Te puru metilīni, te puru Parūhia, me te hydroxocobalamin: e toru ngā rongoā whakakore paihana mō ngā raruraru rerekē

He kupu tae kei roto i ngā ingoa o ēnei rongoā e toru, engari he iti noa atu ā rātou āhuatanga ōrite. Ko te puru metilīni he waikano puru mō te hāoratanga me te whakahekenga. Ko te puru Parūhia he hanganga tioata puru. Ko te hydroxocobalamin, e hokona ana hei Cyanokit, he matū whero e puta mai ai te huaora B12. Ki te whakarōpū te kaipānui i ēnei i runga i ō rātou ingoa, ka whakapae ia he rite ā rātou mahi. Kāore i te rite. He ariā rerekē te tūāpapa o ia rongoā mō te raruraru kua pā ki te tinana, ā, kāore e whai hua ia rongoā i waho i taua ariā.

He poto te whakamārama tika i ā rātou mahi. Ka whakahoki te puru metilīni i te mahi a te hemoglobin kua kore e mahi nā te hāoratanga. Ka here tika te hydroxocobalamin i te cyanide. Ka mau te puru Parūhia i te caesium iraruke me te thallium ki roto i te whēkau kia taea ai e te tinana te whakaputa ki waho. Ko te tae te āhuatanga e kitea ana. Ko te tikanga mahi kei raro iho te ariā, ā, ka hua te rangirua i te hono i te tae ki taua tikanga mahi.

He whakataurite tēnei hei ako, ehara i te tohutohu maimoatanga. He ohotata te whakapae kua pā te methemoglobinemia, kua pāngia te tangata e te cyanide, e te hauhā waro, e te whakaparu iraruke rānei. Waea atu ki ngā ratonga ohotata, ā, whāia ngā tohutohu a te ratonga whakahaere paihana o tō rohe, kaua e mahi i runga i tētahi tuhinga.

Te puru metilīni: he kaiwhakawhiti e whakahoki ana i te mahi a te hemoglobin

Ka kawe te hemoglobin noa i te hāora mā te rino i tōna āhua ferrous, Fe2+. I te methemoglobinemia, kua hāoratia taua rino ki te āhua ferric, Fe3+, ā, kāore e taea e taua āhua te here i te hāora. Ka āhua parauri tiakarete te toto. Ka whakapohehe te ine hāora mā te ine paoho noa. Kāore i te rawaka te hemoglobin e mahi ana i roto i te tūroro, ahakoa e uru ana, e puta ana hoki te hau i ngā pūkahukahu.

Ka whai hua te puru metilīni i konei nā tōna mahi hei kaiwhakawhiti irahiko, e whakamāramatia ana i te kōrero mō te neke a te puru metilīni i ngā irahiko i waenga i ngā kaituku me ngā kaiwhiwhi. I roto i ngā pūtau toto whero, ka whakahekea ki te leucomethylene blue mā tētahi ara e whakawhirinaki ana ki te NADPH. Ka tuku taua āhua kua whakahekea i ngā irahiko ki te rino ferric, me te kore whākōkī, kia hoki ai ki te āhua ferrous. Ka mahi ā-huringa te waikano, kāore e pau. Nā taua tikanga mahi, ko te whakamahi i te puru metilīni mō te methemoglobinemia he tukanga hōhipera e inea ai ngā taumata, e mātakina ai hoki te urupare, ehara i te kawa mō te kāinga.

E ai ki te tapanga puru metilīni o nāianei, ko tōna whakamahinga kua whakaaetia ko te methemoglobinemia kua riro mai i ngā pakeke me ngā tamariki. Ko te horopeta paerewa mō ngā pakeke me ngā tamariki he 1 mg mō ia kg, ka tukuna mā te ia toto i roto i te 5 ki te 30 meneti. Ka taea te tuku anō kotahi ki te mau tonu ngā taumata, ngā tohumate rānei. Kei te tapanga puru metilīni o nāianei ngā taipitopito mō ngā tepenga horopeta, ngā paearu mō te tuku anō, me te wā e tika ana kia huri ki tētahi atu maimoatanga. Kei te kōrero mō te tuku horopeta me te aroturuki i te puru metilīni ngā pātai ā-mahi mō te ara tuku me te aroturuki.

