: Yeka omabini amachiza kwaye uye ku-ER ngokukhawuleza"]
    B -->|"I-Acute overdose <0.5 mg/kg (umzekelo, i-7 ukuya kwi-30 mg kumntu omdala we-70-kg)"| D["UMNGCIPHEKO OMKHULU: Uthutho lwe-EMS olukhawulezayo lweGastric Lavage (ukuba < 1 hr) + Multidose Activated Charcoal"]
    B -->|"I-Acute overdose 0.5 ukuya ku-0.8 mg/kg (35 ukuya ku-56 mg kwi-70-kg yabantu abadala)"| E["OKUBALULEKILEYO EBUBONGENI UBUTHOVU: Lindela ukothuka okukhulu kwe-GI + I-Bone Marrow Aplasia (i-10% ukuya kwi-50% yokusweleka)"]
    B -->|"Ukugqithiswa kwedosi ebukhali> 0.8 mg/kg (> 56 mg kuma-70-kg omdala) okanye i-gloriosa tuber epheleleyo"| F["I-FULMINANT LETHAL DOSE (Isondela kwi-80% ukuya kwi-100% yokusweleka): Ukudluliselwa kwe-ICU / ECMO kwangoko"]
    C --> G["Isigaba 1 (Iiyure ze-2 ukuya kwi-24): I-Aggressive IV Crystalloid Resuscitation ye-Cholera-Njenge-GI Fluid Loss"]
    D --> G
    E --> G
    F --> G
    G --> H["Isigaba se-2 (Iintsuku 1 ukuya kwi-7): ICU Inkxaso ye-Cardiac (Norepinephrine / VA-ECMO) + G-CSF (Filgrastim) ye-Neutropenia"]

Indlela i-colchicine kunye ne-podophyllin ezibulala ngayo iiseli: ukutshixa i-mitotic spindle¶

Ukuqonda ukuba kutheni i-colchicine ityhefu ibonakala kuqala njengetyhefu yokutya eqatha, emva koko njengohlaselo olukhulu lwentliziyo, kwaye kwiintsuku ezintlanu kamva njengokugula ngemitha ebukhali okanye i-leukemia chemotherapy toxicity, jonga indlela imolekyuli esebenza ngayo ngaphakathi kuyo yonke iseli yomntu.

I-Microtubule depolymerization kunye nokubanjwa kwecandelo leseli kwi-metaphase¶

Yonke iseli ephilayo kumzimba womntu iqulethe i-skeleton yangaphakathi yesakhiwo kunye nenkqubo yendlela ephezulu eyenziwe ngeetyhubhu zeprotheyini ezingenanto ezibizwa ngokuba yi-**microtubules **, ezihlanganiswe kwiibhloko zokwakha ezibizwa ngokuba yi-**alpha-tubulin kunye ne-beta-tubulin dimers **. IiMicrotubules zenza imisebenzi emibini ebalulekileyo:

1. I-Mitotic Spindle ngexesha lokwahlulwa kweeseli (mitosis): Nanini na xa i-stem cell kulwelo lwamathumbu akho, umongo wethambo, okanye iifollicles zeenwele zahlulahlula ukuze zithabathel’ indawo iiseli ezindala, iimicrotubules zenza iintambo ezincinane (imitotic spindle) ezitsala iichromosome eziphindaphindwe kabini zibe ziiseli ezintsha zamantombazana.
2. ** Ukuthuthwa kwe-intracellular kunye ne-myocardial contractility ngaphakathi kweeseli ezingahluliyo: ** Ngaphakathi kweeseli zemisipha yentliziyo (cardiomyocytes), ii-axon ze-nerve, kunye neeseli zesibindi, ii-microtubules zisebenza njengamabhanti okuhambisa ahambisa i-mitochondria, iziteshi ze-calcium, kunye ne-neurotransmitter vesicles kwiseli.

I-Colchicine (kunye ne-podophyllotoxin esuka kwisityalo seMayapple / intsumpa yentlaka, kunye ne-vinca alkaloids esetyenziswa kwi-chemotherapy yomhlaza) ibophelela ngokusondeleleneyo okungaguqukiyo kwi-beta-tubulin dimers enyibilikayo, ibamba isiphelo esikhulayo se-microtubule ukuze isombulule kwaye inyibilike (*lymermicrotubule dedimers).

