You are on page 1of 27

GUA PARA EL MANEJO GENERAL

DEL PACIENTE INTOXICADO


!
!
!
!

!!!!!!!!!!!!!!!
!
!
!
!

!
!
!

!"#$%&'($#$)"*'+$*',"-.$#/$'.#/&0.-"+&!

!
!

!
!

ABCD;E5F5;GHC%E;%IBJ;GD5K%;G%DKLC%E;%
5GHCM5DKD5NG%
!

!" "#$%&'! #$% &$% '()*+*,-! ()*+*,-%./$0*%)*1! 2#*! 3$! '/#44.&'! #%$! .%)'5./$/.-%6! #7)*&!
&*8*!&$4!.%7)4#//.'%*7!7'84*!+'7!7.9#.*%)*7!:#%)'7;!
!
$< =4.0*4'7!$#5.+.'7!2#*!*+!&#*>'!:#*&*!$:+./$4<!
8< ?#$4&$4! *+! :4'&#/)'! 7'7:*/3'7'! *%! 7#! *%@$7*! '4.9.%$+! A! $/'0:$>$4+'! /'%! *+!
:$/.*%)*<!
/< B#*!7*!4*/'C$!*+!@-0.)'!*%!#%!,4$7/'!+.0:.'!'!*%!#%$!8'+7$!&*!:+D7)./'<!
&< B#*!7*!)4$%7:'4)*!$+!:$/.*%)*!$!#%!/*%)4'!&*!)4$)$0.*%)'!&*!#49*%/.$!A!&$4!$@.7'!
$!)$+!/*%)4'!&*!7#!++*9$&$!.%0.%*%)*<!
!
." E.9.+*!A!0$%)*%9$!+$!/$#0*/-,*1'!&*+!:$/.*%)*!A!/'%)4'+*!*+!#2(,3<!
!

!
!

4" 56$')*+*78$% $&% )19*,(! 7.! *7! :'7.8+*6! :*4'! %'! 4*)4$7*! *+! /'%)4'+! $&*/#$&'! &*! +$!
4*7:.4$/.-%!A!&*!+$!:4*7.-%!$4)*4.$+!
!
:" ;9)/-*<-%$&%)19*,(6!:$4$!2#*!+$!$87'4/.-%!A!*+!&$>'!7*$%!0F%.0'7;!

Toxicos ingeridos!G&0.%.7)4$4!*0H)./'7!'!:4$/)./$4!+$@$&'!9D7)4./'<!
G&0.%.7)4$4!/$48-%!$/).@$&'!
!
Txicos inoculados!I%0'@.+./*!$+!:$/.*%)*<!G&0.%.7)4$4!*+!$%)F&')'<!
!
Contaminacin de piel u ojos!J$@*!/'%!$9#$!/'44.*%)*!)*0:+$&$!
&#4$%)*!KL!0.%#)'7<!
!

Txicos inhalados!M*).4*!$+!:$/.*%)*!&*!+$!N'%$!&*!*5:'7./.-%!A!&*+*!
!

'5F9*%'!'!4*7:.4$/.-%!$4).,./.$+!7.!*7!%*/*7$4.'<!

Txicos por va rectal!G&0.%.7)4*!*%*0$<!


!
!
!

=" G&0.%.7)4*!*+!-')>6()(%$#0$,>+*,(!(7.!*7)D!&.7:'%.8+*16!0.*%)4$7!7*!:4'7.9#*!/'%!+$!
*5)4$//.-%!&*+!)-5./'<!O'!&*8*4D%!#7$47*!$%)F&')'7!$!0*%'7!2#*!7*!3$A$!.&*%).,./$&'!+$!
7#7)$%/.$!/$#7$%)*!&*!+$!.%)'5./$/.-%<!PH!)/-)-?*$')(%6$%-0(@(<!
!
!

!
!
!

!"#$%&'($#$)"*'+$*',"-.$#/$'.#/&0.-"+&!

!
!

