Aifọwọyi-Brewery Syndrome (Endogenous Gut Fermentation) vs Oti Majele (Methanol ati Ethylene Glycol) Iyatọ Gap Osmolal¶

Nigbati eniyan ba ṣafihan pẹlu ọrọ sisọ ti ko ni alaye, ataxia (gait ti o yanilenu), dizziness, rudurudu, tabi ọmuti ti o han gbangba lakoko ti o tẹnumọ pe wọn ko jẹ ẹyọ kan ti awọn ohun mimu ọti-lile, awọn oniwosan pajawiri dojuko orita iwadii pataki laarin awọn ipo idakeji meji patapata: Auto-Brewery Syndrome (Endogenous Syndrome) ninu eyiti idagbasoke ti awọn elu fermenting ( julọ ti o wọpọ * Saccharomyces cerevisiae , * Candida albicans , tabi * Candida glabrata ) tabi awọn kokoro arun ti o nmu ethanol ga ( Klebsiella pneumoniae * ati * Enterococcus faecium bladder, inu awọn carbohydrates inu ito kekere tabi awọn adiye ninu awọn ito inu inu ito kekere ninu awọn ile ito). pasita, omi onisuga, oje eso) taara sinu ** ethanol endogenous funfun (\(\ ọrọ{CH}_3\ọrọ{CH}_2\ọrọ{OH}\))**, ati Majele Oti Oti Ainirun lati inu ijamba, ayika, ẹmi-agbala, tabi jijẹ ara ẹni ipalara ti Methanol, kikun fẹẹrẹfẹ afẹfẹ tinrin), Ethylene Glycol (adidididiọti ọkọ ayọkẹlẹ, ito de-icing, omi brake), tabi Isopropanol (ọti mimu, afun ọwọ). Lakoko ti alaisan pẹlu Auto-Brewery Syndrome ni ipele ipele ethanol omi ti o ga ** (nigbagbogbo \(100 ọrọ{si }400\ọrọ{mg/dL}\) lẹhin ounjẹ carbohydrate) pẹlu pH ẹjẹ iṣọn deede, omi ara bicarbonate deede, ati osmolal gap odo ti ko ni iṣiro ** tabi alaisan Ethancol ** odo tabi ipele ethanol kekere , ni ibẹrẹ ** Ọrun-giga Serum Osmolal Gap (\(> 10\ọrọ{si}20\ọrọ{mOsm/kg}\)) ti o yipada ni ilọsiwaju diẹ sii ju wakati 6 si 24 nipasẹ ẹdọ-ẹdọ ** Ọtí Dehydrogenase (ADH)* sinu apaniyan *HAGcidosis **High- ** formic acid ** lati kẹmika (eyiti o npa nafu opiki ati putamen run, ti o fa ** “nrin ninu iji yinyin” ifọju wiwo ** ati idaduro atẹgun) tabi ** glycolic ati oxalic acid ** lati ethylene glycol (eyiti o ṣafẹri ** awọn kirisita oxalate calcium oxalate ti o ni apoopu ** inu awọn kidinrin, ti o fa **acute oliguric renal ikuna, oliguric renal ati ikuna oliguric). Ti enikeni ba farahan ti o ti mu ọti-lile lai mu ọti, tabi ti o ndagba iriran/iriran snowfield, mimi ti o jinlẹ (Kussmaul respirations), irora ẹgbẹ, ikọlu, tabi aibikita, pe agbegbe rẹ. pajawiri awọn nọmba lẹsẹkẹsẹ. Tun ṣe ayẹwo awọn itọsọna arakunrin wa lori methanol, ethylene glycol antifreeze, ati oloro oti oloro, oti mimu, hangover, ati ailewu gbigbe, ati majele ati ifihan majele ti iranlowo akọkọ.

Ohun pataki rẹ lẹsẹkẹsẹ ni eyikeyi ọti ti ko ni alaye ni lati **pakuro hypoglycemia ti o lewu igbesi aye ati mimu ọti-lile majele ni KỌKỌTA *, ṣe iṣiro mejeeji ** Serum Osmolal Gap (Diwọn didi-Point Serum Osmolality iyokuro Osmolarity Iṣiro, pẹlu ethanol pinpin-nipasẹ-4.6 ifosiwewe) ** ati Gap Serum + ifosiwewe. HCO3-]$), ṣe abojuto ** Fomepizole inu iṣọn-ẹjẹ (4-methylpyrazole, \(15\text{mg/kg}\) IV doseing loading) lẹsẹkẹsẹ laisi iduro fun awọn abajade chromatography gaasi ti a firanṣẹ-jade ** ti methanol tabi ethylene glycol ko ba le yọkuro, so Fomepizole pọ pẹlu kan pato ** Vitamin Foucidol Apọjuuju (IV Lehan) Pyridoxine [Vitamin B6] + Thiamine [Vitamin B1] fun ethylene glycol), ati ifipamọ ** Idanwo Ipenija Glucose Oral ti Ile-iwosan ti Abojuto ** fun ṣiṣe iwadii Arun-Brewery Auto-Brewery ni kete ti majele nla ati awọn pajawiri ti iṣan ti yọkuro.