• ** Kwizicubu ezahlula ngokukhawuleza (i-Gut mucosa kunye ne-Bone marrow): ** Yonke i-stem cell eyahlulayo iyancipha ngokusisigxina kumbindi wecandelo leseli (**ukubanjwa kwe-metaphase **) kwaye iphantsi kwenkqubo yokufa kweeseli.apoptosis). Ngenxa yokuba iiseli ezihlala emathunjini akho amancinci zithatha indawo yazo rhoqo kwiiyure ezingama-24 ukuya kwezingama-48, lonke ulwenze lwamathumbu luyaphuma ngoSuku loku-1 (Isigaba soku-1 sorhudo olufana nekholera). Ngenxa yokuba iiseli ezimhlophe zegazi kunye neeplatelets kumongo wakho wethambo zithatha indawo yazo rhoqo emva kweentsuku ezi-3 ukuya kwezi-5, amajoni akho omzimba kunye ne-blood-clotting system ayanyamalala ngeeNtsuku ze-3 ukuya kwe-7 (**Isigaba se-2 pancytopenia kunye ne-sepsis **).
• ** Kwi-heart muscle kunye neeseli ze-nerve: ** Ukuchithwa kwenethiwekhi ye-microtubule ngaphakathi kweeseli ze-muscle zentliziyo kuphazamisa ukuphathwa kwe-calcium ye-sarcoplasmic kunye nokuthuthwa kwamandla e-mitochondrial, kubangela ** i-myocardial emangalisa ngokuthe ngqo, i-refractory cardiogenic shock, i-heart block epheleleyo, kunye ne-asystole ngokukhawuleza ** kwiiyure ezingama-24 ukuya kwii-72.

Kutheni i-hemodialysis kunye ne-hemoperfusion AYIKWAZI ukususa i-colchicine emzimbeni¶

Ngokungafaniyo ne-caffeine, i-lithium, okanye i-salicylates (i-aspirin), ehlala inyibilika kwi-plasma yamanzi yegazi apho umatshini we-dialysis unokuwahluza, i-colchicine efunxa ikhupha igazi phakathi kwe-1 ukuya kwiiyure ze-3 kwaye ivale ngokuqinileyo kwiiprotheni ze-tubulin ** nzulu ngaphakathi kwezicubu eziqinileyo zomzimba , ukudala ukusabalalisa okukhulu ( ** umthamo omkhuluVd = 2 to 12 L/kg, ukuya kwi-21 L / kg kwi-overdose). Ngenxa yokuba ngaphantsi kwe-1 ukuya kwi-2 ipesenti ye-colchicine yomzimba ihlala idada egazini, ** i-hemodialysis, i-hemofiltration, kunye ne-charcoal hemoperfusion ayinamsebenzi ngokupheleleyo ekususeni i-colchicine ** (nangona i-dialysis isasetyenziselwa ukuxhasa izigulane ezinezintso ezihluleka kwiSigaba 2). Yiyo loo nto ukutshatyalaliswa kwamathumbu kwangethuba nge-Multidose Activated Charcoal ngaphambi nangexesha lokuphinda kusetyenziswe i-enterohepatic ibaluleke kakhulu.

Umgaqo wobungozi obusekwe kubunzima (Bismuth & Baud classification)¶

Kwi-toxicology yeklinikhi (eyasekwa ekuqaleni nguBismuth, uBaud, kunye noogxa kwiZiko lokuLawula ityhefu laseParis), ukusinda kwesigulane emva kokugqithisa ngokweqile kwe-colchicine kuqikelelwa ngokuchaneka okubandayo ngokubala idosi ye-milligram efunyenweyo eyahlulwe ngobunzima bomzimba wesigulana ngeekhilogram (mg/kg):

Izigaba ezithathu ezahlukeneyo zeklinikhi zeColchicine kunye neGloriosa Lily yetyhefu¶

Ityhefu yeColchicine ihamba ngezigaba ezithathu ezilandelelanayo zonyango ngaphezulu kweentsuku ezili-10 ukuya kwezili-14:

Isigaba 1: IGastrointestinal & Hypovolemic Phase (Iiyure ze-2 ukuya kuma-24 emva kokutyiswa)¶