E toru ngā tepenga nui. Tuatahi, he tino take aukati te ngoikoretanga glucose-6-phosphate dehydrogenase, nā te mea kua raru te tuku NADPH e hiahiatia ana hei whakaheke i te waikano. Nā tēnei ka kore e whai hua te rongoā, ka piki hoki te tūraru o te pakarutanga o ngā pūtau toto whero. Tuarua, ka aukati te puru metilīni i te monoamine oxidase A i ngā kukū nanomolar. Nō reira, he whakatūpato kua tāia ki roto i tētahi pouaka mō te mate serotonin ina tukuna ngātahitia me ngā SSRI, ngā SNRI, ngā MAOI, me ētahi opioid. Ka arotakengia tēnei take i te kōrero mō te haumaru o te puru metilīni me ōna pāhekoheko ki ētahi atu rongoā. Tuatoru, ka whakarerekē te ngoikoretanga o ngā whatukuhu i te nui o te rongoā ka pā ki te tinana. Ka whakawhāiti te tapanga i te maimoatanga mō ngā tūroro he āhua nui, he tino nui rānei taua ngoikoretanga, ki te horopeta kotahi. Ehara ēnei i ngā kōrero iti hei tāpiri noa. Ka ahu mai ia tepenga i taua ariā kaiwhakawhiti anō: ka pāhekoheko tētahi rongoā e whakamahi ana i te puna irahiko o te pūtau, e pā ana hoki ki ngā whākōkī monoamine, ki ēnei mea e rua.

He hītori anō tō te puru metilīni i te maimoatanga paihana cyanide, i tīmata i ngā tau 1930s, engari ehara te hītori i te tikanga maimoatanga o nāianei. I whakatakoto ngā kairangahau o mua i ngā whakapae mō ngā pānga mā te hāoratanga me te whakahekenga, mā te methemoglobin rānei. Tae rawa ki ngā tau 1950s, i whakatauria he ngoikore te rongoā ki te cyanide ina whakatauritea ki ngā tikanga nitrite me te thiosulfate. Kāore he whakamahinga cyanide kua whakaaetia mōna i te US i ēnei rā. Ko ngā rangahau hou ki ngā kiore me ngā pūtau mō te cyanide he tohu rangahau i mua i ngā whakamātautau haumanu, ehara i te take hei whakamahi i taua rongoā i tētahi ohotata cyanide.

Te hydroxocobalamin: he pokapū konukurahina e here ana i te cyanide

Ka aukati te cyanide i te cytochrome c oxidase i roto i ngā pungao, nō reira kāore e taea e ngā pūtau te whakamahi i te hāora ahakoa he āhua rawaka te hāora i roto i ngā ia toto matua. Ka whai mai te waikawatanga nā te waikawa lactic, te rerekētanga o te mauri mōhio, me te hinganga o te pūnaha manawa me ngā ia toto. Ko te ariā maimoatanga he tango i te cyanide ake, ehara i te whakarerekē i te hemoglobin.

Ka mahi tika te hydroxocobalamin, e hokona ana hei Cyanokit, i tēnei. Ka here tōna pokapū konukurahina i tētahi katote cyanide hei whakakapi i tōna ligand hydroxo, ka hanga i te cyanocobalamin, arā, te huaora B12 noa, ka whakaputaina ki waho e ngā whatukuhu. He hopu, he pupuri tēnei, ehara i te huringa hāoratanga me te whakahekenga. Ko te horopeta pakeke kua whakaaetia he 5 g mā te ia toto i roto i te 15 meneti pea, me tētahi atu 5 g ki te kore e rawaka te urupare, tae atu ki te mōrahi 10 g. Koia te take ka tere mārama ngā whakataurite i te puru metilīni ki Cyanokit ina tika te whakatakoto i te pātai: mō te paihana cyanide kua mōhiotia, kua whakapaetia rānei, ko te hydroxocobalamin te rongoā tuatahi o nāianei i te United States, me te hua nitrite me te thiosulfate motuhake mō ētahi āhuatanga kua kōwhiria. Kāore te puru metilīni e taea te whakakapi i a ia mō taua whakamahinga.