Ṣe eyi ni bayi¶

1. klzzwxh:52 (Awọn alaye oloro 13 11 26), tabi wo itọsọna agbaye wa ti pajawiri awọn nọmba.
2. Ṣayẹwo glukosi ẹjẹ capillary ti ika ika kan lẹsẹkẹsẹ ki o daabobo ọna afẹfẹ. Hypoglycemia nla, ketoacidosis dayabetik (DKA, eyiti o nmu ẹmi acetone eso nigbagbogbo n ṣe aṣiṣe fun ọti), ọpọlọ iṣan ti ẹhin, ati encephalopathy hepatic, gbogbo wọn dabi ọti. Ti alaisan ba sun tabi eebi, yi wọn si ẹgbẹ wọn ni ipo imularada ita **.
3. ** Ayewo Aye fun Ọkọ ayọkẹlẹ, Ile, tabi Awọn Apoti Ti a Ti Ilẹ, TABI Agbogun Agbogun Laipẹ / Awọn okunfa Carbohydrate giga:**
4. ** Awọn itọsi Ọti majele:** Wa ** omi ifoso afẹfẹ bulu tabi Pink Pink ***, ** Fuluorisenti ofeefee-alawọ ewe tabi imooru imooru osan **, ** epo fondue akolo ***, **paint stripper *, ** sanitizer / fifi pa ọti, tabi awọn igo oti ti ko ni aami.
5. ** Awọn amọran Arun Aifọwọyi-Brewery:** Beere boya alaisan naa ni ** iṣọn ifun kukuru kukuru, arun Crohn, Roux-en-Y gastric bypass, ẹdọ cirrhosis / NAFLD, diabetes, tabi awọn iṣẹ aporo aporo-ọpọlọ to ṣẹṣẹ laipẹ, ati boya awọn iṣẹlẹ wọn lu ** 1 si 4 wakati lẹhin ounjẹ carbohydrate giga, pizza,… ãwẹwẹ.
6. Paṣẹ fun dandan 5-Apá Hospital Triage Panel Panel (Diwọn Osmolality nipasẹ Didi-Point şuga, Ipilẹ Metabolic Panel, Serum Ethanol, Ẹjẹ Gas + Lactate, ati Urinalysis pẹlu Maikirosikopi). iyipada kẹmika ati ẹmu ati ki o fun a ** eke deede osmolal aafo).
7. ** Ti o ba jẹ pe Ọti Majele (Methanol tabi Ethylene Glycol) Ṣe ifura: Ṣe abojuto Fomepizole inu iṣan (15 mg/kg IV ju iṣẹju 30 lọ) Lẹsẹkẹsẹ, MAA ṢE Duro fun Imudaniloju Chromatography Gaasi.** **Fomepizole (Antizol) iyẹn ni awọn akoko 8,000 ti o ga ju methanol tabi ethylene glycol, tiipa enzymu tiipa laarin awọn iṣẹju ki odo formic acid tabi oxalic acid le dagba. (Ti Fomepizole ko ba si, fun IV tabi iwọn lilo Ethanol ẹnu lati ṣetọju ipele ẹmu omi ara-ara ifigagbaga ti \(100\ọrọ{si}150\ọrọ{mg/dL}\).)
8. Ti Awọn Idanwo Lab Jẹrisi Ethanol Alailowaya Alaifọwọyi (Aifọwọyi-Brewery Syndrome) Pẹlu pH deede Ẹjẹ, Deede Bicarbonate, ati Zero Unaccounted Osmolal Gap: Gbe alaisan naa sori ** o muna Zero-Sugar, Low-Carbohydrate, Diet Protein High-High-Protein Diet**, supervinnese diet eje \(0\ọrọ{mg/dL}\), ki o tọkasi fun Abojuto Alabojuto 100g-si-200g Idanwo Ipenija Glucose Oral, ifun olu/awọn aṣa kokoro-arun, ati ibi-afẹde ** antifungal (fluconazole, nystatin, tabi echinocandin) tabi itọju ailera antibacterial**.

Igi ipinnu: mimu mimu ile-iwosan ti ko ṣe alaye, aafo osmolal, ati ipin aafo anion¶

flowchart TD
    A["Alaisan Ṣe Ifarahan Pẹlu Ọti-Ọti Ailopin (Ataxia, Ọrọ sisọ, Idarudapọ, tabi Supor) Kiko Lilo Ọti"] --> B{"Lẹsẹkẹsẹ Bedside & STAT Lab Triage: Glucose Fingerstick + Iwọn Didi-Point Serum Osmolality + BMP (Na+, Cl-, HCO3-, Cr, Glucose, BUN) + Serum Ethanol + Ẹjẹ Gas"}
    B -->|Serum Ethanol ELEVATED (50 to 400 mg/dL) + Normal Blood pH (7.35-7.45) + Normal HCO3- + Osmolal Gap Fully Explained by Ethanol (OG < 10 after subtracting EtOH/4.6)| C{"Njẹ Alaisan Ni Imumumujẹ Ounjẹ Lẹhin-Kabohydrate Loorekoore pẹlu Mimu Ọti Alailowaya Odo ti Jẹri bi?"}
    C -->|YES: Episodes Triggered 1-4 Hrs After Bread/Pasta/Sugar in Patient with Short Bowel, Roux-en-Y, Crohn's, Cirrhosis, or Post-Antibiotics| D["SYNDROME AṢẸRỌ-BREWERY ti a fura (Ikẹhin ikun ti inu nipasẹ Saccharomyces, Candida, tabi Klebsiella pneumoniae)"]
    C -->|NO: Acute Exogenous Ethanol Ingestion| E["Itọju Intoxication Ethanol Standard: Idaabobo oju-ofurufu, IV Thiamine (100 miligiramu) ṣaaju glukosi, Awọn ito, Akiyesi"]
    D --> F["Itọju Ẹgan Lẹsẹkẹsẹ: Ounjẹ Kabohydrate Kekere / Amuaradagba Giga + Akiyesi Ailewu Titi BAC = 0 + Abojuto Imudaniloju 24-Hr Awẹ & Idanwo Ipenija Glucose Oral + Antifungal Ifojusi (Fluconazole/Nystatin) tabi Itọju Kokoro"]
    B -->|Serum Ethanol ZERO or Low (or Unaccounted Osmolal Gap > 10 mOsm/kg After Subtracting Ethanol) OR High-Anion-Gap Metabolic Acidosis (pH < 7.30, HCO3- < 18)| G["MÁJÉJÌ Ọtí MÉJÌ tí a fura sí (Methanol, Ethylene Glycol, tàbí Isopropanol)"]
    G --> H{"Ṣayẹwo Ipo Acid-Base (Anion Gap) & Awọn ami Ẹran ara isẹgun"}
    H -->|Elevated Osmolal Gap (> 10-20) WITH Normal Anion Gap & Normal pH + Sweet/Fruity Acetone Breath + Ketonuria/Ketonemia (Zero Acidosis)| I["ISOPROPANOL (Ọti Fifọ) Ingestion: Metabolized nipasẹ ADH si Acetone (Ketone, KO Acid); Ṣe itọju pẹlu Itọju Atilẹyin NIKAN (Maṣe fun Fomepizole)"]
    H -->|Visual Blurred/Snowstorm Vision, Blindness, Dilated Unreactive Pupils, Optic Disc Hyperemia + Severe HAGMA| J["METHANOL OJE (Majele Acid Formic)"]
    H -->|Flank Pain, Hematuria, Oliguria/AKI, Envelope/Needle Calcium Oxalate Crystals in Urine, Hypocalcemic Tetany + Severe HAGMA + Falsely Sky-High Point-of-Care Lactate| K["ETHYLENE GLYCOL Oloro (Glycolic & Oxalic Acid Majele)"]
    H -->|Very Early Presentation (< 1 to 6 Hours): High Osmolal Gap (> 15-20) with Normal Anion Gap (Before ADH Converts Parent Alcohol to Acid)| L["TETE METHANOL TABI ETHYLENE GLYCOL IGBO"]
    J --> M["Lẹsẹkẹsẹ Antidote: Fun IV FOMEPIZOLE 15 mg/kg Ju 30 Min Ni Bayi (Ṣaaju Awọn abajade Chromatography Gaasi) + IV Sodium Bicarbonate (ti o ba jẹ pH <7.30)"]
    K --> M
    L --> M
    M --> N["Ṣafikun Awọn olutọpa Metabolic Specific: 1. Fun Methanol: IV FOLINIC ACID (Leucovorin) 1 mg / kg (to 50 mg) q4h; 2. Fun Ethylene Glycol: IV PYRIDOXINE (Vit B6) 50-100 mg q6h + IV THAIMIN (Vit B1) 100 mg q6h"]
    N --> O{"Itọkasi eyikeyi fun Hemodialysis Pajawiri? (Coma/Seizures, Visual Deficit, Àrùn Àrùn Àrùn, pH <7.15-7.25, tàbí Ìpele Majele> 50 mg/dL)"}
    O -->|YES| P["HEMODIALYSIS AGBẸRẸ PAJAWỌ (Ṣe alekun Igbohunsafẹfẹ Fomepizole si Gbogbo Wakati 4 Lakoko Dialysis)"]
    O -->|NO| Q["Tẹsiwaju IV Fomepizole 10 mg/kg Ni gbogbo wakati 12 Titi Ipele <20 mg/dL ati Acidosis/Osmolal Gap Ti yanju"]