• Ifestile efihlakeleyo yeeyure ezi-2 ukuya kwezili-12 ezikhohlisayo: Kwiiyure ezi-2 ukuya kwezi-6 zokuqala emva kokuginya i-overdose yeepilisi ze-colchicine okanye ukutya iiglowubhu ze-Gloriosa / Colchicum eziphekiweyo, isigulane siziva siqhelekile ngokupheleleyo (ngaphandle kokutshisa okungephi emlonyeni nasemqaleni ngamathuba athile ngezityalo ezikrwada). Musani ukukhohliswa ngokuhlala ekhaya ngeli xesha lefestile ithuleyo.
• Iziqhushumbisi zeGastroenteritis (Iiyure ze-6 ukuya kuma-24): Njengoko i-crypt mitosis yamathumbu iyeka kwaye iiseli ze-mucosal zihamba, isigulane siba nesicaphucaphu, isicaphucaphu esinganyangekiyo, ukugabha, ukuqaqamba kokuphazamiseka kwesisu, kunye ** nobuninzi, obuqhubekayo, bunamanzi amanzi kunye negazi.
• I-Hypovolemic Shock kunye ne-Electrolyte Collapse: Ilahleko yolwelo oluphuma emathunjini lungadlula 5 ukuya kwi-10 ilitha (1.3 ukuya kwi-2.6 iilitha) kwiiyure ezingama-24, okubangela ukothuka okukhulu kwe-hypovolemic, prerenal acute kidney injury, metabolic lactic acidosis, hypokalemia, hyponatremia, hyponatremia kunye ne-leukocytosis yokuqala* spike kwisibalo seeseli ezimhlophe zegazi ngaphezulu kwe-20,000/mcL phambi kokuba umongo wethambo untlitheka).

Isigaba sesi-2: Ukungaphumeleli kwe-Multi-Organ, Shock Cardiogenic, kunye neSigaba se-Bone Marrow Aplasia (Iintsuku 1 ukuya kwi-7)¶

Kanye njengoko ukuhlanza kunye nohudo kubonakala ngathi kucotha malunga neyure engama-24 ukuya kuma-36, isigulane singena kwisigaba sesibini esibulalayo:

1. I-Refractory Cardiogenic Shock kunye ne-Arrhythmias (Iiyure ze-24 ukuya kwi-72 - Isizathu sokuqala sokuFa):
2. Ukutshatyalaliswa kwe-tubulin ngokuthe ngqo ngaphakathi kwe-myocytes yenhliziyo kubangela ukungaphumeleli kwentliziyo ye-biventricular (left ventricular ejection fraction dropping below 15% to 20%), i-hypotension enzulu eyeka ukuphendula kwi-IV fluids kunye ne-vasopressors, i-sinus bradycardia, i-atrioventricular heart block epheleleyo, i-ventricular tachycardia, kunye ne-sudden ** asystolic cardiac arrest **.
3. Gqibezela i-Bone Marrow Aplasia / Pancytopenia (Iintsuku ezi-3 ukuya kwe-7):
4. Phakathi koSuku lwe-3 kunye noSuku lwe-7, isibalo esipheleleyo se-neutrophil yesigulana sehla siye ku zero (agranulocytosis) kunye neeplatelet zehla ngaphantsi kwe-10,000 ukuya kuma-20,000/mcL (severe thrombocytopenia).
5. Ngenxa yokuba ulwelwesi lwamathumbu luphulukene nomqobo ngokuchasene neebhaktheriya zamathumbu kwangelo xesha linye umzimba uneeseli ezimhlophe zegazi, i-Gram-negative bacteria (E. coli, Klebsiella, Pseudomonas) ugalela ngqo ukusuka emathunjini ukuya egazini, kubangela fulminant neutropenic shock kunye ne-Disseminated Intravascular Coagulation (DIC).
6. I-Acute Respiratory Distress Syndrome (ARDS), iRhabdomyolysis, kunye nokunyuka kokukhubazeka:
7. Ukuvuza kwe-capillary emiphungeni kubangela i-edema ye-pulmonary edema engekho-cardiogenic (ARDS) efuna umoya wokungena ngoomatshini.
8. Umonakalo othe ngqo we-skeletal muscle kunye nomonakalo we-axonal microtubule ubangela kakhulu ** i-myoneuropathy ** (ubuthathaka obusondeleyo bemisipha bulinganisa i-Guillain-Barré syndrome, i-creatine kinase ephakamileyo rhabdomyolysis, kunye nokulahleka kwe-reflexes), kunye nokulimala kwesibindi, i-pancreatitis, kunye ne-ileus ekhubazekile.