5GLHBIDD5CG;L%K%PCL%ABCA5;HKB5CL%E;%
KG5FKP;L%5GHCM5DKECL%
!
!
%

PRIMERAS ACCIONES A REALIZAR


!

I%)*%)$4!.&*%).,./$4!+$!7#7)$%/.$!A!+$!4#)$!&*!.%)'5./$/.-%<!
Q4$*4!*+!:$2#*)*!'!*%@$7*!('!+'!2#*!2#*&*!&*!H+1!$!+$!/+F%./$<!
Q4$7+$&$4! $+! :$/.*%)*! $! +$! /+F%./$! +'! 0D7! :4'%)'! :'7.8+*6! $@.7$%&'! :4*@.$0*%)*! &*! 7#!
++*9$&$<!

TXICOS INGERIDOS
!
5'68,*/%&-%$?$#*#%#1&(%#*O%
J$!.%9*7).-%!3$!7.&'!&*%)4'!&*!+'7!R+).0'7!STUVT!0.%#)'7<!
J$!7#7)$%/.$!.%9*4.&$!%'!*7!#%!D/.&'!'!D+/$+.!,#*4)*<!
J$!7#7)$%/.$!.%9*4.&$!%'!*7!#%!&*7).+$&'!&*!:*)4-+*'!(W*4'7*%'6!9$7'+.%$6!*)/<1<!
X+!$%.0$+!*7)D!/'%7/.*%)*6!$+*4)$!A!/'':*4$).@'<!
!
5'68,*/%&-%$?$#*#%8#-'6(O%
G9#$!'5.9*%$&$!$+!SY!:#*&*!&$47*!:'4!@F$!'4$+!*%!#%$!/#/3$4$&$!/'%!/$&$!KT!W9<!
Z$+6! 0'7)$N$! A! 0#/3$7! ')4$7! 7#7)$%/.$7! &*7/4.)$7! ).*%*%! 0*%'4! *,*/).@.&$&! A! *%!
'/$7.'%*7!:#*&*%!7*4!:*+.94'7$7<!
!
Z.! +$! 7#7)$%/.$! *7! #%! D/.&'! '! #%$! 8$7*! ,#*4)*! !" #$" %&'()*+%!" %&" ,&(-.*&!" +/!$'&0+-" +*"
:4':!"#$%!&' ()"' $*+!,!-#%"' ."/0"' &' 0)"1&' 2' .."1$%' %34!*$+",#"' $.' 4$/!",#"' $' .$' /.5,!/$' 4$%$'
!"#$%#&'()*+)$('$',%*#$"-)./,%#%0$('!%1#)%#,*/%'$')/*)!'(21#)'!$%3'/")4+**()+')*$%5&*$')6'(')
!"#$%&'&(#)%*#+!#)*%)'+,"*'%-#./0+*%&%&#)*%$/1,%&#+&,23#$'&)%3'4!+&5#)*4'!:'/'7!:4':.*)$4.'7!
+'7!).*%*%!$!0$%'<!
!

TXICOS INHALADOS

!
!

"'+'/$4!$+!:$/.*%)*!*%!#%!+#9$4!,4*7/'!'!*%!#%!D4*$!/'%!$&*/#$&$!@*%).+$/.-%<!!
=4'@**4!&*!4*7:.4$/.-%!$4).,./.$+!7.!*7!:'7.8+*<!!
Q4$%7:'4)$4!$!+$!/+F%./$!)$%!:4'%)'!/'0'!7*!:#*&$<!

CONTAMINACIN POR VA DRMICA


!

Z.!*+!:$/.*%)*!3$!7.&'!/'%)$0.%$&'!/'%!#%!:'+@'!7*/'6!+.0:.$4!/#.&$&'7$0*%)*!*+!:'+@'!
#7$%&'! #%! /*:.++'! &*! /*4&$7! &#4$7<! X7! *5)4*0$&$0*%)*! .0:'4)$%)*! :4')*9*4! +'7! 'C'76!
%$4.N! A! 8'/$! &*+! :$/.*%)*! A! &*! +$! :*47'%$! 2#*! +'! 0$%*C$! :$4$! *@.)$4! !"# $%&"!"'$(%# )#
!"#$%&!'"()$(*+,-+()./0"&$($,(*/+1$%+2!
Enjuagar vigorosamente el rea contaminada con abundante agua corriente.!

