Methylene blue, Prussian blue, ndi hydroxocobalamin: mankhwala atatu othetsa poizoni pa mavuto osiyanasiyana

Mankhwala atatuwa ali ndi mawu a mtundu wa utoto m'mayina awo, koma pafupifupi palibe china chimene amagawana. Methylene blue ndi utoto wabuluu umene umagwira ntchito posinthanitsa ma elekitironi. Prussian blue ili ndi dongosolo la kristalo wabuluu. Hydroxocobalamin, yogulitsidwa ngati Cyanokit, ndi chinthu chofiira chimene chimasandulika kukhala vitamini B12. Wowerenga amene amawaika m'gulu limodzi potengera mayina awo angaganize kuti amagwira ntchito zofanana. Sizili choncho. Iliyonse inapangidwa potengera lingaliro losiyana la chimene chalakwika m'thupi, ndipo siigwira ntchito pa mavuto amene sali m'lingaliro limenelo.

Kugwirizanitsa mankhwala ndi ntchito yake moyenera n'kosavuta. Methylene blue imabwezeretsa hemoglobin imene yasiya kugwira ntchito chifukwa cha kutaya ma elekitironi. Hydroxocobalamin imamanga cyanide mwachindunji. Prussian blue imagwira cesium yotulutsa cheza ndi thallium m'matumbo kuti thupi lizitulutse. Mtundu wa utoto ndi zimene timaona. Njira yeniyeni yogwirira ntchito ndiyo lingaliro lofunika, ndipo chisokonezo chimayambira pa kugwirizanitsa zimene timaonazo ndi mmene mankhwalawo amagwirira ntchito.

Uku ndi kufananitsa kophunzitsa, osati malangizo a chithandizo. Kukayikira kuti munthu ali ndi methemoglobinemia, wakhudzidwa ndi cyanide kapena carbon monoxide, kapena waipitsidwa ndi zinthu zotulutsa cheza ndi vuto ladzidzidzi. Itanani ogwira ntchito za chithandizo chadzidzidzi ndipo tsatirani malangizo a akatswiri othana ndi poizoni a m'dera lanu m'malo mochita zinthu potengera nkhaniyi.

Methylene blue: yotumiza ma elekitironi kuti ibwezeretse hemoglobin

Hemoglobin yabwinobwino imanyamula oxygen pa iron yomwe ili mumkhalidwe wa ferrous, Fe2+. Mu methemoglobinemia, iron imeneyo yataya elekitironi n'kukhala mumkhalidwe wa ferric, Fe3+, umene sungamange oxygen. Magazi angaoneke abulauni ngati chokoleti. Kuyeza oxygen ndi chipangizo cha pulse oximetry cha nthawi zonse kungapereke zotsatira zosokeretsa. Wodwalayo amakhala ndi hemoglobin yochepa yogwira ntchito ngakhale kuti mapapu akulowetsa ndi kutulutsa mpweya.

Methylene blue imagwira ntchito pano chifukwa imatumiza ma elekitironi, monga momwe zafotokozedwera pa mmene methylene blue imasunthira ma elekitironi pakati pa zinthu zopereka ndi zolandira ma elekitironi. M'maselo ofiira a magazi, imalandira ma elekitironi n'kusandulika kukhala leucomethylene blue kudzera mu njira yodalira NADPH. Mtundu umenewu umapereka ma elekitironi ku ferric iron popanda kugwiritsa ntchito ma enzyme, n'kuibwezeretsa mumkhalidwe wa ferrous. Utotowo umangobwerezabwereza kugwira ntchito m'malo moti utheretu pogwiritsidwa ntchito. Njira imeneyi ndiyo chifukwa chake kugwiritsa ntchito methylene blue pa methemoglobinemia kumachitika m'chipatala, poyezetsa milingo ndi kuyang'anira mmene wodwala akuyankhira ku mankhwalawo, osati kutsatira ndondomeko ya kunyumba.