Inqanaba lesi-3: UkuBuyisa kwakhona kunye neSigaba esipheleleyo seAlopecia (Usuku lwesi-7 ukuya kwiVeki yesi-3+)¶

Ukuba isigulana sisinda kwingxaki yentliziyo kunye neseptic yeSigaba 2 kwi-ICU:

• I-Rebound Leukocytosis: Iiseli zomongo wethambo ziphinda ziqale ukwahlukana malunga noSuku lwe-7 ukuya kwe-10, nto leyo ebangela ukuba ukubalwa kweeseli ezimhlophe zegazi ukuba zibuyele ngokukhawuleza.
• ** Ukulahleka kweenwele ngokupheleleyo, okumangalisayo (Total Alopecia):** Malunga noSuku lwe-7 ukuya kwi-14, kuba iiseli ze-hair-follicle matrix zahlula ngokukhawuleza njengezigulane ze-chemotherapy, ** zonke i-scalp, ishiya, kunye neenwele zomzimba ziphuma kwii-clumps ** (ekugqibeleni zikhula ngokupheleleyo kwiinyanga ezi-3 ukuya kwezi-6). Ubuthathaka be-neuromyopathy bunokuthatha iiveki okanye iinyanga zokuvuselelwa komzimba ukusombulula.

Ukusebenzisana kweziyobisi ezibulalayo: Idosi ye-gout yeepilisi ezi-2 iba yinto ebulalayo¶

Ngaphezu kwe-*isiqingatha sayo yonke ityhefu ye-colchicine echazwe ngugqirha ezibhedlele ayiveli kwiipilisi ezigqithisiweyo ngabom **; zenzeke kwizigulane ezithatha iipilisi zazo ze-colchicine ezimiselweyo ze-0.6-mg ezinikwa ngaxeshanye isibulala-ntsholongwane esiqhelekileyo okanye ipilisi yentliziyo, okanye abanezintso ezingapheliyo okanye isifo sesibindi.

I CYP3A4 kwaye P-glycoprotein (P-gp) i-clean trap¶

Ngokuqhelekileyo, iiseli zomntu ziyazikhusela kwi-colchicine zisebenzisa iipompo ezimbini zebhayoloji:

1. P-glycoprotein (P-gp / ABCB1): Ipompo esebenzayo yeselula efflux kumphezulu weeseli zamathumbu, isibindi se-biliary canaliculi, kunye nee-tubules zezintso ezithi ** zimpompa ngokusebenzayo i-colchicine ngaphandle kweeseli kwi-stool kunye nomchamo **.
2. I-Cytochrome P450 3A4 (CYP3A4): I-enzyme yesibindi ekhupha i-methylation ize ingasebenzi i-colchicine.

Ukubukeka kweBhotani: iGloriosa Superba (iNyibiba eFlame) kunye neColchicum Autumnale (iCrocus yasekwindla)¶

Izityalo ezibini ezikhuliswe ngokubanzi ezihonjisiweyo kunye nezityalo zasendle ziqulathe ukugxila kwendalo okukhulu kwe-colchicine ecocekileyo kwaye zibangela uninzi lwetyhefu ebulalayo minyaka le phakathi kwabalimi basekhaya, abafuyi begalikhi yasendle, kunye nabantwana:

1. I-Colchicum autumnale (I-Autumn Crocus / Meadow Saffron / Naked Ladies)¶

• IGarlic yasendle (Allium ursinum / Ramps) Umgibe wokutya: Ngentwasahlobo, i-Colchicum autumnale ithumela amagqabi aluhlaza, akhazimlayo amile okwelance avela kwiibhalbhu eziphantsi komhlaba kumadlelo afumileyo aseYurophu nakuMntla Merika-ahlala ekhula ** kanye ecaleni kweGarlic yasendle etyiwayo (Allium ursinum / ikonofile yebhere)** okanye iirampu. Abaphangi abachola amagqabi ekonofile yasendle besenzela ipesto okanye isuphu ngempazamo baqokelela amagqabi e-Colchicum kunye negalikhi.
• Indlela yokwahlulahlula: Ukutyumza igqabi legalikhi yasendle elityiwayo kukhuphaivumba elibukhali ikonofile, kwaye amagqabi alo akhula kwiziqu ezisuka kwibhalbhu; Amagqabi anetyhefu I-Colchicum autumnale anevumba le-ZERO ikonofile, aqinile, kwaye asonge ngokuqinileyo omnye komnye kwisingxobo esirhabaxa emazantsi. Ukutya nje amagqabi okanye iintyatyambo ze-Colchicum ezimbalwa zisa umthamo obulalayo we-colchicine. (Qaphela: I-Colchicum autumnale ikwahluke ngokupheleleyo kwisiqholo esiyinyani sokupheka Isafron [Crocus sativus], yosapho luka-iris Iridaceae kwaye inebala ezi-3, kanti i-Colchicum enetyhefu iyeyako Colchicaceae kwaye inestamens ezi-6).