Bii o ṣe le ṣe iṣiro Gap Serum Osmolal ati Aafo Serum Anion ni ẹgbẹ ibusun¶

Nitori ọpọlọpọ awọn ile-iwosan ile-iwosan ko ni 24-wakati inu ile Gas Chromatography (GC) lati wiwọn taara ẹjẹ methanol tabi awọn ipele ethylene glycol, fifiranṣẹ awọn ayẹwo wọnyẹn si laabu itọkasi ti o gba awọn wakati 12 si 48, awọn oniwosan pajawiri gbarale ** awọn idogba mathematiki ibusun meji *** pẹlu kan ** ojuami-ti-itọju lactate iṣẹju 5:

1. Idogba 1: Iṣiro Gap Osmolal Serum (Idi ti O Gbọdọ Pin Ethanol nipasẹ 4.6, Kii ṣe 3.7)¶

Ni akọkọ, paṣẹ ** Serum Osmolality ti a Ṣewọn (\(\text{Osm}_{\text{measured}}\))** ni lilo Ibanujẹ-Point didi (deede: \(275\ọrọ{si}295\ọrọ{mOsm/kg}\)). Ẹlẹẹkeji, ṣe iṣiro ** Serum Osmolarity (\(\text{Osm}_{\text{iṣiro}}\))** lati inu Panel Metabolic Basic Igbakanna ati ipele Ethanol Serum:

• Ninu Awọn ẹya Amẹrika ti aṣa (\(\ọrọ {glukosi, BUN, ati Ethanol ni mg/dL}\); \(Na+\ọrọ{ ni mmol/L}\)): $\(\text{Iṣiro Osmolarity} = 2 \ igba [Na+] + \frac{\text{Glucose}}{18} + \frac{\text{BUN}}{2.8} + \frac{\text{Ethanol (mg/dL)}}{4.6}\)$
• (Akiyesi Isẹgun: Lakoko ti iwuwo molikula otitọ ti ethanol jẹ 46 [pin nipasẹ 4.6], nitori awọn ifọkansi giga ti ethanol ṣe afihan ihuwasi osmotic ti kii ṣe bojumu ni omi ara eniyan, ọpọlọpọ awọn onimọ-jinlẹ pin $ ọrọ {Ethanol (mg/dL)} $ nipasẹ ** $ 3.7 $ si $ 4.0 $ * atunṣe fun paapaa.
• Ni International SI Units (Gbogbo iye, \(Na+, \ ọrọ {glukosi, Urea, ati Ethanol}\), tẹlẹ ninu \(\text{mmol/L}\)): $\(\text{ Iṣiro Osmolarity} = 2 \ igba [Na+] + [\text{Glucose}] + [\text{Urea}] + [\text{Ethanol (mmol/L)}]\)$
• Aafo Osmolal Serum (\(\ọrọ{OG}\)): $\(\text{Osmolal Gap} = \text{Measured Osmolality} - \text{Osmolarity Iṣiro}\)$
• ** Deede Osmolal Gap:** \(-10\ọrọ{si }+10\ọrọ{mOsm/kg}\).
• Ninu Aifọwọyi-Brewery Syndrome (tabi Ethanol Mimu Mimu mimọ): Ni kete ti ipele ethanol ti alaisan ti wọn wọn ti wa ni edidi sinu idogba (\(\text{Ethanol} / 4.6\)), iyokù ** Osmolal Gap jẹ deede patapata ($ <10\text{ mOsm/kg}$) ni ogorun ti o wa lati ọdọ **10 osmol funrararẹ.
• Ni kutukutu methanol, Ethylene Glycol, tabi Isopropanol Majele: Nitori agbekalẹ iṣiro ko pẹlu methanol tabi ethylene glycol, ** Osmolal Gap ti ko ni iṣiro ti ga ni pataki (\(> 10 ọrọ{si}20\text{mOsm/kg\text}\), ati nigbagbogbo \(0} mOsm/kg}\))**. (Gbogbo \(1 ọrọ{mOsm/kg}\) ilosoke ninu aafo osmolal ni ibamu si aijọju \(3.2\ọrọ{mg/dL}\) ti kẹmika kẹmika, \(6.2\ọrọ{mg/dL}\) ti Ethylene Glycol, tabi **$6.0\ọrọ{mg/dL} $

