I-methylene blue yamakati: ukuphepha, imiphumela engemihle nokuqondiswa udokotela wezilwane

Ikati liphuza ethangini lezinhlanzi elisanda kufakwa umuthi wokulwa nesikhunta. Umnikazi ufunda ku-inthanethi ukuthi i-methylene blue yasiza inja eyayinenkinga yegazi, abese ezibuza ukuthi kungaba njalo yini nasekatini. Lezi zimo zombili zibukeka zifana uma zibhekwa ngaphandle. Ngaphakathi ekatini, azifani.

Amakati asengozini enkulu ngokungavamile yohlobo oluthile lokulimala okubangelwa i-methylene blue: ukulimala kwamangqamuzana abomvu egazi ngenxa ye-oxidation. Lokho kuthambekela kuvela ekwakhekeni kwe-hemoglobin yamakati uqobo, futhi yikho okwenza ukuqondiswa ngokuphathelene namakati kudingeke kuzimele. Iseluleko esibhalelwe izinhlanzi zasethangini, izinja, noma odayi baselabhorethri asinakusetshenziswa emakatini. Lesi sihloko sichaza ukusebenza komzimba, lokho okushiwo ngempela izincwadi zokwelapha izilwane, nokufanele ukwenze uma ikati lichayeka.

Amangqamuzana abomvu egazi lamakati akheke ngendlela ehlukile

I-hemoglobin ithwala umoya-mpilo, kodwa ukwakheka kwayo kuphinde kunqume ukuthi izinto ezibangela i-oxidation zingayilimaza kalula kangakanani. I-hemoglobin yamakati inamaqembu e-sulfhydryl angaba yisishiyagalombili asebenzisanayo nge-tetramer ngayinye, cishe okuphindwe kabili kwenani elitholakala ezinjeni noma kubantu. Lawo maqembu ayizindawo ezihlaselwa yi-oxidation. Uma kwenzeka i-oxidation kuwo, amaketanga e-globin alahlekelwa ukwakheka kwawo bese enqwabelana abe yizigaxa ezimnyama ezibizwa ngokuthi imizimba ye-Heinz, ezibonakala emasampuleni egazi asatshalaliswe engilazini futhi afakwa udayi.

Ezinye izici ezimbili zenza inkinga ibe yimbi nakakhulu emakatini. Okokuqala, uma kuqhathaniswa, amangqamuzana abomvu egazi lamakati anekhono elilinganiselwe lokuvikela ku-oxidation nokwenza i-reduction, ngakho ukulimala kuqhubekela phambili kakhulu uma sekuqalile. Okwesibili, ubende lwamakati alusebenzi kahle kangako ekususeni imizimba ye-Heinz emangqamuzaneni abomvu ngaphandle kokulimaza ingqamuzana, okuyisinyathelo sokuhlanza ezinye izinhlobo zezilwane ezisifeza kangcono, njengoba kuchazwe kulokhu kubuyekezwa kwesayensi yegazi lamakati. Ngakho amangqamuzana alimele ahlala ejikeleza egazini esikhundleni sokulungiswa.

Amakati aphilile angaba nenani elincane lemizimba ye-Heinz ngaphandle kokugula. Kuye ngomthombo wolwazi nangendlela yokufaka udayi, ukuba nemizimba ye-Heinz cishe emaphesentini amahlanu kuya kwayishumi amangqamuzana abomvu kungase kungabi yinto engavamile. Ukukhathazeka kuqala lapho inani likhulu noma izigaxa zinkulu: omunye umthombo wolwazi wezokwelapha zaselabhorethri uphawula ukuthi i-anemia iba nokwenzeka kakhulu lapho imizimba emikhulu ye-Heinz ithinta amangqamuzana abomvu angaphezu kwamaphesenti angamashumi amathathu, umkhawulo ofingqiwe kulokhu kubuka konke nge-anemia ebangelwa imizimba ye-Heinz. Ngakho kunoma yikuphi ukuchayeka, umbuzo awukaze ube ukuthi imizimba ye-Heinz ikhona yini. Umbuzo uthi mingaki, mikhulu kangakanani, nokuthi kulandela yini i-hemolysis, okuwukuqhekeka kwamangqamuzana abomvu egazi.