!
!
!

!"#$%&'($#$)"*'+$*',"-.$#/$'.#/&0.-"+&!

!
!

!"#$%&'$()&$&*$+,&#$-#$./01$%/21,1.#3&"4&$&"5)#2#0#6$*#%#,$&*$+,&#$71"$5#89"$:$#2)#$:!
@'+@*4!$!*%C#$9$4!0#A!8.*%<!
Continuar el bao y enjuagado al menos durante 15 minutos.!
No intentar neutralizar el txico.!
!

TXICOS EN LOS OJOS


!

!"#$%&'()*(+ ,&-&.+ ,/0+ /1/0+ 2/)+ &34&+ /+ 04(./+ 0&,$)/+ 5+ 2/)*$)4&.+ (,+ ,&-&%/+ 2/)+ &34&+
&#4$%)*!$+!0*%'7!KT!0.%#)'7<!!
!"#$%&'()*+#$"&)+"#,$#-,(%.,+/"/"#0!"!#$%&#'()*+%&#%,-$!"(&#.#/-(+(#"(!$*0!"&(#(1#,!&!#
!"!#$%&#'()(*+*,!-!#$.!/(#%(/!0(#%(1%/!(!(+&(0$.-'(#%(!2+!(.%130!#!4!

;#%?8@%*?0(/)-')$%78$%$&%0/(0*$)-/*(%)/-*<-%*'+(/?-,*1'%#(Q/$%
$&%)19*,(%-%&-%,&>'*,-%R$&%$'S-#$T%Q()$&&-%(%,8-&78*$/%,(#-%78$%
08$6-%-@86-/%0-/-%*6$')*+*,-/%$&%*'</$6*$')$%-,)*S(%)19*,(U%

%
%
%
%
%
%
%
%

!
!
!

!"#$%&'($#$)"*'+$*',"-.$#/$'.#/&0.-"+&!

!
!

E5KJGNLH5DC%E;%PK%5GHCM5DKD5NG%
!!
!

I'%,(//$,)(%@%/[0*6(%6*-<'1#)*,(%)$'6/[%$+$,)(#%
?8@%0(#*)*S(#%#(Q/$%&-%/$#(&8,*1'%6$&%,-#(%
%
Ventajas de una correcta identificacin del agente txico
!

!"#$#%&#'(&)*&%#+%",(%$#%"-%*-./$(.(%#,0#1/'21(%(%$#%"-$!)*4$:.$!2#*!:#*&*;!
o Z*4!*+!7$+@$@.&$7!&*+!:$/.*%)*<!
o =4*@*%.4!/'0:+./$/.'%*7<!
o G/*+*4$4!+$!4*/#:*4$/.-%<!
=#*&*!&*7$/'%7*C$4!$+9#%$!&*!+$7!0*&.&$7!&*+!)4$)$0.*%)'!9*%*4$+!&*!+$7!.%)'5./$/.'%*7<!
P*!.%/$+/#+$8+*!@$+'4!*%!+'7!/$7'7!0H&./'+*9$+*7!A!,'4*%7*7<!
GA#&$4D!$!+$!3'4$!&*!*@.)$4!*%@*%*%$0.*%)'7!:'7)*4.'4*7<!
M*&#/*!*+!4.*79'!&*!%#*@$7!*5:'7./.'%*7!*%!3#0$%'7!A!$%.0$+*7<!
G#0*%)$!+$!:4'8$8.+.&$&!&*!2#*!*+!@*)*4.%$4.'!4*/'%'N/$!%#*@'7!/$7'7!&*!.%)'5./$/.-%<!