2. Idogba 2: Ibaṣepọ Iyatọ Laarin Aafo Osmolal ati Aafo Anion Lori Akoko¶

TIME-COURSE OF OSMOLAL GAP vs. ANION GAP IN TOXIC ALCOHOL POISONING
=======================================================================
Gap Magnitude
  |
  |  [OSMOLAL GAP]                            [ANION GAP (HAGMA)]
  |  (Unmetabolized Parent                    (Toxic Acid Metabolites:
  |   Methanol or Ethylene Glycol)             Formate or Glycolate/Oxalate)
  |   \                                               /
  |    \   HIGH OSMOLAL GAP                          /   HIGH ANION GAP
  |     \  + NORMAL ANION GAP                       /    + NORMAL OSMOLAL GAP
  |      \ (Hours 0 to 4)                          /     (Hours 12 to 36)
  |       \                 \                     /
  |        \                 \   BOTH ELEVATED   /
  |         \                 \ (Hours 4 to 12) /
  |          \_________________\_______________/_______________________
  +------------------------------------------------------------------->
  Hour 0 (Ingestion)        Hour 6          Hour 12         Hour 24-36
=======================================================================

3. Awọn "Lactate Gap" olobo fun Ethylene Glycol majele¶

Atọka iwadii iyara ti o wuyi ni awọn yara pajawiri n ṣe afiwe ** Lactate Gas Gas Point-ti-Itọju ** lodi si ** Serum Lactate yàrá aarin ***: - ** Glycolic acid *** (metabolite acid akọkọ ti ** ethylene glycol antifreeze ***) ni eto kemikali ti o fẹrẹ jẹ aami si ** L-lactate **. - Pupọ julọ awọn ẹgbe ibusun ** Point-of-Care / Awọn ẹrọ Gas Ẹjẹ Arterial (ABG) ** lo ẹrọ itanna * L-lactate oxidase * ti ** ko le sọ fun glycolic acid yato si lactate *, ṣe ijabọ ** eke ọrun-giga “lactate” ti $ 15 ọrọ-ọrọ{ si } 40\text{ lactate, nibiti ile-iwosan 40. dehydrogenase ṣe iwọn lactate otitọ ni \(2\ọrọ{si }4\ọrọ{mmol/L}\) nikan. Iyatọ nla Lactate Gap (\(> 10\ọrọ{mmol/L}\) laarin ẹrọ ABG ati laabu aarin) fẹrẹẹ jẹ pathognomonic fun Ethylene Glycol oloro.

Ifiwewe ẹgbẹ-ẹgbẹ: Aifọwọyi-Brewery Syndrome vs. Methanol vs. Ethylene Glycol vs. Isopropanol¶

Dive jin 1: Arun-Brewery Aifọwọyi (Itọpa ikun inu inu), Ẹkọ aisan ara, Ayẹwo, ati Itọju¶

1. Bawo ni Ifun Eniyan Yipada sinu Micro-Brewery inu¶

Ninu eto ifun inu eniyan ti o ni ilera, awọn itọpa ti ethanol endogenous (o kere ju \(0.5\ọrọ{si}1.0\ọrọ{mg/dL}\)) ṣe jade lojoojumọ nipasẹ awọn kokoro arun amunisin ati pe a yọkuro lainidii ni ipadanu lori ọna akọkọ wọn nipasẹ iṣọn ẹnu ọna nipasẹ ẹdọ ** Ọtí Dehydrogenase (ADH). Aisan-Brewery Syndrome (ABS) nwaye nigbati “ijin pipe” ti awọn nkan mẹta pejọ: 1. ** Stasis Anatomical or Altered Gut Architecture: ** Aisan ifun kuru**, Roux-en-Y gastric fori surgery, Crohn's disease strictures, onibaje ifun-idojukuro, gastroparesis, tabi kekere oporoku kokoro-arun/fungal overgrowth, awọn carbohydrates ti o rọrun / fungal overgrowth, awọn carbohydrates ti o rọrun ni inuSI FO. lumen anaerobic ti jejunum ati ileum. 2. ** Dysbiosis Awọn wọnyi ni Broad-Spectrum Antibiotics: Ilana gigun tabi leralera ti awọn oogun apakokoro gbooro (gẹgẹbi amoxicillin-clavulanate, fluoroquinolones, tetracyclines, tabi cephalosporins) n pa awọn ilana aabo kuro Lactobacillus ati *Bifidobacteriast… cerevisiae * (iwukara Brewer's / baker), * Candida albicans *, * Candida glabrata *, * Candida parapsilosis *, tabi * Candida krusei *, tabi awọn igara ti o nmu ọti-lile ti *** Klebsiella pneumoniae , Enterococcus, ati colonium faec oke ikun. 3. ** Ikunrere Ẹdọ-akọkọ-akọkọ: ** Nigbati alaisan ba jẹ ounjẹ ọlọrọ carbohydrate (burẹdi funfun, erun pizza, pasita, iresi funfun, pastries, tabi awọn ohun mimu suga), iwukara tabi * Klebsiella * yi glukosi ati fructose pada nipasẹ pyruvate decarboxylase ati dehydrogenase ọti-waini sinu ** massivenous heinter imukuro akọkọ-kọja ati awọn ifọkansi ọti-ẹjẹ agbeegbe (BAC) si \(80\ọrọ{si }400\ọrọ{mg/dL}\) (\(0.08\%\) si \(0.40%\)) laarin 1 si 4 wakati onje. - Akiyesi lori ito àpòòtọ Auto-Brewery Syndrome: Ninu awọn alaisan ti o ni iṣakoso ti ko dara ** diabetes mellitus (samisi glycosuria) ati ito stasis/neurogenic bladder ti a ṣe akoso nipasẹ Candida glabrata, suga ferment suga taara inu ito àpòòtọ ***, ti nmu ọrun-giga ** ito ethanol nigba ti awọn abaje idanwo \(0. mg/dL}\) (nitori ethanol ko le tan kaakiri urothelium àpòòtọ sinu ẹjẹ).