Okushiwo izincwadi zokwelapha izilwane

Uhlelo oludala lwe-Plumb's Veterinary Drug Handbook luthi odokotela abaningi babheka i-methylene blue njengomuthi ongafanele ukusetshenziswa emakatini, ngoba amakati angaba ne-anemia ebangelwa imizimba ye-Heinz kanye ne-methemoglobinemia. Ukukhathazeka okubalwe kulo kubandakanya izinguquko ekwakhekeni kwamangqamuzana abomvu, i-methemoglobinemia ebangelwa umuthi obekufanele uyelaphe, nokufinyezwa kwesikhathi sokuphila kwamangqamuzana abomvu. Nokho, yona leyo ncazelo yomuthi inikeza umthamo ophuthumayo wamakati one-methemoglobinemia, ngokuvamile ongu-1 kuya ku-1.5 mg nge-kg ofakwa emthanjeni njengokwelashwa okukodwa. Lokho kuhlanganiswa kwezitatimende kuveza isimo sangempela: lapha ukuthi umuthi awufanele ukusetshenziswa kusho ukuthi uyagwenywa ngaphandle kwezimo ezilinganiselwe eziqondisiwe nezegadwayo, hhayi ukuthi awukaze unikezwe. Umbhalo omdala wencazelo yomuthi otholakalayo ugcinwe kule khophi yencwadi ka-Plumb, kanti uhlelo lweshumi lwamanje luqukethe le ncazelo ekhasini 859.

I-Merck Veterinary Manual ithatha isikhundla esifanayo eziqondisweni zayo zokwelapha ubuthi obubangelwa imithi yokudambisa ubuhlungu, ibala i-methylene blue engu-1 kuya ku-1.5 mg nge-kg yesisombululo sephesenti elilodwa esifakwa emthanjeni njengendlela engasetshenziswa ukunciphisa i-methemoglobin, kuqashelwe i-methemoglobinemia, i-anemia ebangelwa imizimba ye-Heinz, kanye ne-hemolysis. I-Merck iphinde iphawule ngokwehlukana ekubukeni kwayo konke nge-anemia ezilwaneni ukuthi amakati athambekele kakhulu ekwakhekeni kwemizimba ye-Heinz kunezinye izinhlobo zezilwane.

Isitatimende esiqine kakhulu esivela kubalawuli siphathelene nemikhiqizo ephuzwa ngomlomo. Umthethonqubo kahulumeni wobumbano wase-US 21 CFR isigaba 500.27 ubhala ukuthi imikhiqizo emibili yokubulala amagciwane emgudwini womchamo, ephuzwa ngomlomo futhi equkethe i-methylene blue, yabangela i-anemia yokubhujiswa kwamangqamuzana abomvu ngenxa yemizimba ye-Heinz emakatini lapho isetshenziswa ngokweziqondiso zelebula, ngezinye izikhathi kwaze kwafa amakati, futhi i-methylene blue yahlonzwa njengembangela. Umthethonqubo uphetha ngokuthi imithi yezilwane yalolo hlobo ye-methylene blue ephuzwa ngomlomo yayingaphephile futhi ingaqashelwa njengephumelelayo ngaphandle kwesicelo esigunyaziwe. Ekuhlolweni, izinja nazo zaba nohlobo olufanayo lokulimala, ngakho lo muthi awuyona into engenabungozi nasezinjeni. Kodwa ingozi yomthamo obhalwe kulebula yaboniswa kuqala emakatini.

Imiphumela engemihle ebikiwe emakatini igxile egazini: ukwakheka kwemizimba ye-Heinz, i-anemia yokubhujiswa kwamangqamuzana abomvu, kanye ne-methemoglobinemia ebangelwa umuthi obekufanele uyelaphe lapho ukuchayeka kuphezulu noma kuphindaphindiwe. Izincwadi ezijwayelekile zemithi nazo zibala isicanucanu nokuhlanza, kodwa ubufakazi obuqondene namakati buphathelene negazi, futhi yilapho ukuqapha kufanele kugxile khona.