Requisitos para llegar al diagnstico correcto


%

M*$+.N$4!#%$!*53$#7).@$!4*/':.+$/.-%!&*!&$)'7!&*!+$!3.7)'4.$<!
[87*4@$/.-%!*53$#7).@$6!0.%#/.'7$!A!:'40*%'4.N$&$!&*!+'7!7.9%'7!/+F%./'7!A!7#!/4'%'+'9F$<!
M*0.).4!+$7!0#*7)4$7!:$4$!7#!$%D+.7.7!*%!*+!:+$N'!&*!).*0:'!0D7!84*@*!:'7.8+*<!
P.7:'%*4!&*!#%!7*4@./.'!&*!$)*%/.-%!*%!*+!2#*!)'5./-+'9'7!*5:*4.0*%)$&'76!A!$!7*4!:'7.8+*!
@*)*4.%$4.'76! '4.*%)*%! &#4$%)*! *+! &.$9%-7)./'! 2#*! %'7! :*40.)$! $:+./$4! #%! )4$)$0.*%)'!
*,./$N<!
X+!:4':.*)$4.'!&*8*!:4'@**4!.%,'40$/.-%!7'84*!:'7.8+*7!)-5./'7!:4*7*%)*7!*%!*+!$08.*%)*!
&*+!$%.0$+<!
J$!.%,'40$/.-%!&*!+'7!)*7).9'7!*7!:4.0'4&.$+!(.%9*7).-%!&*!/*8'6!/'%7#0'!&*!:+$%)$7!4*/.H%!
,#0.9$&$76! *)/1<! Z.! %'! 3$A! )*7).9'7! *%)4*@.7)*! $! /#$%)$7! :*47'%$7! ).*%*%! 4*+$/.-%! /'%! *+!
$%.0$+<!

%
B;KP5D;%PKL%AB;JIGHKL%KE;DIKEKL%AKBK%CVH;G;B%PK%5GWCBFKD5NG%
AB;D5LK%
%
GC%HCEC%;P%FIGEC%LKV;%XIY%;L%C%XIY%GC%;L%HNM5DC%C%Z;G;GCLC%

!
!
!

!"#$%&'($#$)"*'+$*',"-.$#/$'.#/&0.-"+&!

!
!

!
!

E;LDCGHKF5GKD5NG%HCM5DCPNJ5DK%
!

P-%0/*?$/-%/$<&-%6$&%)/-)-?*$')(O%

\;S*)-/%78$%$&%)19*,(%#$%#*<-%-Q#(/Q*$'6(]%

!
!
X%! 0*&./.%$! @*)*4.%$4.$! *+! )4$)$0.*%)'! :4.0$4.'! :$4$! +$! *5:'7./.-%! $! 7#7)$%/.$7! )-5./$7!
&*8*4F$!7*4!+$!&*7/'%)$0.%$/.-%!A!&*)'5.,./$/.-%!&*+!:$/.*%)*!
!
X+! '8C*).@'! &*! +$! &*7/'%)$0.%$/.-%! *7! .%3.8.4! '! 4*&#/.4! $+! 0F%.0'! +$! $87'4/.-%! &*!
7#7)$%/.$7! )-5./$7! A! :4'0'@*4! +$! *5/4*/.-%! '! *+.0.%$/.-%! &*! +$7! 7#7)$%/.$7! )-5./$7! &*+!
/#*4:'<!
X+! /'%'/.0.*%)'! &*+! 0*/$%.70'! &*! $//.-%! &*+! )-5./'6! $7F! /'0'! &*! +$! )'5./'/.%H)./$!
(.%/+#A*%&'! +$! $87'4/.-%6! &.7)4.8#/.-%6! 0*)$8'+.70'! A! *5/4*/.-%1! A! +$! &'7.7! )-5./$! &*! +$!
7#7)$%/.$! )-5./$! *7! %*/*7$4.'! :$4$! :'&*4! &*)*40.%$4! *+! ).:'! &*! &*7/'%)$0.%$/.-%!
%*/*7$4.'!A!*+!)4$)$0.*%)'!$&*/#$&'!:$4$!*+!:$/.*%)*<!
J$! &*7/'%)$0.%$/.-%! *7! *5)4$'4&.%$4.$0*%)*! R).+6! :*4'! ).*%*! +$! &*7@*%)$C$! &*! 2#*! 7-+'!
:#*&*! ++*@$47*! $! /$8'! &*%)4'! &*! #%! *7)4*/3'! 0$49*%! &*! ).*0:'! :$4$! +$! 0$A'4F$! &*! +$7!
7#7)$%/.$76!:'4!+'!)$%)'6!*7!.0:'4)$%)*!'8)*%*4!#%$!3.7)'4.$!/'0:+*)$!A!*+!).*0:'!&*7&*!+$!
*5:'7./.-%<!
J$7! /$)*9'4F$7! &*! &*7/'%)$0.%$/.-%! :#*&*%! .%/+#.4! +$! '/#+$46! /#)D%*$! .%3$+$)'4.$6!
9$7)4'.%)*7).%$+6!+$!&.#4*7.7!,'4N$&$!*!.%/+#7'!+$!*+.0.%$/.-%!2#.4R49./$6!)'&'!*++'!/'%!*+!,.%!
&*!:4*@*%.4!+$!$87'4/.-%!'!$#0*%)$4!+$!*+.0.%$/.-%!&*!+$!7#7)$%/.$!)-5./$<!

