Ngā Werohanga Kikorangi Metilīni me ngā Whāngai IV

Ka ōrite pea te āhua o ngā ipu iti e rua e mau ana i te wai kikorangi hōhonu i runga i te paemahi. Ko tētahi he werohanga horomata i hangaia mō ngā ia toto. Ko tētahi atu he ipu whakatō mō te waha, he waikano taiwhanga, he hua rānei mō te puna ika, ā, kaua rawa e uru ki tētahi ia toto. Kāore te tae e whakaatu i te pai o te hua. Mā te hanganga o te wairewa kē e whakaatu.

Koinei te ariā matua o tēnei tuhinga: ehara te tuakiri matū i te tohu e tika ana te hua mō te werohanga. Ka whai kikorangi metilīni tūturu pea tētahi wairewa, he tino parakore ā-matū, engari kāore tonu e tika mō te werohanga. Me horomata hoki ngā werohanga, me iti ngā paitini huakita, me āta whakahaere ngā matūriki, ā, me tākai ki roto i tētahi ipu e tika ana. Kia mau ki taua rerekētanga, ka mārama ai te toenga o tēnei aratohu.

Te werohanga horomata kua whakaaetia

Ko ProvayBlue te hua tohutoro, he werohanga kikorangi metilīni mā te whakahaunga rongoā, kua whakaaetia mō te methemoglobinemia kua pā mai ki ngā pakeke me ngā tamariki. Ko tōna kukū he 5 mg/mL (0.5%), kua whakaaturia i runga i te pūtake kikorangi metilīni trihydrate. Ka tukuna hei 10 mg i roto i te 2 mL, hei 50 mg hoki i roto i te 10 mL, ki ngā ampoule, ki ngā ipu iti rānei mō te horopeta kotahi. Ko te Wai mō te Werohanga anake te kai whakauru kāore e hohe, ā, ko te pH o te wairewa he 3.0 ki te 4.5, e ai ki te tapanga ProvayBlue o nāianei i DailyMed.

He maha ngā hua ōrite ingoa whānui e whakamahi ana i taua hua hei tohutoro ināianei. Nō reira, he ingoa waitohu a ProvayBlue, ehara ko ia anake te werohanga kua whakaaetia. He kupu whakatūpato: ehara te noho o tētahi whārangi hua ki DailyMed i te taunakitanga, ko ia anake, kua whakaaetia e te FDA. Kotahi neke atu ngā werohanga kikorangi metilīni 1% e hokona ana, e kī ana tōna ake tapanga kāore te FDA i whakatau he haumaru, he whai hua hoki taua hua. Tirohia tōna tūnga whakaaetanga me ngā kupu e tohu ana he horomata, he horopeta kotahi, kaua e whakapae ka tika noa ngā ipu kikorangi katoa.

He whāiti ngā tikanga horopeta i raro i te tapanga kua whakaaetia. Ka whiwhi ngā pakeke me ngā tamariki i te 1 mg/kg ki roto i te ia toto mō te 5 ki te 30 meneti, e ōrite ana ki te 0.2 mL/kg o te wairewa 5 mg/mL. Ki te noho tonu te methemoglobin ki runga ake i te 30%, ki te mau tonu rānei ngā tohu, ka taea te tuku i tētahi atu horopeta 1 mg/kg i muri i te hāora kotahi. Ki te kore ngā horopeta e rua e whakatika i te raruraru, ka tohu te tapanga ki ētahi atu maimoatanga, kaua ki te tuku kikorangi metilīni anō. Kotahi anake te horopeta 1 mg/kg mā ngā tūroro he āhua nui, he tino nui rānei te ngoikoretanga o ngā tākihi, nā te mea ka tino piki te nui o te rongoā ka pā ki te tinana i te hekenga o te mahi a ngā tākihi.

He ture anō mō te tuku. Mā roto i te ia toto anake tēnei hua, ā, kaua e tukuna ki raro i te kiri. He hypotonic te wairewa, nō reira ka taea te waimeha ki te 50 mL o te dextrose 5% hei whakaiti i te mamae ki te wāhi tuku, otirā ki ngā tamariki. Me whakamahi tonu te wairewa kua waimehatia. Kaua e waimeha ki ngā wairewa konutai pūhaumāota, nā te mea ka whakaiti te pūhaumāota i te memeha o te kikorangi metilīni. Tirohia ia ipu, whakamahia kotahi noa ngā mea o roto i te ampoule, i te ipu iti rānei mō te horopeta kotahi, ā, whakarerea te toenga. Me rokiroki ki te pāmahana rūma, me tiaki i te mārama, ā, kaua e whakamātao ki te pouaka mātao, e whakatio rānei.