Zolemba zamakono za methylene blue zimafotokoza kuti ntchito yake yovomerezeka ndi kuchiza methemoglobinemia imene si yobadwa nayo mwa akulu ndi ana. Mlingo wa nthawi zonse kwa akulu ndi ana ndi 1 mg pa kg, woperekedwa kudzera m'mtsempha pa mphindi 5 mpaka 30, ndipo ukhoza kubwerezedwa kamodzi ngati milingo kapena zizindikiro zikupitirirabe. Tsatanetsatane wa malire a mlingo, zoyenera kukwaniritsidwa musanabwereze mlingowo, ndi nthawi yosinthira ku chithandizo china wafotokozedwa mu zolemba zamakono za methylene blue. Mafunso othandiza okhudza njira yoperekera mankhwalawo ndi kuyang'anira wodwala afotokozedwa pa mmene milingo ya methylene blue imaperekedwera ndi kuyang'aniridwa.

Malire atatu ndi ofunika. Choyamba, kusowa kwa glucose-6-phosphate dehydrogenase ndi chifukwa chovomerezeka choletsa kupereka mankhwalawa. Izi zili choncho chifukwa kupezeka kwa NADPH yofunika popereka ma elekitironi ku utotowo kumakhala kosokonekera, zomwe zimapangitsa mankhwalawo kusagwira ntchito ndi kuwonjezera chiopsezo cha kusweka kwa maselo ofiira a magazi. Chachiwiri, methylene blue imalepheretsa monoamine oxidase A ngakhale pa kuchuluka kwa nanomolar. Choncho kupereka pamodzi ndi SSRIs, SNRIs, MAOIs, ndi mankhwala angapo a opioid kuli ndi chenjezo lalikulu loikidwa m'bokosi lokhudza serotonin syndrome. Mfundo imeneyi yafotokozedwa pa chitetezo cha methylene blue ndi kugwirizana kwake ndi mankhwala ena. Chachitatu, kufooka kwa impso kumasintha kuchuluka kwa mankhwala amene thupi limakumana nawo, ndipo zolemba za mankhwalawa zimalola mlingo umodzi wokha kwa odwala amene impso zawo zafooka pang'ono kwambiri kapena kwambiri. Palibe mwa mfundozi imene ndi yaing'ono. Iliyonse imachokera ku lingaliro lomwelo la kutumiza ma elekitironi: mankhwala amene amagwiritsa ntchito ma elekitironi a selo komanso amakhudza ma enzyme a monoamine amagwirizana ndi zonsezi.

Methylene blue ilinso ndi mbiri yogwiritsidwa ntchito pa poizoni wa cyanide, kuyambira m'zaka za m'ma 1930s, koma mbiri si njira ya chithandizo ya masiku ano. Ofufuza oyambirira anapereka malingaliro akuti ingagwire ntchito kudzera mu kusinthanitsa ma elekitironi kapena kudzera mu methemoglobin. Pofika m'zaka za m'ma 1950s, mankhwalawa anaonedwa kuti sagwira bwino ntchito polimbana ndi cyanide poyerekeza ndi njira za nitrite ndi thiosulfate. Masiku ano ku US alibe ntchito yovomerezeka yochizira poizoni wa cyanide. Kafukufuku watsopano wa cyanide pa makoswe ndi maselo umapereka zizindikiro zoyambirira zomwe sizinayesedwe mwa anthu, osati chifukwa chosankha mankhwalawa pakakhala vuto ladzidzidzi la cyanide.

Hydroxocobalamin: pakati pa cobalt pomanga cyanide

Cyanide imalepheretsa cytochrome c oxidase m'zigawo za maselo zotchedwa mitochondria, choncho maselo sangathe kugwiritsa ntchito oxygen ngakhale kuti oxygen m'magazi a m'mitsempha yochokera ku mtima ikuoneka yokwanira. Izi zimatsatiridwa ndi kuchuluka kwa asidi wa lactic, kusintha kwa kuzindikira zinthu, ndi kulephera kwambiri kwa mtima ndi kayendedwe ka magazi. Lingaliro la chithandizo ndi kuchotsa cyanide yeniyeniyo, osati kusintha hemoglobin.