%
Descontaminacin ocular
!

Z.! 7*! 3$! :4'&#/.&'! *5:'7./.-%! '/#+$4! $! #%$! 7#7)$%/.$! )-5./$! :#*&*! 7*4! %*/*7$4.$! +$!
*@$+#$/.-%!$!,'%&'!$)*%/.-%!0H&./$!$&*/#$&$!&*!+'7!'C'7<!
!
J$!&*7/'%)$0.%$/.-%!$&*/#$&$!*7!$!0*%#&'!&.,F/.+!&*!4*$+.N$4!:$4$!*+!&#*>'!&*!+$!0$7/')$6!
A$! 2#*! 7#*+*! 7*4! #%! :4'/*&.0.*%)'! 0'+*7)'! '! &'+'4'7'! 2#*! 4*2#.*4*! &*! 4*)*%/.-%! &*+!
$%.0$+<!

!
!
!

!
!

!"#$%&'($#$)"*'+$*',"-.$#/$'.#/&0.-"+&!

!
!

X7!%'!'87)$%)*!4*/'0*%&$8+*!2#*!+'7!:4':.*)$4.'7!4*$+./*%!+$!&*7/'%)$0.%$/.-%!'/#+$4!*%!
/$7$! A$! 2#*! *+! ,$/)'4! ).*0:'! *7! &*/.7.@'<! =$4$! *++'! &*8*%! *%C#$9$4! +'7! 'C'7! /'%! 7'+#/.-%!
7$+.%$! ,.7.'+-9./$! (:'4! *C*0:+'6! +$! 7'+#/.-%! :$4$! +*%)*7! &*! /'%)$/)'! 7.%! %.%9R%! ).:'! &*!
$9*%)*!&*!+.0:.*N$6!C$8'%*76!*)/1!'!8.*%!/'%!$9#$!).8.$!&#4$%)*!KLU\T!0.%#)'7!$%)*7!&*!7#!
)4$+$&'! $+! @*)*4.%$4.'<! X7)'! $A#&$4D! $! 0$5.0.N$4! +$! &*7/'%)$0.%$/.-%! A! +$! +*7.-%!
7*/#%&$4.$!$!+$!/-4%*$<!X7!.0:4*7/.%&.8+*!+$!$)*%/.-%!@*)*4.%$4.$!.%0*&.$)$<!P*8*%!&$47*!
.%)4#//.'%*7! $! +'7! :4':.*)$4.'7! /'%! *+! ,.%! &*! *@.)$4! +*7.'%*7! 2#*! :#*&$! 3$/*47*! *+! $%.0$+!
:'4! ,4')$0.*%)'! &*! +'7! 'C'7! &#4$%)*! *+! )4$7+$&'<! X7! :'4! *++'! 4*/'0*%&$8+*! +$! /'+'/$/.-%!
.%0*&.$)$!&*!#%!/'++$4!.7$8*+.%'<!
Q$08.H%!7*!:#*&*!#7$4!^#(&8,*1'%#-&*'-%,-#$/-_!
! .%,8,2-/-6-#%#(0$/-#%6$%#-&%6$%?$#-%0(/%,-6-%&*)/(%6$%-<8-%!
]%$!@*N!++*9#*!$!+$!/+F%./$;!
o "'%).%#$4!+$!.44.9$/.-%!&*!+'7!'C'7!/'%!7'+#/.-%!7$+.%$!*7)H4.+!$)*0:*4$&$!&#4$%)*!$+!
0*%'7!ST!0.%#)'7<!
o ?')$7!&*!$%*7)H7./'!',)D+0./'!)-:./$7!(7.!+'!/'%7.&*4$!:4*/.7'1<!