2. Gloriosa superba (Inyibiba edangazelayo / inyibiba yozuko / inyibiba eNyokayo)¶

• Itapile eSweet / iYam / iGinger Tuber Trap: IGloriosa superba ngumdiliya onyukayo wetropikhi onedangatye elibomvu-namthubi elijikajikayo lentyatyambo ekhule kwi-Asiya, Afrika, Ostreliya, nanjengesityalo sokuhombisa sasekhaya e-US naseYurophu. Ngaphantsi komhlaba, ikhula imilebe engu-V okanye emile okwenyama engu-L izigaqa ezingaphantsi komhlaba ezikhangeleka ngokuphawulekayo njenge itapile eziswiti, iiyam, icassava, okanye ingcambu yejinja.
• Ukubulala ngokugqithisileyo: Ituber eyodwa ene-20-to-50-gram Gloriosa superba iqulethe 60 ukuya kwi-150 milligrams ye- pure colchicine kunye negloriosine - eyaneleyo yokubulala abantu abadala ababini ukuya kwabathathu. Nabani na opheke ngempazamo kwaye atye iGloriosa ityhubhu udinga ukukhutshwa kwesisu esiswini kwangoko esibhedlele nangaphambi kokuba isisu sokuqala siqale.

I-PodophyllinPodofilox / Mayapple) Ityhefu: ingozi yentsumpa¶

** I-Podophyllin ** i-resin egxininisiweyo yesityalo ekhutshwe kwiingcambu ze-*Mayapple yaseMelika (Podophyllum peltatum)**, equlathe ityhefu yemicrotubule esebenzayo podophyllotoxin (podofilox / Condylox). Imiselwe njengesisombululo se-0.5% / ijeli okanye idityaniswe njenge-10% ukuya kwi-25% ye-benzoin tincture ukutshisa iintsumpa zangasese (condyloma acuminata) kunye neentsumpa zeplantar.

• Yenzeka njani ityhefu: Ukuginya ngengozi ibhotile esusa intsumpa ngumntwana oselula, ukutya iziqhamo/iingcambu zeMayapple eziluhlaza ehlathini, okanye **ukufaka i-10% ukuya kwi-25% yentlaka yepodophyllin kwiintsumpa ezinkulu, ezikrwada, ezophayo ezikwilungu langasese okanye eziperianal kunye nokusilela ukuyihlamba emva kweyure enye ukuya kwe-4 yokuyihlamba.
• I-neurological twist eyodwa ecaleni kokungaphumeleli komongo wethambo: Njenge-colchicine, i-podophyllin itshixa i-mitotic spindle kwaye ibangele iSigaba soku-1 sokugabha/urhudo olulandelwa siSigaba 2 i-bone marrow pancytopenia, ukusilela kwesibindi, kunye nokothuka. Ukongeza, i-podophyllin iwela isithintelo segazi-ingqondo ngamandla ngakumbi kune-colchicine, ebangela **i-acute central nervous system encephalopathy (ukudideka, ukubona izinto ezibonwayo, ukutyhafa, ukuqaqanjelwa, ukuxhuzula) ngaphakathi kwe-6 ukuya kwiiyure ezingama-24 **, ilandelwa bubunzima, obuhlala ixesha elide ** i-sensorimotor peripheral neuropathy / ukuvutha konyawo, ukuqaqamba kwentliziyo, ukuqaqamba konyawo, ukuqaqamba kwentliziyo ileus.