E rua ngā hua ā-mahi o tēnei matū. He tino whero te rongoā, nō reira he mea tūmanako te kiri whero me te mimi whero, ā, i ētahi wā ka mau tonu te rerekētanga o te tae mimi mō ngā wiki. Nā tōna kaha ki te ngongo i te aho ka whakapōrearea hoki i ngā whakamātautau taiwhanga e ine ana mā te tae, me ngā pānuitanga co-oximetry o te carboxyhemoglobin, te methemoglobin, me te oxyhemoglobin. Ka rerekē te nui me te ahunga o te hapa i runga i te pūrere tātari. Ki te kore te kaiwhakaora e mōhio ki tēnei, ka hē pea tana whakamārama i ngā tau tonu e whakamahia ana hei aromatawai i te paihana. He rerekē te mahi a te kete cyanide tawhito i hangaia ki te amyl nitrite, te sodium nitrite, me te sodium thiosulfate: ka āta hanga te nitrite i te methemoglobin hei here i te cyanide, ā, ka āwhina te thiosulfate ki te huri i te cyanide hei thiocyanate. Ka whakaiti taua tikanga i te kaha kawe hāora, ā, ka heke pea te pēhanga toto. He kino taua utu ina pā mai te hauhā waro i te whakangā paoa. Ka karo te hydroxocobalamin i taua utu mā te here i te cyanide me te kore hanga methemoglobin.

Te puru Parūhia: he mahanga tioata ka noho ki te whēkau

Ko te puru Parūhia, e hokona ana hei Radiogardase, he ferric hexacyanoferrate kāore e memeha. Ko te kupu cyanide i taua tātai e tohu ana i ngā ligand kua mau ki roto i tētahi tioata rino, ehara i te cyanide wātea, ā, kāore tēnei rongoā e whakamahia mō te paihana cyanide. Ko tōna whakamahinga kua whakaaetia he whakaparu o roto ki te caesium iraruke, ki te thallium iraruke, ki te thallium kāore he iraruke rānei.

Ko tōna ariā he whakawhiti katote i te kōhao o te whēkau. Kāore ngā tioata e ngongohia mā te pakitara whēkau kāore i pakaru. Ka noho ki te whēkau, ka whakapiri i ngā katote caesium, thallium rānei ki roto i te hanganga tioata, tae atu ki ngā katote kua whakaputaina ki te wai ate. Ka haukoti hoki i te huringa anō i waenga i te whēkau me te ate, kia nui ake ai te konganuku ka puta mā te tūtae. E whakamārama ana te whārangi maimoatanga a te CDC mō te puru Parūhia i taua tikanga mahi ki ngā kupu māmā: ka mau i a ia ēnei konganuku ki roto i ngā whēkau, ā, ka whakatere i te whakaputanga mā te tūtae. Ko te hōtaka mō ngā pakeke me ngā taiohi he 3 g mā te waha, e toru ngā wā ia rā, me ngā horopeta iti iho e hāngai ana ki te taumaha mō ngā tamariki nohinohi. He maha ngā wā ka haere tonu mō te 30 rā, neke atu rānei, me te aroturuki i te whakaparu.