Okuyindida: ukwelapha nobuthi engqamuzaneni elilodwa lomuthi

Ngaphakathi kwengqamuzana elibomvu, i-methylene blue ingaguqulwa nge-reduction ibe yi-leucomethylene blue, edlulisela ama-electron ensimbini ye-haem ethinteke yi-oxidation bese ibuyisela i-hemoglobin esebenzayo. Yilokho kusabela okwelaphayo okwenza isetshenziswe ku-methemoglobinemia, futhi kuchazwe kabanzi esihlokweni esichaza i-methemoglobinemia. Kodwa i-methylene blue uqobo iyinto ebangela i-oxidation. Uma ukuchayeka kukhuphuka noma izinhlelo zengqamuzana ezenza i-reduction zehluleka ukubhekana nakho, yona leyo ngqamuzana lomuthi yandisa i-methemoglobin nokulimala kwe-globin esikhundleni sokukulungisa. Ngakho i-methemoglobinemia iyisizathu sokusebenzisa lo muthi futhi iwumphumela wawo ongemuhle. Ibanga phakathi kwalokhu okubili lincane, futhi lincane kakhulu emakatini.

Ubufakazi obucace kakhulu emakatini buvela ocwaningweni olulawulwayo lwango-1992 lwamakati amadala angamashumi amane. Umthamo owodwa ongu-1.5 mg nge-kg ofakwe emthanjeni walungisa ngokushesha i-methemoglobinemia eyayibangelwe yi-nitrite ngaphandle kokwandisa amangqamuzana anemizimba ye-Heinz ajikeleza egazini. Imithamo emibili enjalo enikezwe ngokuhlukaniswa ngamahora amane yandisa kakhulu ukuvama kwemizimba ye-Heinz, ikakhulukazi ngemva kokuchayeka ku-nitrite, nakuba i-anemia esobala yokubhujiswa kwamangqamuzana abomvu ingazange ivele ngesikhathi socwaningo (Rumbeiha no-Oehme, 1992). Umthamo owodwa wasiza. Umthamo ophindiwe emahoreni ambalwa washintsha ibhalansi yabhekisa ekulimaleni.

Imibiko yokwelashwa ikhomba okufanayo. Ukubuyekezwa kwango-2019 ku-Journal of Veterinary Internal Medicine kuchaza i-methylene blue efakwa emthanjeni njengokwelashwa okukhethwa kuqala kwe-methemoglobinemia ebukhali enezimpawu, kubalula ukusetshenziswa kwayo emakatini ngo-1 mg nge-kg emthanjeni, futhi kuxwayisa ngokuthi ikati eselivele line-methemoglobinemia noma i-anemia ebangelwa imizimba ye-Heinz lingathola ukulimala okwengeziwe ngenxa ye-oxidation, kutuswa ukuhlolwa kwe-hematocrit izinsuku ezimbalwa ngemva kwalokho (DOI 10.1111/jvim.15637). Umbiko oshicilelwe wekati elincane elalisolwa ngokuba ne-methemoglobinemia ehlobene namanzi okuphuza wachaza ukusabela phakathi nemizuzu ngemva kokunikezwa u-1 mg nge-kg wesisombululo sephesenti elilodwa emthanjeni, kwenziwa izilinganiso ze-co-oximetry ngokulandelana ngesikhathi lilaliswe esibhedlela (umbiko wesigameko). Isigameko esiphuthumayo sango-2023 sekati lohlobo lwe-Ragdoll elinezinyanga eziyisithupha elaline-methemoglobinemia enzima ebiphindaphinda sasingathwa kuqala ngokufaka umuthi emthanjeni, kwase kulandelwa inkambo yokuwunikeza ngomlomo ngokucophelela, ikati lalulama futhi akubanga nemiphumela engemihle ephawulekayo ehlobene nokwelashwa (DOI 10.1111/vec.13298). Impumelelo ngayinye yayiyisimo esikhethekile esaqondiswa futhi saqashwa, hhayi isibonelo esivumela ukusetshenziswa ekhaya.