Ulawulo lweSibhedlele se-ICU yeColchicine kunye nePodophyllin toxicity¶

1. I-Immediate Gastric Lavage (ngaphakathi kwemizuzu engama-60) kunye ne-Multidose Activated Charcoal (MDAC):
2. Ngenxa yokuba ukufa okungaphezulu kwe-0.5 ukuya kwi-0.8 mg / kg kuphezulu kakhulu kwaye i-dialysis ihluleka, oogqirha benza i-nasogastric aspiration / lavage yokuqala ukuba isigulane sifika ngaphakathi kweyure ye-1 yokungenisa kwaye ilawula ** i-charcoal esebenzayo (50 g ekuqaleni, ilandelwa yi-25 g nganye kwiiyure ze-2 kwiiyure ze-4) ** ecaleni kwe-IV kwi-interruption interrupt
3. Ukuvuswa kwe-Hemodynamic kwangethuba kunye ne-VA-ECMO:
4. Ukutshintshwa kolwelo olukhulu lwecrystalloid (0.9% normal saline okanye Ringer's lactate) ekhokelwa yi-echocardiography ye-bedside ngexesha leSigaba 1, ukuguqulwa ngokukhawuleza kwi-** norepinephrine / epinephrine infusions ** kunye nokuqala ** I-Veno-Arterial Extracorporeal I-Membrane Oxygenation (VA-ECMO) ** ukuba i-refractory cardiogenic shock ikhula kwiSigaba 2 (VA-ECMO igcine i-mg kg / i-microcardium eninzi igcina i-microcardiograms8) ihlaziywe 5 ukuya kwiintsuku ezisi-7 kamva).
5. Into evuselela iGranulocyte Colony-Early (G-CSF / Filgrastim) kunye Neutropenic Sepsis Precautions:
6. Ngaphambi okanye ngokukhawuleza ukuba inani leeseli ezimhlophe zegazi liqala ukuhla ngoSuku lwe-2 ukuya ku-3, i-hematologists kunye nee-toxicologists zilawula yonke imihla nge-subcutaneous okanye nge-intravenous filgrastim.G-CSF, 5 mcg/kg/day) ukuvuselela iiseli ezisindileyo zomongo wethambo kunye nokunciphisa ubude be-neutropenia ebulalayo, idibaniswe ne-antibiotics ebanzi ye-intravenous (cefepime, piperacillin-tazobactam, okanye meropenem) kunye notofelo-gazi lweplatelet.
7. Amacandelo oPhando lweColchicine-Specific Fab Antibody: Kumaziko akhethekileyo aseYurophu (eFransi), umfuniselo amaqhekeza eFab ye-ovine ye-colchicine (eyakhiwe ngokufana ne-Digibind/DigiFab esetyenziselwa ukugqithisa ngokweqile kwe-digoxin) iye yakhupha ngempumelelo icolchicine ngaphandle kwezicubu kunye ne-cardiogenic lethausel iiprothokholi.

Iinombolo zengingqi zikaxakeka kunye neeprothokholi ze-arhente¶

• I-United States neKhanada: Shayela ** 911 ** kunye ** Ukulawulwa kwePoison yase-US kwi-1-800-222-1222 ** (Canada: ** 1-844-POISON-X **). I-US Food and Drug Administration (FDA) Colcrys (Colchicine) Safety Labeling inika umyalelo ongqongqo 1.8 mg ubuninzi be-3-tablet acute gout flare cap (1.2 mg ilandelwa yi-0.6 mg 1 iyure kamva) kwaye ithwala i-Black Box contraindications ngokuchasene nokuphatha kunye ne-colchicine CYP3A4/P-gp inhibitors (clarithromycin, ritonavir/Paxlovid, cyclosporine) kwizigulane ezine-renal okanye hepatic impairment.
• EUnited Kingdom: Fowunela 999 ngoko nangoko malunga nayo nayiphi na i-colchicine ekrokrelekayo okanye i-Colchicum overdose. I-Arhente yokuLawula amayeza kunye neemveliso zezempilo zase-UK (MHRA) kunye neNkonzo yeSizwe yeNgcaciso yePoisons (NPIS / TOXBASE) ihlela NAYIPHI na i-colchicine yokugqithisa ngabom okanye ngengozi njengemeko engxamisekileyo yonyango efuna ukungeniswa esibhedlele ngokukhawuleza, i-Multidose Activated Charcoal, kunye ne-24-yure encinci ye-cardiac / biosymptomatic observation.
• ** IManyano yaseYurophu:** Fowunela 112. I-European Alliance of Associations for Associations for Rheumatology (EULAR) izikhokelo ze-gout kunye neFrench Poison Control / European Association of Poisons Centres kunye ne-Clinical Toxicologists (EAPCCT) iiprothokholi ziqondisa idosi ephantsi ye-colchicine yokumisela, ukuphepha okungqongqo kwe-macrolide, kunye nokuthunyelwa kwe-ICU / VA-ECMO kwangaphambili ukuze kufakwe >= 0.5 mg / kg.
• Ostreliya neNew Zealand: Fowunela 000 eOstreliya (IiNgcaciso zePoisons 13 11 26) okanye 111 eNew Zealand (0800 764 766). Ulawulo lweeMpahla zeTherapeutic (TGA) kunye ne-Medsafe NZ zilumkisa kakhulu "ngokuthatha kude kube lurhudo" ukudongwa kwegawuthi.
• ** I-Indiya kunye ne-Asia-Pacific: ** Fowunela ** 112 ** eIndiya, ** 995 ** eSingapore, ** 119 ** eJapan naseMzantsi Korea, okanye ** 999 ** eMalaysia naseHong Kong. EIndiya naseSri Lanka, iGloriosa superba (Karthigai Kilangu / Niyagala) ityhefu yetuber ngoyena nobangela uphambili owaziwayo we-acute pancytopenia enetyhefu kunye nomothuko wentliziyo ofuna ukuthunyelwa kwangoko kwisibhedlele senqanaba lesithathu. Jonga incwadi yethu ye iinombolo zikaxakeka zamazwe ngamazwe.