Hydroxocobalamin, yogulitsidwa ndi dzina la Cyanokit, imachita zimenezi mwachindunji. Cobalt yomwe ili pakati pake imamanga ion ya cyanide m'malo mwa gulu lake la hydroxo lomangirirapo, n'kupanga cyanocobalamin, vitamini B12 wamba, amene impso zimatulutsa. Uku ndi kumanga ndi kutsekereza cyanide, osati kusinthanitsa ma elekitironi mobwerezabwereza. Mlingo wovomerezeka kwa akulu ndi 5 g kudzera m'mtsempha pa pafupifupi mphindi 15, ndi 5 g ina ngati kusintha sikukwanira, mpaka malire a 10 g. N'chifukwa chake kufananitsa methylene blue ndi Cyanokit kumakhala kosavuta funso likangofotokozedwa bwino: pa poizoni wa cyanide wotsimikizika kapena wokayikiridwa, hydroxocobalamin ndi mankhwala amakono oyamba kusankhidwa ku United States, pamodzi ndi mankhwala ena osiyana ophatikiza nitrite ndi thiosulfate pa odwala ena osankhidwa. Methylene blue singalowe m'malo mwake pa ntchito imeneyi.

Zotsatira ziwiri zofunika pa kagwiritsidwe ntchito zimachokera ku kapangidwe ka mankhwalawa. Mankhwalawa ndi ofiira kwambiri, choncho khungu lofiira ndi mkodzo wofiira zimayembekezeredwa, ndipo kusintha kwa mtundu wa mkodzo nthawi zina kumatha milungu. Mmene amatengera kuwala kwambiri kumasokonezanso mayeso a labotale oyezera zinthu potengera mtundu wa utoto, komanso zotsatira za co-oximetry zoyezera carboxyhemoglobin, methemoglobin, ndi oxyhemoglobin. Kukula kwa cholakwikacho komanso ngati chiwerengero chikukwera kapena kutsika zimasiyana malinga ndi chipangizo choyezera. Katswiri wa zachipatala amene sadziwa zimenezi angatanthauzire molakwika manambala omwewo ogwiritsidwa ntchito poyesa kuopsa kwa poizoni. Zida zakale zochizira cyanide pogwiritsa ntchito amyl nitrite, sodium nitrite, ndi sodium thiosulfate zinkagwira ntchito mosiyana: nitrite inkapanga methemoglobin mwadala kuti imange cyanide, pamene thiosulfate inkathandiza kusandutsa cyanide kukhala thiocyanate. Njira imeneyi imachepetsa kuthekera konyamula oxygen ndipo ingatsitse kuthamanga kwa magazi. Izi si zabwino pamene kupuma utsi kukutanthauza kuti carbon monoxide ingakhaleponso. Hydroxocobalamin imapewa vutoli pomanga cyanide popanda kupanga methemoglobin.

Prussian blue: msampha wa kristalo umene umakhalabe m'matumbo

Prussian blue, yogulitsidwa ngati Radiogardase, ndi ferric hexacyanoferrate yosungunuka. Mawu akuti cyanide m'kapangidwe kameneka amafotokoza magulu omangiriridwa mkati mwa kristalo wa iron, osati cyanide yaulere, ndipo mankhwalawa alibe ntchito pa poizoni wa cyanide. Ntchito yake yovomerezeka ndi kuchiza kuipitsidwa mkati mwa thupi ndi cesium yotulutsa cheza kapena thallium yotulutsa cheza kapena yosatulutsa cheza.

Lingaliro lake ndi kusinthanitsa ma ion m'kati mwa matumbo. Makristalowo salowa m'thupi kudzera m'khoma la matumbo losawonongeka. Amakhala m'matumbo, n'kumanga ma ion a cesium kapena thallium mu dongosolo la kristalo, kuphatikizapo ma ion amene amatulutsidwa mu ndulu. Amadula kuzungulira kobwerezabwereza kwa zinthuzi pakati pa matumbo ndi chiwindi, kotero kuti chitsulo chochuluka chimatuluka m'chimbudzi. Tsamba la CDC lokhudza chithandizo cha Prussian blue limafotokoza njira yomweyi m'mawu osavuta: imagwira zitsulo zimenezi m'matumbo ndi kufulumizitsa kutuluka kwake m'chimbudzi. Ndondomeko ya akulu ndi achinyamata ndi 3 g kudzera pakamwa katatu patsiku. Ana aang'ono amapatsidwa milingo yocheperapo potengera kulemera kwawo, ndipo nthawi zambiri chithandizo chimapitirira masiku 30 kapena kupitirira pamenepo pamene kuipitsidwa kwa thupi kukuyang'aniridwa.