2. Ilana Iṣayẹwo Awuwọn goolu: Abojuto Ile-iwosan Abojuto Ipenija Glucose ẹnu¶

Nitoripe awọn alaisan ti wọn fi ẹsun wiwakọ labẹ ipa (DUI) tabi mimu ọti ni ibi iṣẹ nigbagbogbo koju aigbagbọ lati ọdọ awọn alamọdaju ati awọn kootu, ṣiṣe iwadii aisan Auto-Brewery Syndrome otitọ nilo ẹri ti o muna, ti o ni idiwọ ** Idanwo Ipenija Carbohydrate Inpatient Inpatient Abojuto**: 1. ** A ṣe akiyesi Quarantine-wakati 24 ti o muna: *** Alaisan ti gba si yara ile-iwosan ti a ṣe abojuto lẹhin wiwa awọn ohun-ini lati ṣe iṣeduro ** iraye si odo si ọti ita, ẹnu, tabi imototo ọwọ , pẹlu atẹgun atẹgun ipilẹ ati ipele ethanol ẹjẹ iṣọn ti a fọwọsi ni \(0.0 ọrọ{mg/dL}\) lẹhin alẹ moju. 2. Ipenija Glukosi ẹnu (\(100\ọrọ{si}200\ọrọ{gram}\)): Alaisan naa njẹ \(100\ọrọ{si}200\ọrọ{gram}\) ti glukosi ẹnu funfun (tabi ounjẹ oni-kabohydrate ti o ni idiwọn). 3. Serial Timed Venous Blood & Breath Ayẹwo Ethanol: Ẹjẹ ati awọn ipele ethanol ẹmi ni a fa ni \(0, 0.5, 1, 2, 4, 8, 16,\text{ ati }24\text{wakati}\) (idanwo titi di wakati 24) (idanwo titi di wakati 24) jẹ pataki nitori pe o le fa fifalẹ awọn wakati 16 fungus lati lọ si oke giga. Eyikeyi ilosoke ninu ẹjẹ iṣọn tabi ethanol ẹmi loke \(20\ọrọ{si }50\ọrọ{mg/dL}\) labẹ akiyesi titiipa jẹri Aisan-Brewery Syndrome. 4. ** Oke GI Endoscopic / Jejunal Aspirate Culture: Awọn onimọ-jinlẹ n gba awọn aspirates ito lati inu ikun, duodenum, ati jejunum isunmọ (pẹlu awọn ayẹwo stool) fun ** olu ati aṣa kokoro-arun pẹlu idanwo alailagbara antifungal / aporo aporo **.

3. Ilana Itọju Igbesẹ Mẹrin fun Imudaniloju Auto-Brewery Syndrome¶

1. ** Ounjẹ Alakoso Ikanna (Sugar Zero-Sugar ti o muna, Carbohydrate-Kekere pupọ, Ounjẹ Amuaradagba-giga):** Lẹsẹkẹsẹ gige gbogbo awọn suga ti o rọrun ati awọn carbohydrates ti a tunṣe ti npa iwukara iwukara / kokoro arun ti sobusitireti wọn, dẹkun iṣelọpọ ethanol endogenous laarin awọn wakati 24 si 48 ***.
2. ** Antifungal Ifojusi tabi Iparun Apanirun (Itọsọna nipasẹ Awọn Imọra Aṣa):**
3. Fun Saccharomyces cerevisiae tabi Candida albicans: Oral Fluconazole (\(100\text{ to }200\text{mg}\) ojoojumo fun 3 si 6 ọsẹ) ati/tabi **Nystatin Oral Non-Absorbable (\(500,000\text times)*\)500,000\text time it IU}.
4. Fun Azole-Resistant Candida glabrata tabi Candida krusei: Echinocandin inu iṣọn-ẹjẹ (Micafungin \(100\ọrọ{mg}\) IV lojoojumọ) tabi posaconazole ẹnu.
5. Fun ** Ṣiṣejade Ọti-giga * Klebsiella pneumoniae :* Ẹkọ oogun aporo ẹnu/IV ti a fojusi (gẹgẹbi carbapenem tabi fluoroquinolone ti o da lori awọn ifamọ).
6. ** Imupadabọ microbiome:** Agbara giga ** awọn probiotics kokoro-ọpọlọpọ (Lactobacillus acidophilus, Lacticaseibacillus rhamnosus, Bifidobacterium), ni muna ** yago fun * Saccharomyces boulardii * iwukara probiotics, eyiti o le buru si irẹwẹsi glycemic fungal. carbohydrates ju ọsẹ 6 si 12 lọ lakoko ti o n ṣe abojuto atẹgun ile kan.