Imibuzo edla ngokubuzwa¶

Leliphi inani eliphezulu elikhuselekileyo leepilisi zecolchicine ekufuneka uzithathele uhlaselo oluqatha lwegout?¶

I-FDA yanamhlanje kunye nezikhokelo ze-rheumatology yamazwe ngamazwe (ngokusekelwe kuvavanyo lwezonyango lwe-AGREE oluyimbali) lumisela ukuba ubuninzi bedosi ekhuselekileyo nesebenzayo yokuvutha kwegawuthi ebukhali kumntu omdala onezintso eziqhelekileyo kunye nesibindi iipilisi ezimbini ze-0.6-milligram (1.2 mg) ezithathwe kuphawu lokuqala lwe-flare, ilandelwa NYE nje eNYE eyongezelelweyo 0.6-milligram tablet (0.6-milligram tablet (0.18 mg) iyure iyonke emva kwe-tablet . Kuya kufuneka ke uyeke kwaye ulinde ubuncinci iiyure ezingama-72 ngaphambi kokuba uthathe enye ikhosi yokudangala. Ukuthatha iipilisi ezi-6, ezili-10, okanye ezili-15 ngosuku akuyenzi ukuba iintlungu zegawuthi ziphele ngokukhawuleza kwaye kunokubangela ityhefu ebulalayo yamalungu amaninzi.

Kwakutheni ukuze oogqirha bamandulo baxelele izigulana zegawuthi ukuba ziqhubeke zithatha i-colchicine rhoqo ngeyure de zibe norhudo, kwaye kwakutheni ukuze iyekiswe oko?¶

Kangangamashumi eminyaka ngaphambi kokuba kwenziwe izifundo zokulinganisa umthamo wanamhlanje, oogqirha babengenazo ezinye iindlela ezikhuselekileyo zokulwa nokudumba kwaye baxhomekeke kumgaqo osebenzayo wenkulungwane ye-19 wokunika ithebhulethi eyi-1 ye-colchicine rhoqo ngeyure de isigulane sibe norhudo olunzima kunye nokuhlanza. toxicologists Medical ekugqibeleni baqonda ukuba utyatyazo colchicine-eyenziwe asiyongozi isiphumo icala - luphawu ngqo ukuba iyeza lityhefe kwaye wabulala iiseli stem ekwahlulahlulayo ucanda amathumbu akho amancinane, kwaye ithamo ebangela urhudo overlaps ngokuthe ngqo idosi ebangela ukusilela umongo wamathambo kunye nokungaphumeleli kwentliziyo ebulalayo.

Kutheni kuyingozi kangaka ukuthatha isithinteli-ntsholongwane i-clarithromycin okanye i-COVID-19 Paxlovid ngelixa uthatha i-colchicine yemihla ngemihla?¶

Umzimba wakho uthembele kwipompo yeselula ebizwa ngokuba yi-P-glycoprotein kunye ne-enzyme yesibindi ebizwa ngokuba yi-CYP3A4 ukupompa i-colchicine kwiiseli zakho kwi-bile kunye nomchamo ukuze ingakhi. I-Clarithromycin (i-Biaxin), i-erythromycin, amachiza e-antifungal afana ne-itraconazole, kunye necandelo le-ritonavir le-COVID-19 Paxlovid zivale ngokupheleleyo zombini i-P-glycoprotein kunye ne-CYP3A4. Ukuba uqhubeka uthatha iipilisi zakho eziqhelekileyo ze-1 okanye i-2 zemihla ngemihla ye-colchicine ngelixa uthatha i-clarithromycin okanye i-Paxlovid, i-colchicine ibamba ngaphakathi kwentliziyo yakho kunye nomongo wethambo kwi-3 ukuya ku-4 amaxesha aqhelekileyo amanqanaba aqhelekileyo, okubangela ityhefu ebulalayo phakathi kweentsuku.