Ka taea e ngā kaipānui e hiahia ana ki ngā whakamārama mō te mahi a te rāpoi ngota ina tae ki te toto te tīmata ki te āhua o te mahi a te kikorangi metilīni i roto i te tinana. Ka wehe taua tuhinga i te mātauranga mahi rongoā i ngā pātai mō te hanganga wairewa e kōrerotia ana i konei.

Ka whakamahia e ngā whāngai i waho i te tapanga taua rāpoi ngota anō, engari he rerekē ngā ture

I tua atu i te methemoglobinemia, i ētahi wā ka tukuna e ngā kaimātai hauora te kikorangi metilīni ki roto i te ia toto mō ngā āhuatanga pēnei i te vasoplegia i muri i te pokanga manawa, i te ohorere sepsis rānei. Kei te rangahautia ōna pānga ki te kōpiritanga o ngā ia toto i ēnei āhuatanga. I te nuinga o te wā, he rerekē ngā horopeta o ēnei kawa, he whāngai haere tonu, he tuku tāruarua rānei, kāore e hāngai ki te tikanga horopeta e rua kua whakaaetia. Nō reira, he whakamahinga ēnei i waho i ngā whakaaetanga o te tapanga: he werohanga kua whakaaetia pea te hua rongoā, engari ehara te tikanga tuku i te tikanga kua whakaaetia e te FDA. Ka whakaatu ngā taunakitanga tōmua o ngā whakamātautau mō te vasoplegia me te ohorere sepsis i te take e kaingākau ai ngā kairangahau, me te take hoki kei te rangahautia tonutia ngā horopeta, kāore anō kia whakatauria.

He rerekētanga anō kei ngā whāngai kua whakaranua motuhaketia. Ka rerekē pea te kukū whakamutunga, te wai waimeha, te ipu, ngā kai whakauru āwhina, me te wā whakamutunga e whakaaetia ana kia whakamahia. Hei kāwai, kāore ngā rongoā kua whakaranua motuhaketia i whakaaetia e te FDA mō te haumaru, mō te whai huatanga rānei, e whakamārama ana te FDA i āna pātai me ngā whakautu mō te whakaranu rongoā. Ahakoa he rongoā waitohu, he rongoā ingoa whānui, he rongoā kua whakaranua motuhaketia rānei kei roto i te pūwero, ka mau tonu i te rāpoi ngota ngā mōrearea e whakaahuatia ana i te tapanga kua whakaaetia. Kei roto ko ngā pāhekoheko serotonin, te mōrea hemolysis, me te tairongo ki te mārama, ka kōrerotia i ngā wāhanga e whai ake nei.

He aha te kōeke anake e kore ai e tohu he pai te wai mō te werohanga

Koinei te wāhi e tino rangirua ai te tangata. Ka pānuitia pea tētahi wairewa hoko ā-toa he kikorangi metilīni kōeke USP, ka whakaatu i tētahi uara whakamātautau ihirangi kei runga ake i te 98%, engari kāore tonu e tika mō te werohanga. Ka whakaahua te kōeke matū i te paura: tōna tuakiri, te whakamātautau ihirangi, ngā poke waro, ngā toenga whakarewa, ngā konganuku, me ētahi atu whakamātautau pēnei. Me tutuki i tētahi hua werohanga aua whakamātautau me ētahi atu whakaritenga mō te tuku ki waho i te ara kūnatu, kāore e kapi i te kōeke anake.

Ka ārai ia rārangi i tētahi momo hapa rerekē. Ka taea e te wai kāore i te horomata te whakaputa mate whakapokenga ki roto i te toto. Ka mau tonu ngā endotoxin mai i ngā huakita mate i muri i te tātari noa, ā, ka puta pea he kirikā tino kaha, he ohorere rānei. Ka mau pea ngā matūriki me ngā matū kua wehe mai i te wairewa ki ngā ia toto ririki. Ka turuturu pea ngā matū i tētahi ipu kāore e tika ana ki roto i te wai, ka kore rānei e mau tōna hiri. Kāore tētahi o ēnei hē e whakarerekē i te tae kikorangi, i te tau whakamātautau ihirangi rānei. Koia tonu te take kāore e ranea te tirohanga ā-kanohi me tētahi ōrau parakore hei whakatau e tika ana tētahi hua mō ngā ia toto. Mō te whakamārama whānui o ngā mea e kapi ana i ngā whakamātautau parakore katoa, tirohia te āhua o te manatoko i te kōeke USP.