%
%

Descontaminacin de la piel

J'7! )-5./'7! $:+./$&'7! $! +$! :.*+! :#*&*%! /$#7$4! +*7.-%! ,F7./$! *%! *+! :#%)'! &*! $:+./$/.-%! '!
/'%)$/)'<!
!
X+!'8C*).@'!&*!+$!&*7/'%)$0.%$/.-%!&H40./$!*7!*@.)$4!+$!4**5:'7./.-%!'4$+!:'4!$/./$+$&'!A!
:$4$!:4*@*%.4!+$!$87'4/.-%!)4$%7&H40./$!2#*!:#&.*4$!'/$7.'%$4!*,*/)'7!7.7)H0./'7<!
!
P*8*! $&@*4).47*! $! +'7! :4':.*)$4.'7! :$4$! 2#*! *@.)*%! 2#*! *+! $%.0$+! 7*! $/./$+*! A! &*! 2#*! 7*!
:4')*C$%! *++'7! 0.70'7! &*! +$! *5:'7./.-%! $! +$! 7#7)$%/.$! )-5./$! 0.*%)4$7! 7*! 0$%.:#+$! $+!
$%.0$+!'!7*!)4$%7:'4)$!$!+$!/+F%./$!@*)*4.%$4.$<!
P#4$%)*!+$!&*7/'%)$0.%$/.-%!&*!#%!:$/.*%)*!*7!.0:'4)$%)*!2#*!*+!:*47'%$+!@*)*4.%$4.'!A!
+'7! &#*>'7! &*+! $%.0$+! (7.! 7*! 4*2#.4.*4$! 7#! $A#&$1! #$% 0/()$`-'% -6$,8-6-?$')$%
,(')/-%$&%-<$')$%)19*,(;!
o ]7$4! 9#$%)*7! &*! 9'0$6! &*+$%)$+! .0:*40*$8+*6! :$%)$++$! ,$/.$+! '! 0$7/$4.++$6!
/3#8$72#*4'6!*)/<!

A/()$<$/%-&%0-,*$')$%6$%&$#*('$#%68/-')$%&-%6$#,(')-?*'-,*1'O%
%

o Z.!*+!:$/.*%)*!*7)D!.%/'%7/.*%)*!:4')*9*4!+$!@F$!&*!$.4*<!
o Z.! *+! :$/.*%)*! *7)D! $/).@'! :4'/#4$4! 2#*! %'! .%9.*4$! *+! )-5./'! &#4$%)*! +$!
&*7/'%)$0.%$/.-%<!
o E.9.+$4!+$!3.:')*40.$<!

!
!
!

!"#$%&'($#$)"*'+$*',"-.$#/$'.#/&0.-"+&!

