Lectures on cassava poisoning

2021-08-07 02:54 PM

Symptoms of cyanohydrin acid poisoning: this acid inhibits the activity of respiratory enzymes, especially cytochrome oxidase enzymes, making the tissues unable to use oxygen

Outline

There are 2 types of cassava:

Manihot aipi Pohl: less toxic.

Manihot utilissima: often causes poisoning.

Toxicity

In the cassava tuber, there is a heterosite that is hydrolyzed in water to cyanohydrin acid, acetone, and glucose. The toxicity of tapioca is due to cyanohydrin acid. To avoid poisoning, the cassava must be peeled and soaked in water before boiling.

Symptoms of acute poisoning

Clinical:

Symptoms of cyanohydrin acid poisoning: this acid inhibits the activity of respiratory enzymes, especially cytochrome oxidase enzymes, making the tissues unable to use oxygen.

Digestive disorders: abdominal pain, nausea, vomiting, diarrhea.

Nervous disorders: dizziness, headache, more severe may convulsions, convulsions, dilated pupils, coma.

Respiratory disorders: suffocation, cyanosis, acute respiratory failure causing rapid death.

Toxicology test:

Venous blood is bright red because oxygen is not being used.

Vomiting and urine containing cyanydric acid.

To solve

Induce vomiting, wash the stomach with 0.2% potassium permanganate solution.

Intubate, give mechanical ventilation, increase ventilation to quickly eliminate toxins through the respiratory tract.

Rapid injection of substances that cause methemoglobinemia. Methemoglobin will combine with cyanohydrin acid to release cytochrome oxidase. The following methemoglobinogens may be used:

Methylene blue: up to 30 ml of 1% solution can be used slowly intravenously, can be re-injected until the patient is cyanotic.

Sodium nitrite solution 3%: 5 - 10 ml intravenously slowly, can be re-injected until the patient is cyanotic.

Vitamin B 12 1000 gamma 10 - 20 slow IV ampoules. Can be re-injected multiple times. Vitamin B 12 is hydroxocobalamin with the element cobalt, which combines very strongly with cyanohydrin acid to form cyanocobalamin commonly found in B 12. Cobalt tetradentate (ketocyanor) can be used instead of vitamin B12.

Sodium hyposulphate 25% solution can be used, 20 ml by slow intravenous injection, up to 50 g can be injected. The drug combines with cyanohydrin acid to form sulfuric acid 200 times less toxic than cyanohydrin acid.

Glucose 30% also works.

Anti-shock: when taking drugs that cause methemoglobinemia, patients are prone to shock. Fluids needed if additional vasopressors are required.