He poto te ture whaihua: kaua rawa e werohia tētahi hua kikorangi metilīni mō te waha, mō te puna ika, mō te taiwhanga rānei, ahakoa te parakore kua whakapuakina. Mō te werohanga, me whai hua kua hangaia, kua whakamātauria, kua tapaina, kua whakaritea mā te whakahaunga hei werohanga.

Ngā take haumaru nō te tapanga kua whakaaetia

Ka whakakotahi te tapanga kua whakaaetia i ngā mōrearea e tika ana kia mōhiotia i mua i tētahi whakamahinga ki roto i te ia toto. Ko te tuatahi ko te mate serotonin, he whakatūpato pouaka tōna: ka aukati te kikorangi metilīni i te monoamine oxidase. Nō reira, ki te whakakotahitia ki ngā rongoā ārai pōuritanga e mahi ana mā te serotonin, ki ētahi opioid, me ngā rongoā whai pānga, ka puta pea he tauhohenga tino kino, whakamate rānei. Ka tohutohua ngā tūroro kia karo i aua rongoā mō te 72 hāora i muri i te horopeta whakamutunga, ki te kore tētahi kaimātai hauora e whakatau kāore e taea te karo te tuku ngātahi, me te āta aroturuki hoki.

Ko te tuarua ko te korenga o te glucose-6-phosphate dehydrogenase, he take tēnei kia kaua e whakamahia te rongoā: ka mōrearea ngā tūroro pēnei ki te hemolysis tino kino, ā, kāore pea te rongoā e mahi nā te mea e whakawhirinaki ana tōna mahi ki tētahi ara whākōkī kāore i ēnei tūroro. Ko tētahi atu take kia kaua e whakamahia ko te mate pāwera tino kino ki te kikorangi metilīni, ki tētahi atu waikano thiazine rānei.

Ko ētahi atu whakatūpato ko te ngoikoretanga o ngā tākihi me te pikinga o te nui o te rongoā ka pā ki te tinana katoa; ko te kino ki te kukune ina pā te rongoā ki roto i te pūkoro wai whakawhānau, me tētahi rārangi aroturuki mō ngā pēpi whānau hou kua whānau i te wā tika, kua pāngia hoki; me ngā pūrongo mō te kino nā te pānga o te mārama, e tika ai te tiaki i te mārama. E rua ngā āhuatanga aroturuki motuhake e whai tikanga ana i ngā hōhipera: ka whakaheke hē te tae kikorangi i ngā pānuitanga o te ine hāora mā te patukinga, nō reira he pai ake te tātari toto i te ia kawe toto atu i te manawa. Ka whakararu hoki pea i ngā pūrere aroturuki i te hōhonutanga o te whakarehu me ngā whakamātautau mimi mā te waikano kikorangi. I te huinga raraunga haumaru mō ngā tūroro pakeke 31, i pā ngā tauhohenga tino kino ki te āhua 3%. Ko ngā tauhohenga i kitea i te 2% neke atu ko te ānini, te whakapairuaki, te korere, te iti o te pāhare pāporo me te konupora, ngā kōhikohiko uaua, me ngā āhuatanga rite ki te hukihuki.

Ehara ēnei kōrero i te tautoko, i te whakahē rānei i tētahi kawa motuhake i waho i ngā whakaaetanga o te tapanga. He whakamaharatanga kē ka haere tahi ngā mōrearea me te rāpoi ngota, ahakoa ngā kōrero kei te pēke whāngai.

Ngā mea hei manatoko i mua i tētahi whakamahinga IV

Mēnā he tūroro koe, he kaitiaki rānei, whakaūngia ēnei mea e whā ki te rōpū maimoa: he werohanga horomata te hua, kua whakaaetia, kua whakaranua motuhaketia rānei mō te tuku ki roto i te ia toto; e whai ana te whakamahinga me te horopeta i tētahi kawa kua āta whakaritea; kua arotakengia ngā rongoā e mahi ana mā te serotonin me te tūnga G6PD; ā, ka kapi i te aroturuki te ine hāora mā te tātari toto, kaua mā te ine hāora mā te patukinga anake. Ki te kī tētahi kia werohia he wai nō te ipu whakatō hoko ā-toa, he wairewa taiwhanga rānei, me whakamutu rawa taua mahi, ka tono kē ki te whare rongoā o te hōhipera.

Ko te hanganga wairewa te ariā, ko te tapanga te kirimana. Whakatauritea te wai ki te ara tuku e tika ana, ka mutu te noho o te tae kikorangi hei take rangirua.