Dive Jin 2: Ilana Antidote Ile-iwosan fun Methanol ati Ethylene Glycol Majele¶

METABOLIC BLOCKADE & COFACTOR SHUNTING IN TOXIC ALCOHOL POISONING
=======================================================================
1. METHANOL PATHWAY:
   [Methanol] ==(ADH - BLOCKED BY FOMEPIZOLE)==> [Formaldehyde] ==> [FORMIC ACID]
                                                                          |
                                     +------------------------------------+
                                     |  <== IV FOLINIC ACID (Leucovorin 50 mg q4h)
                                     v      Accelerates 10-Formyl-THF Synthetase.
                          [Harmless CO2 + H2O Exhaled by Lungs]

2. ETHYLENE GLYCOL PATHWAY:
   [Ethylene Glycol] ==(ADH - BLOCKED BY FOMEPIZOLE)==> [Glycolic Acid]
                                                                |
                                                                v
                                                        [Glyoxylic Acid]
                                                       /                \
        +--(IV PYRIDOXINE [Vit B6] 50-100 mg q6h)--+  /                  \
        |   & IV THIAMINE [Vit B1] 100 mg q6h       |v                    v
        +==> [Harmless Glycine & Alpha-OH-Beta-Ketoadipate]     [TOXIC OXALIC ACID]
                                                                (Calcium Oxalate Stones)
=======================================================================

1. Fomepizole inu iṣọn-ẹjẹ (Antizol) Ilana Dosing (Pẹlu Atunse Dialysis)¶

• ** Iwọn ikojọpọ:** \(15\ọrọ{mg/kg}\) IV ti a fi sii fun ọgbọn išẹju 30 (ti fomi sinu \(100\ọrọ{mL}\) ti \(0.9\%\) iyọ deede tabi \(\ọrọ{D5W}\)).
• Itọju Itọju (Laisi Hemodialysis): \(10\text{mg/kg}\) IV ni gbogbo wakati 12 fun awọn abere mẹrin (wakati 48), lẹhinna ** pọsi si \(15\ọrọ{mg/kg}\) IV ni gbogbo wakati 12** ti o bẹrẹ ni Wakati 48 (nitori Femepizole) lati mu iṣelọpọ agbara rẹ pọ si P15. 48 wakati).
• ** Atunse Dosing Dandan Nigba Hemodialysis:** Nitori Fomepizole jẹ kekere kan, omi-tiotuka moleku ti o ti wa ** ni kiakia nso lati ẹjẹ nipasẹ awọn hemodialysis àlẹmọ **, o **gbọdọ mu Fomepizole doseji igbohunsafẹfẹ si gbogbo 4 wakati nigba hemodialysis *** (tabi se akoso kan lemọlemọfún IV idapo ti \(1\ttext. mg/kg/wakati}\)).

2. Kini idi ti iṣuu soda bicarbonate inu iṣan jẹ pataki ni kẹmika ati Ethylene Glycol Acidosis¶

Nigbati pH ẹjẹ iṣọn-ẹjẹ ba lọ silẹ ni isalẹ $ 7.30 \(, ti kii ṣe ionized ** formic acid ** ati ** glycolic acid ** ni irọrun sọdá awọn membran cell lipid sinu ** retina, nafu ara opiki, ganglia basal ọpọlọ, ati awọn sẹẹli tubular kidirin *** - Ṣiṣakoso ** Sodium Bicarbonate inu iṣan (\)1\ọrọ{si}2\ọrọ{mEq/kg}$ IV bolus, atẹle nipa idapo isotonic ti \(132\ọrọ{si}150\ọrọ{mEq}\) sodium bicarbonate ninu \(1\ọrọ{Liter}\) ti \(\text{00}\)2 ni \(15W\) ni \(15W\)2 mL/hr}$ lati ṣetọju iṣọn-alọ ọkan \(\ ọrọ{pH}> 7.35\ọrọ{si}7.45\))** yiyipada formic acid sinu agbara agbara rẹ, fọọmu ionized (formate), eyiti ** ko le kọja ọpọlọ-ẹjẹ tabi idena-ẹjẹ-retinal **, nfa awọn neurotoxins jade kuro ninu iṣan afọju ito ati jijẹ ifọju ito.

3. Specific Vitamin Cofactor Shunting¶

• ** Ninu Majele ti Methanol ti o jẹrisi tabi ti a fura si:** Fun Folinic Acid inu iṣọn-ẹjẹ (Leucovorin) \(1\ọrọ{mg/kg}\) (ti o to \(50\ọrọ{mg}\)) IV ni gbogbo wakati 4 si 6 (tabi ** IV Folic Acid \(50'ọrọ{mg}\) ni gbogbo wakati mẹrin). Folate n pese cofactor tetrahydrofolate ti nṣiṣe lọwọ ti o nilo nipasẹ ẹdọ * 10-formyl-THF synthetase* lati yi majele ti ** formic acid pada sinu erogba oloro oloro (\(\ọrọ {CO}_2\)) ati omi **.
• ** Ninu Majele Ethylene Glycol ti o jẹrisi tabi ti a fura si:** Fun ** Pyridoxine inu iṣan (Vitamin B6) \(50\ọrọ{si}100\ọrọ{mg}\) IV ni gbogbo wakati mẹfa ** PLUS ** Thiamine inu iṣọn-ẹjẹ (Vitamin B1) \(100\ọrọ{6 mg}\)* IV ni gbogbo wakati. Thiamine ati pyridoxine daduro agbedemeji majele glyoxylic acid kuro lati dida kidinrin-run oxalic acid ki o si darí rẹ sinu laiseniyan glycine ati \(\alpha\)-hydroxy-\(\beta\)-ketoadipate.