Izi zimayankha mwachindunji kusaka kofananitsa Prussian blue ndi methylene blue. Methylene blue imagwira ntchito m'magazi monga yotumiza ma elekitironi. Prussian blue imagwira ntchito m'matumbo monga msampha umene sulowa m'thupi. Imodzi imabwezeretsa ntchito ya puloteni yokhala ndi chitsulo. Inayo imachepetsa nthawi imene chitsulo chimakhala m'thupi. Kuzisinthanitsa kungasiye mavuto onse awiri osachizidwa: methemoglobin ingakhalebe yotaya elekitironi, ndipo cesium ingapitirire kuzungulira m'thupi.

Carbon monoxide: pamene methylene blue siyoyenera

Carbon monoxide imamanga hemoglobin mwamphamvu kwambiri kuposa oxygen ndipo imasintha mpendero wosonyeza mmene oxygen imasiyanirana ndi hemoglobin. Imakhudzanso malo ena mumtima ndi m'mitochondria. Chithandizo cha nthawi zonse ndi kuchotsa munthu pamalo amene akukumana ndi mpweyawu ndi kupereka oxygen wa 100 peresenti mpaka zizindikiro zitatha, nthawi zambiri kwa maola angapo. Oxygen woperekedwa pa kuthamanga kopitirira kwa mpweya wamba amaganiziridwa pa odwala ena amene ali ndi zizindikiro zoopsa, monga kufooka kwakukulu kwa ntchito ya ubongo ndi mitsempha, kukomoka, kukhudzidwa kwa mtima, kapena kuchuluka kwambiri kwa asidi m'thupi. Zolemba za boma la feduro zokhudza chithandizo chadzidzidzi zomwe zasonkhanitsidwa mu mndandanda wa CDC wa zolemba zokhudza chithandizo chadzidzidzi zimaika oxygen ndi chithandizo chosunga ntchito za thupi patsogolo pa njira imeneyi.

Choncho kusaka methylene blue pa poizoni wa carbon monoxide kumachokera ku cholakwika chimene chimamveka ngati chanzeru: ngati utoto wabuluu umakonza vuto limodzi la hemoglobin, mwina ungakonzenso lina. Sikutero. Mankhwalawa alibe ntchito yovomerezeka pa carbon monoxide, ndipo ndondomeko zamakono za chithandizo cha carbon monoxide siziwaphatikiza. Lingaliroli ndi lakale: linaperekedwa mu kafukufuku wa nyama kumayambiriro kwa zaka za m'ma 1930s ndipo linakanidwa pasanathe chaka chimodzi pambuyo pofufuza moyesa. Kafukufuku umodzi wamakono wa makoswe umene nthawi zina umatchulidwa unayesa kuteteza ubongo ndi mitsempha mochedwa pambuyo pokhudzidwa ndi poizoni, osati kubwezeretsa carboxyhemoglobin nthawi yomweyo. Iron yotaya elekitironi ndi iron yomangidwa ndi carbon monoxide ndi mikhalidwe yosiyana ya puloteni yomweyo. Njira yotumiza ma elekitironi yokonzedwera mkhalidwe woyamba ilibe ntchito yotsimikizika pa wachiwiri. Owerenga amene akutsatira malire amenewa adzaona kuti ndi othandiza akamayang'ananso kafukufuku wa methylene blue wonse, umene umasiyanitsa ntchito zovomerezeka mwa anthu ndi zizindikiro zochokera mu kafukufuku wa maselo ndi nyama.

Kufufuza zinthu moyandikana musanafananitse

Gwiritsani ntchito tebulo limenelo pofufuza zolakwika zitatu zofala. Mayina ofanana satanthauza zinthu zofanana zimene mankhwala amalunjika. Mtundu wamphamvu wa utoto sutanthauza kuti mankhwala amagwira ntchito mofanana; kufiira kwa hydroxocobalamin ndi kubuluu kwa ena awiriwa sikunena chilichonse chokhudza ngati angalowe m'malo mwa wina ndi mnzake. Ndipo zotsatira za mayesero pa poizoni wina sizingagwiritsidwe ntchito pa poizoni wina amene amangomveka ngati wofanana naye. Choyamba mumvetse mmene mankhwala amagwirira ntchito, kenako mayina ake, ndipo zisankho za mavuto adzidzidzi zichitidwe limodzi ndi akatswiri a chithandizo chadzidzidzi.