Imibiko yakudala yobuthi ibonisa olunye uhlangothi. Ochungechungeni lwezigameko lwango-1973, amakati ayisithupha aba ne-anemia yokubhujiswa kwamangqamuzana abomvu ngenxa yemizimba ye-Heinz ngemva kokuthola imikhiqizo yomgudu womchamo ephuzwa ngomlomo equkethe i-methylene blue, kanti amanye amakati amabili anikezwa amanani alinganayo ekuhlolweni aba nezimo ezibucayi zokubhujiswa kwamangqamuzana abomvu ezinsukwini ezimbalwa futhi adinga ukumpontshelwa igazi (Schechter nabanye, 1973). Isigameko sangowe-2016 esaholela ekufeni kwekati elincane elixubene nohlobo lwe-Angora, elalilashelwa isifo somgudu womchamo, sabonisa ukuguquka okukhulu kolwelwesi lwamafinyila nezicubu kube luhlaza okwesibhakabhaka, kanye nokulimala kwesibindi nezinso; ngokomlando wokwelashwa nangokuhlolwa kwezicubu, kwatholakala ukuthi kwakuwubuthi be-methylene blue (umbiko wesigameko). Akukho mkhawulo womthamo onobuthi onokwethenjelwa ongatholakala kule mibiko bese usetshenziswa kukho konke ukuchayeka ngomlomo, emthanjeni, esikhunjeni, noma emanzini ethangi lezinhlanzi ahlanjululwe ngamanzi amaningi, futhi lesi sihloko asinikezi mkhawulo onjalo.

Okunye ukuqhathanisa kudinga ukulungiswa. I-acetaminophen yaziwa kakhulu ngokuba yingozi emakatini ngoba awanawo ama-enzyme abalulekile enqubo ye-glucuronidation, futhi abanye ababhali basebenzisa leyo ncazelo naku-methylene blue. Lokho kusebenzisa incazelo efanayo akusekelwa ubufakazi. Ukungasebenzi kahle kwe-glucuronidation kuyindlela esiqinisekisiwe yokwenzeka kobuthi be-acetaminophen, ebuyekezwe kulolu cwaningo ngokuguqulwa kwemithi emzimbeni wamakati. Nge-methylene blue, imithombo yokwelapha izilwane igcizelela ukuziphatha kwayo kwemvelo kwe-redox kanye nokuthambekela kwamangqamuzana abomvu egazi lamakati ekulimaleni, kanti i-FDA ithi indlela eqondile yokulimala okubangelwa imizimba ye-Heinz ayikaziwa ngokuphelele. Indaba ye-acetaminophen iyisikhumbuzo esiwusizo sokuthi amakati aguqula imithi emizimbeni yawo ngendlela ehlukile. Ayiyona incazelo yokusebenza kwalo muthi.

Uma ikati lichayeka: imibuzo evame ukubuzwa

Ikati lami liphuze amanzi ethangi lezinhlanzi afakwe i-methylene blue. Ingabe lokho kuwukungenwa ubuthi?

Akusho njalo, futhi asikho isihloko esingaphendula lokho ngaphandle kwezilinganiso. Ukuphuza amanzi ambalwa ethangi asevele enomuthi ohlanjululwe ngamanzi amaningi akufani nokugwinya umuthi ongakahlanzululwa, futhi awukho umkhawulo wamakati oshicilelwe ocwaningweni olubuyekezwe ngochwepheshe wamanzi ethangi anomuthi ohlanjululwe. Ungabali ukwelashwa ususela eziqondisweni zethangi lezinhlanzi noma ezingxoxweni zemithamo yezinja. Xhumana nodokotela wezilwane welikati, umtholampilo wezimo eziphuthumayo, noma isevisi yokulawula ubuthi ezilwaneni, unemininingwane yomkhiqizo.

Yiluphi ulwazi okufanele ngiluphathe?

Ilebula lomkhiqizo noma isithombe salo, isithako esisebenzayo nokugxila kwaso, inani lomuthi ongakahlanzululwa elifakwe emanzini angakanani uma lokho kuthinteka, isilinganiso samanzi ikati eliwaphuzile, isisindo sekati, isikhathi sokuchayeka, kanye nanoma yimuphi umuthi eliwuthathayo noma isifo elinaso njengamanje. Ukuqondiswa okujwayelekile ngokuphathelene nobuthi okuvela ku-ASPCA kucela abanikazi ukuba bagcine isiqukathi futhi bashaye ucingo kunokuba balinde izimpawu. Lokho kuyasebenza nalapha.