Awọn nọmba pajawiri agbegbe ati awọn ilana ile-ibẹwẹ¶

• ** United States ati Canada: *** Tẹ 911 lẹsẹkẹsẹ fun eyikeyi ifura oti majele ti jijẹ tabi oti mimu nla ti ko ṣe alaye, ati pe ** Iṣakoso majele AMẸRIKA ni 1-800-222-1222** (tabi Awọn ile-iṣẹ Majele ti Ilu Kanada ni 1-844-POISON-X). Tẹle ** Ile-ẹkọ giga Amẹrika ti Ile-iwosan Toxicology (AACT) ** ati ** EXTRIP (Awọn itọju Apọju ni Majele) Ẹgbẹ iṣẹ *** awọn ilana fun IV Fomepizole lẹsẹkẹsẹ ati hemodialysis.
• ** Ijọba Gẹẹsi: *** Tẹ 999 fun majele nla tabi aiji yi pada. Awọn oṣiṣẹ ile-iwosan kan si ** Iṣẹ Alaye Awọn majele ti Orilẹ-ede (NPIS / TOXBASE)** fun pajawiri ** IV Fomepizole** doseji, itọju ailera cofactor, ati awọn ibeere hemodialysis.
• European Union: Titẹ 112 kọja gbogbo awọn orilẹ-ede ọmọ ẹgbẹ EU. Awọn ile-iṣẹ majele ti Ilu Yuroopu tẹle ** Ẹgbẹ Yuroopu ti Awọn ile-iṣẹ Oloro ati Awọn Onimọ-ọgbẹ Toxicologists (EAPCCT) ** ati awọn itọsọna ** EXTRIP ***.
• ** Australia ati Ilu Niu silandii:** Titẹ ** 000** ni Australia (ati ** Ile-iṣẹ Alaye Awọn majele ti Ọstrelia ni 13 11 26 ) tabi ** 111 ** ni Ilu Niu silandii (Ile-iṣẹ Awọn majele ti Orilẹ-ede ** 0800 764 766).
• ** Asia-Pacific: *** Titẹ 119 ni Japan ati South Korea, 995 ni Singapore, 999 ni Malaysia ati Hong Kong, tabi 112/108 ni India fun gbigbe ile iwosan pajawiri.

Awọn ibeere ti a beere nigbagbogbo¶

Bawo ni ẹnikan ṣe le mu yó ni ofin lori ẹrọ atẹgun laisi mimu ọti-lile kan (Aifọwọyi-Brewery Syndrome)?¶

Ni Auto-Brewery Syndrome (ti a mọ ni ile-iwosan bi Endogenous Gut Fermentation Syndrome), ifun kekere ti alaisan tabi ikun yoo di ileto pupọ nipasẹ iwukara fermenting (gẹgẹbi Saccharomyces cerevisiae [iwukara Brewer] tabi eya Candida) tabi awọn igara pataki ti kokoro arun (gẹgẹbi awọn oogun oogun Klebsiella p. so pọ pẹlu awọn ipo ifun bii Roux-en-Y inu ikun, iṣọn ifun kukuru, arun Crohn, tabi àtọgbẹ. Nigbakugba ti eniyan ba jẹ ounjẹ ti o ga ni awọn carbohydrates, bii pizza, pasita, akara, iresi, tabi omi onisuga sugary, awọn microbes inu wọnyẹn nmu awọn carbohydrates inu ifun lọ taara sinu ọti ethyl funfun (ethanol). Laarin wakati 1 si 4 ti jijẹ, ethanol pupọ n gba sinu iṣọn ẹnu-ọna ti ẹdọ ko le yọ kuro ni iyara to, ti o fa ki awọn ipele ọti-waini ẹjẹ pọ si 100 si 400 mg/dL (0.10% si 0.40%) botilẹjẹpe eniyan mu ọti odo.

Bawo ni awọn dokita yara pajawiri ṣe yara sọ fun Arun-Brewery Aifọwọyi yatọ si Methanol ti o lewu tabi majele Ethylene Glycol?¶

Awọn ayẹwo ẹjẹ mẹta ati ito ṣe iyatọ Auto-Brewery Syndrome lati majele oti oloro laarin ọgbọn iṣẹju: (1) Ipele Ethanol Serum: Ni Auto-Brewery Syndrome, idanwo ethanol ẹjẹ deede ga (nitori iwukara ikun ṣe ethanol gidi), lakoko ti o jẹ pe methanol mimọ tabi majele antifreeze, idanwo ethanol jẹ odo; (2) Aafo Osmolal ti ko ni iṣiro: Ni kete ti dokita ba yọkuro ipele ethanol ti a ṣewọn (ti pin nipasẹ 4.6) lati inu Serum Osmolity Freezing-Point, alaisan ti o ni Arun-ọti-Brewery ni Gap Osmolal deede patapata (labẹ 10 mOsm/kg), lakoko ti methanol kutukutu tabi majele Osmola ti o tobi; ati (3) Acid-Base Status: Auto-Brewery Syndrome ni deede ẹjẹ pH ati deede bicarbonate, lakoko ti methanol ati ethylene glycol fa igbesi aye-idẹruba High-Anion-Gap Metabolic Acidosis, afọju, tabi ikuna kidinrin.

Kilode ti alaisan ti o mu antifreeze tabi omi ifoso afẹfẹ afẹfẹ le ni Gap Anion deede ni kutukutu, ati pe o jẹ deede Osmolal Gap nigbamii?¶

Nigbati eniyan ba kọkọ gbe methanol (omi ifoso afẹfẹ) tabi ethylene glycol (antifreeze), awọn ohun elo oti obi ti ko ni iṣelọpọ leefofo loju omi ninu ẹjẹ, ti o wakọ Serum Osmolal Gap ọrun-giga nigba ti pH ẹjẹ ati Anion Gap jẹ deede deede fun wakati 1 si 6 akọkọ. Ni awọn wakati 6 si 24 to nbọ, enzyme Alcohol Dehydrogenase (ADH) ẹdọ jẹ diẹdiẹ ọti-waini ti obi ti o si sọ di acids apaniyan (formic acid tabi glycolic/oxalic acid). Bi ọti-waini obi ti parẹ ti o si yipada si acid, Osmolal Gap ṣubu pada si isalẹ lati deede lakoko ti Anion Gap n gbe soke. Nitori ipa seesaw yii, awọn dokita nigbagbogbo ṣayẹwo BOTH Osmolal Gap ati Gap Anion.