Ukuba umntu uginye iipilisi ze-colchicine ezingaphezulu kwiiyure ezi-3 ezidlulileyo kwaye usaziva i-100% eqhelekileyo, ngaba uphumile engozini?¶

Hayi - loo festile engenazo iimpawu ngowona mgibe unobungozi kwityhefu ye-colchicine. I-Colchicine ithatha i-2 kwiiyure ze-12 ukuphazamisa i-microtubule spindles ngaphakathi kokuhlula iiseli zamathumbu, ngoko ke isigulane ngasinye siziva silungile ngokupheleleyo kwiiyure ezimbalwa zokuqala emva kokuginya umthamo obulalayo. Ukulinda ekhaya de kuqale ukugabha okuqatha kunye norhudo olunegazi kuthetha ukuba ityhefu sele iphumile emathunjini kwaye itshixelwe ngokungenakulungiseka ngaphakathi kwisihlunu sentliziyo kunye nomongo wethambo, apho i-dialysis ingenako ukufikelela kuyo. Ukuya kwigumbi likaxakeka ngexesha lokuqala elizolileyo i-1 ukuya kwiiyure ezi-2 zamalahle asebenzayo kunokusindisa ubomi besigulane.

Abantu batyhefwa njani ngengozi zizityalo ze-Autumn Crocus okanye iGloriosa Lily?¶

Ngentwasahlobo, i-Autumn Crocus enetyhefu (Colchicum autumnale) ishiya ihluma kumadlelo afumileyo ngasekunene ecaleni kwegalikhi yasendle etyiwayo (Allium ursinum / iirempu); iiforoji ezinganukiyo onke amagqabi evumba legalikhi ngempazamo zidibanisa amagqabi eColchicum kwipesto yasendle okanye isuphu. Kwimimandla eshinyeneyo neyeetropikhi (kunye namakhaya aneenyibiba zokukhwela ezihonjisiweyo), izigaqa ezingaphantsi komhlaba zeFlame Lily (Gloriosa superba) zikhangeleka njengebhatata encinci, iiyam, okanye ingcambu yejinja, kwaye ukutya nesiqingatha se-tuber kuzisa umthamo omkhulu, obulalayo wecolchicine.

Imithombo kunye nezikhokelo ezisemthethweni¶

• ** ULawulo lwezoKutya kunye neziyobisi zase-US (i-FDA, eUnited States): ** * Ukuchaza iNgcaciso yoLwazi kunye neSikhokelo soNyango kwiiColcrys (i-Colchicine, i-USP) iipilisi * kunye * kunye ne-FDA yoNxibelelwano loKhuseleko lweDrugs: Ukusebenzisana kweziyobisi eziFatal phakathi kwe-Colchicine kunye ne-P-Glycoprotein / i-CYP3A4 Inhibitors eqinile (i-Clarithromyrine, i-Cycloslospovir)
• Terkeltaub RA et al. (I-Arthritis & Rheumatism, uvavanyo lwe-AGREE): *I-High Versus Low Dosing ye-Oral Colchicine ye-Early Acute Gout Flare: Iziphumo zeeyure ezingamashumi amabini anesine ze-First Multicenter, i-Randomized, i-Double-Blind, i-Placebo-Controlled, i-Parallel-Group, i-Dose-Comparison Study.
• Finkelstein Y, Aks SE, Hutson JR, Juurlink DN, Baud FJ et al. (Clinical Toxicology): Colchicine Poisoning: Icala Elimnyama leChiza laMandulo (Bismuth/Baud-based weight-based mg/kg i-stratification yokufa, i-3-phase ye-clinical progression, i-enterohepatic recirculation, i-Multidose Activated Charcoal, kunye ne-G-CSF / VA-ECMO yokhathalelo olunzulu).
• Amayeza kunye neemveliso zononophelo lwezempilo (i-MHRA) kunye neNkonzo yeSizwe yoLwazi lwePoisons (NPIS, eUnited Kingdom): *Uhlaziyo loKhuseleko lweDrug: Colchicine - I-Intremely Narrow Therapeutic Index kunye neRisk of Fatal Overdose *.
• UMbutho wezeMpilo weHlabathi (i-WHO) kunye nezikhokelo zamaZiko ePoison: ULawulo lweKlinikhi yeZityalo zePoisonings: I-Colchicum autumnale (i-Autumn Crocus), i-Gloriosa superba (i-Flame Lily), kunye ne-Podophyllum peltatum (i-Podophyllin Resin).

Izikhokelo ezinxulumeneyo¶

• Ukutya amakhowa asendle, i-atoxin, kunye nokutyiwa kwezityalo ezinetyhefu
• Umkhuhlane we-neutropenic, usulelo lwe-chemotherapy, kunye neemeko ezingxamisekileyo zonyango
• Ukwenzakala okukrakra kwezintso, i-rhabdomyolysis, kunye novavanyo lomchamo omnyama
• Ityhefu yokutya, i-gastroenteritis ebukhali, kunye nokuphelelwa ngamanzi emzimbeni
• Ityhefu yoncedo lokuqala kunye nokuvezwa yityhefu