Udayi ungene eboyeni. Kwenziwani manje?

Vimbela ikati ukuba lingazikhothi ukuze liwususe, ngoba ukungcoliswa koboya kuba ukuchayeka ngomlomo lapho lizihlanza. Ukuqondiswa okujwayelekile kwe-ASPCA ngokususa izinto ezingcolisayo kuncoma amagilavu, insipho ewuketshezi emnene yokugeza izitsha namanzi afudumele ukuze kususwe izinsalela eziningi, ukugeza kahle ngamanzi, ukugcina umkhiqizo ungafinyeleli emehlweni nasezindlebeni, kanye neseluleko sikadokotela wezilwane ngendlela efanele yaleyo nto. Buza umtholampilo ngaphambi kokugeza ikati elicindezelekile noma elinezimpawu.

Ingabe kufanele ngilibangela ukuba lihlanze?

Cha, ngaphandle uma udokotela wezilwane noma uchwepheshe wobuthi ekuyalela ngokuqondile lokho. Izindlela zasekhaya zokubangela ukuhlanza ezisetshenziswa ezinjeni, ikakhulukazi i-hydrogen peroxide, azifanele amakati.

Yiziphi izimpawu ezidinga ukuhlolwa ngokushesha?

Ubuthakathaka noma ukukhathala okukhulu, ukuphefumula ngokushesha noma kanzima, izinsini eziphaphathekile noma ezinombala ophuzi, igazi noma ulwelwesi lwamafinyila olunombala olufiphele noma olunsundu, ukuwa, noma umchamo omnyama. Qaphela ukuthi ukulimala kwegazi kungase kuvele kamuva: izincwadi zakudala ngemikhiqizo yomgudu womchamo zichaza i-anemia eqala ezinsukwini ezilandelayo, ngakho ikati elibukeka liphilile kusihlwa ngosuku lokuchayeka lisadinga ukuhlolwa ngudokotela wezilwane ukuze kutholakale ukuphuthuma kwesimo, futhi, uma udokotela ekweluleka, ukuhlolwa kwegazi okulandelayo okubandakanya i-hematocrit nokuhlolwa kwesampula yegazi esatshalaliswe engilazini ukuze kubhekwe imizimba ye-Heinz.

Kungani ukuqondiswa ngezinja kufanele kuhlale kwehlukile

Izinja nazo zingaba ne-anemia ebangelwa imizimba ye-Heinz ngenxa ye-methylene blue, ngakho akukho lapha okusho ukuthi lo muthi awunabungozi ezinjeni. Kodwa amakati ahlanganisa i-hemoglobin ethinteka kalula kakhulu yi-oxidation, ukuzivikela okubuthakathaka kwamangqamuzana abomvu, nokuhlanzwa okungasebenzi kahle kangako ubende, okunciphisa ibanga lokuphepha. Izincwadi zokwelapha zibonisa lokho: izindlela ezindala zokwelapha izinja zifinyelela ku-4 mg nge-kg emthanjeni kwezinye izimo, kanti izincwadi eziphathelene namakati zivame ukuba phakathi kuka-1 kuya ku-1.5 mg nge-kg kanye kuphela nge-methemoglobinemia futhi zixwayisa ngokuqondile ngokuphinda umthamo. Ukunciphisa indlela yokwelapha inja ngokwesilinganiso sesisindo somzimba akuyibheki inkinga esemqoka. Ibanga lokuphepha, ukusabela kwegazi, nohlelo lokuqapha kwehlukile, yingakho izinqumo eziphathelene namakati kufanele zibe sezandleni zikadokotela wezilwane ongalinganisa isizathu sokwelapha nengozi ye-oxidation futhi alinganise umphumela. Ukususa amanzi afakwe umuthi ethangini ngemva kokusetshenziswa, njengoba kuchazwe kumhlahlandlela wokususa umuthi ethangini lezinhlanzi, kuwukunakekela izilwane okuvamile. Ukwelapha ikati akunjalo.