Bawo ni antidote Fomepizole (Antizol) ṣe fipamọ iran rẹ ati awọn kidinrin lẹhin kẹmika kẹmika tabi majele apanirun?¶

Methanol ati ethylene glycol ko le ba awọn iṣan opiki rẹ jẹ tabi awọn kidinrin titi ti ẹdọ rẹ Alcohol Dehydrogenase (ADH) henensiamu yi wọn pada si formic acid tabi oxalic acid. Fomepizole (4-methylpyrazole) jẹ oogun apakokoro deede ti o sopọ mọ aaye ti o ṣiṣẹ ti Alcohol Dehydrogenase pẹlu awọn akoko 8,000 ti o tobi ju methanol tabi ethylene glycol. Laarin awọn iṣẹju ti iwọn IV ti Fomepizole, enzymu ADH ti wa ni titiipa patapata, didaduro iṣelọpọ acid majele ti ku ninu awọn orin rẹ nitoribẹẹ methanol ti ko ni iṣelọpọ tabi ethylene glycol le yọkuro lailewu nipasẹ awọn kidinrin tabi ẹrọ iṣọn-ẹjẹ.

Kini "Aafo-ti-Itọju Lactate Gap," ati bawo ni o ṣe fihan pe ẹnikan mu ethylene glycol antifreeze?¶

Nigbati ẹdọ ba fọ ethylene glycol antifreeze, o ṣe agbejade iye nla ti glycolic acid. Glycolic acid ni apẹrẹ molikula ti o fẹrẹ jẹ aami si lactic acid (lactate). Nigbati nọọsi yara pajawiri nṣiṣẹ ẹjẹ silẹ lori ibusun kan ẹrọ Point-of-Care Arterial Blood Gas (ABG), sensọ L-lactate oxidase ti ẹrọ naa jẹ aṣiwere nipasẹ glycolic acid ati ṣe ijabọ ipele “lactate” astronomical eke (nigbagbogbo 15 si 40 mmol/L). Bibẹẹkọ, nigba ti ayẹwo ẹjẹ kanna gangan ba ṣiṣẹ ni ile-iwosan akọkọ ti ile-iwosan nipa lilo henensiamu ti o yatọ (lactate dehydrogenase), lactate otitọ yoo pada wa nitosi deede (1 si 3 mmol/L). Iyatọ nla yẹn laarin awọn idanwo lactate meji, ti a pe ni Gap Lactate rere, lesekese ṣe afihan awọn wakati majele ethylene glycol ṣaaju awọn abajade majele ti a firanṣẹ-jade pada.

Bawo ni awọn dokita ṣe ni idaniloju ni idaniloju Arun Aifọwọyi-Brewery ni kete ti majele pajawiri ti yọkuro bi?¶

Lati fi mule Aisan Ọti-Brewery fun itọju iṣoogun ati aabo ofin, awọn dokita gba alaisan si yara ile-iwosan ti a ṣe abojuto nibiti wọn ti ṣe akiyesi fun awọn wakati 24 pẹlu iraye si odo si ọti ti ita ati timo lati ni ipele oti ẹjẹ ãwẹ ti 0.0 mg/dL. Lẹhinna a fun alaisan naa ni iwọntunwọnsi 100-si-200-gram oral glukosi ipenija ohun mimu, ati pe ẹjẹ ati awọn ipele ọti ẹmi ni idanwo ni 0, 0.5, 1, 2, 4, 8, 16, ati 24 wakati. Iwasoke ti o ni akọsilẹ ninu ethanol ẹjẹ lẹhin jijẹ glukosi mimọ, ni so pọ pẹlu omi ifun kekere endoscopic tabi awọn aṣa ito ti n dagba Saccharomyces cerevisiae, Candida, tabi Klebsiella pneumoniae, jẹrisi okunfa ati awọn itọsọna ti a fojusi ti oogun aporo tabi oogun aporo.

Awọn orisun ati osise itoni¶

• ** Ile-ẹkọ giga ti Ilu Amẹrika ti Ile-iwosan Toxicology (AACT) ati European Association of Poiss Centers ati Clinical Toxicologists (EAPCCT):** * Awọn Itọsọna adaṣe lori Itoju ti Methanol ati Ethylene Glycol majele (Osmolal Gap ati Anion Gap Kinetics, Intravenous Fomepizole Dosing, Sodium/Picarbonate Sodium/Phicarbonate Àwọn olùkópa)*.
• ** EXTRIP (Awọn itọju ti ara ẹni ni majele) Ẹgbẹ iṣẹ:** * Atunwo eto ati Awọn iṣeduro Ifọwọsowọpọ fun Itọju Ẹjẹ Apọju (Hemodialysis intermittent) ni Methanol ati Ethylene Glycol Poison*.
• ** Ile-iṣẹ Orilẹ-ede fun Alaye Imọ-ẹrọ (NCBI / StatPearls) ati Ile-ẹkọ giga ti Amẹrika ti Gastroenterology (ACG) Ijẹwọgbigba Case Ile-iwosan (Malik F, Cordell BJ, McCarthy D):** *Aiṣan-ọti-Brewery (Aisan jijẹ ikun ti Endogenous): Aṣa Aṣa Glucose ti o ni idiwọn, Ipenija Glucose fun GI Protocol Ounjẹ Carbohydrate Kekere, ati Itọju Antifungal *.
• ** Iṣẹ Alaye Awọn majele ti Orilẹ-ede (NPIS / TOXBASE, United Kingdom) ati Awọn Itọsọna Itọju Toxicology (Australia): ** * Iyatọ Ọti Majele Tokiki, Idanimọ Gap Lactate, ati Isakoso Fomepizole *.
• ** New England Journal of Medicine (NEJM) Atunwo Iṣeduro Iṣeduro Iṣoogun (Kraut JA, Kurtz I; Brent J):** * Awọn Imudara Ọti Majele: Awọn ẹya ara ẹrọ isẹgun, Ayẹwo, ati Itọju (Iwadii Methylpyrazole ti Awọn Alcohols Toxic [META] Trial)*.

Jẹmọ awọn itọsọna¶

• Methanol, ethylene glycol antifreeze, ati oloro oti oloro
• Amutimu ọti-lile, ikopa, ati gbigbe gbigbe lailewu
• Majele ati ifihan majele ti iranlowo akọkọ
• Awọn pajawiri ti dayabetik: hypoglycemia ati ketoacidosis dayabetik
• Awọn nọmba pajawiri nipasẹ orilẹ-ede