Ka whakamārama tika tēnei i te rapunga e whakataurite ana i te puru Parūhia ki te puru metilīni. Ka mahi te puru metilīni i roto i te toto hei kaiwhakawhiti irahiko. Ka mahi te puru Parūhia i te whēkau hei mahanga kāore e ngongohia. Ka whakahoki tētahi i te mahi a tētahi pūmua whai konganuku. Ka whakapoto tētahi i te wā e noho ai te konganuku ki te tinana. Ki te whakawhiti i ēnei rongoā, ka noho tonu ngā raruraru e rua me te kore maimoatanga: ka noho hāoratia tonu te methemoglobin, ā, ka huri haere tonu te caesium.

Te hauhā waro: kāore he wāhi mō te puru metilīni

He tino kaha ake te here a te hauhā waro ki te hemoglobin i tō te hāora. Ka neke hoki i te ānau wetewete hāora, me te pā anō ki ngā wāhi o te manawa me ngā pungao. Ko te tiaki paerewa he tango i te tangata i te wāhi e pāngia ana, me te tuku hāora 100 ōrau kia mutu rā anō ngā tohumate, mō ētahi hāora i te nuinga o te wā. Ka whakaarohia te hāora pēhanga tiketike mō ētahi āhuatanga taumaha kua kōwhiria, pērā i te tino ngoikoretanga o te pūnaha io, te ngaronga o te mauri mōhio, te pānga ki te manawa, te waikawatanga taumaha rānei. Ko ngā tohutoro ohotata a te kāwanatanga ā-motu kei roto i te kohinga tohutoro a te CDC mō te maimoatanga ohotata e whakatakoto ana i te hāora me te tiaki tautoko hei tūāpapa mō tēnei ara maimoatanga.

Nō reira, ko te rapu mō te puru metilīni me te paihana hauhā waro e ahu mai ana i tētahi whakaaro hē e āhua tika ana te tangi: ki te whakatika tētahi waikano puru i tētahi raruraru hemoglobin, tērā pea ka whakatika i tētahi atu. Kāore e pēnā. Kāore he whakamahinga hauhā waro kua whakaaetia mō te rongoā, ā, kāore e whakaurua ki ngā hātepe maimoatanga hauhā waro o nāianei. He tawhito te whakaaro, i whakatakotoria i ngā rangahau kararehe i te tīmatanga o ngā tau 1930s, ā, i whakahēngia mā te arotake whakamātau i roto i te tau kotahi. Ko te rangahau kiore hou kotahi e whakahuahia ana i ētahi wā i whakamātau i te whakamarutanga tōmuri o te pūnaha io i muri i te pānga, kaua i te whakahoki wawe i te carboxyhemoglobin ki tōna āhua noa. He āhua rerekē te rino kua hāoratia me te rino kua herea ki te hauhā waro, ahakoa kei roto i te pūmua kotahi. Kāore anō kia whakatūturutia he mahi a tētahi kaiwhakawhiti kua whakaritea mō te āhua tuatahi ki te āhua tuarua. Ka whai hua tēnei tepenga ki ngā kaipānui e whai ana i ēnei rerekētanga, me te tirohanga whānui ki ngā rangahau puru metilīni, e wehewehe ana i ngā whakamahinga mō te tangata i ngā tohu rangahau pūtau me ngā kararehe.

He tirohanga whakatairite i mua i ngā whakataurite katoa

Whakatauritea taua ripanga ki ngā hapa noa e toru. Kāore ngā ingoa ōrite e tohu ana he ōrite ngā matū e whāia ana. Kāore te tae kaha e tohu ana he ōrite ngā mahi rongoā; kāore te wherotanga o te hydroxocobalamin me te purutanga o ērā atu e rua e tohu ana ka taea te whakakapi tētahi ki tētahi. Ā, kāore tētahi hua whakamātau mō tētahi paihana e whakawhiti ki tētahi atu paihana nā te mea noa he āhua tata te tangi o ngā ingoa. Ko ngā ariā i te tuatahi, ko ngā ingoa i muri, ā, me whakatau ngā take ohotata me ngā kaiwhakaora ohotata.