!
!

o =4*@*%.4!+$!*5:'7./.-%!&*!+'7!'C'7!
o Z.! *+! :$/.*%)*! 3$! *7)$&'! *5:#*7)'! $! #%! )-5./'! *%! ,'40$! &*! :'+@'! 7*/'6! 4*).4$4+'!
7#$@*0*%)*!/'%!#%!/*:.++'!&*!/*4&$7!&#4$7!*@.)$%&'!2#*!*+!:'+@'!/'%)$/)*!/'%!+'7!
'C'7!'!@F$7!4*7:.4$)'4.$7!
!

V-a-/%-&%0-,*$')$%,('%-<8-%,(//*$')$%)*Q*-O%
!

o ]7$4! #%! /3$0:R! 7.%! 0*&./$4! (7.%! .%7*/)./.&$76! $%).8.-)./'76! :*4-5.&'! &*! 8*%N'.+'6!
*)/<<1<!
o X%C#$9$4!/'%!$8#%&$%)*!$9#$!/'44.*%)*!&#4$%)*!$+!0*%'7!KL!0.%#)'7<!
o M*:*).4!*+!8$>'!7.!*+!'+'4!&*+!)-5./'!:*47.7)*<!
o Z*/$4!0#A!8.*%!$+!:$/.*%)*!:$4$!:4*@*%.4!+$!3.:')*40.$<!
o Z.!*+!$9*%)*!)-5./'!*7)D!*%!8$7*!'+*'7$!(:<*<!:.4*)4.%$71!&*8*!#).+.N$47*!#%!&*)*49*%)*!
&*7*%94$7$%)*!%*#)4'!(+$@$@$C.++$7!).:'!^$.4A6!_.7)'+6!*)/`1<!
o "#$%&'!+$!*5:'7./.-%!3$!7.&'!$!/D#7)./'7!&*8*%!*5)4*0$47*!+$7!:4*/$#/.'%*7!A$!2#*!
+$!:.*+!:#*&*!*7)$4!&$>$&$!A!,D/.+0*%)*!)4$#0$).N$8+*<!]7$4!94$%!/$%).&$&!&*!$9#$!
&#4$%)*!$+!0*%'7!\T!0.%#)'7!:$4$!&.+#.4!*+!)-5./'<!O'!#7$4!$9#$!$!:4*7.-%!
o G2#*++'7!:$/.*%)*7!2#*!%'!7*!:#*&*%!8$>$4!'!&*!:*+'!+$49'!:#*&*%!8*%*,./.$47*!&*!
#%! /'4)*! 7#$@*! &*! :*+'! (/'%! ).C*4$716! A$! 2#*! &*! *7)$! ,'40$! :#*&*! 4*).4$47*! #%$!
8#*%$!:$4)*!&*+!)-5./'<!
!
X%!'/$7.'%*7!*7!%*/*7$4.$!#%$!4*+$C$/.-%!:4*@.$!(:<*<!9$)'7!/'%!)*08+'4!:'4!*5:'7./.-%!$!
:.4*)4.%$71<! X%! *7)'7! /$7'7! :#*&*! #).+.N$47*! 0*)'/$48$0'+! $%)*7! &*! +$! &*7/'%)$0.%$/.-%!
:$4$!:'&*4!4*$+.N$4+$!/'%!0$A'4!,$/.+.&$&<!
!

G8',-%6$Q$'%8#-/#$%'$8)/-&*b-')$#%#(Q/$%&-%0*$&"%

Descontaminacin en caso de inhalacin


!

!
X+!:$/.*%)*!&*8*!7*4!4*).4$&'!&*!+$!,#*%)*!&*!*5:'7./.-%!A!*@$+#$&'<!G!0*%#&'6!+$!7.0:+*!
4*).4$&$!*7!)'&'!+'!2#*!*7!%*/*7$4.'<!
X+! )4$)$0.*%)'! :'7)*4.'4! :#*&*! .%/+#.4! +$! $&0.%.7)4$/.-%! &*! #%$! ,#*%)*! &*! '5F9*%'!
3#0.&.,./$&'6! *+! 0'%.)'4*'! &*! +$! '5.9*%$/.-%! A! @*%).+$/.-%! (:'4! *C*0:+'6! $! )4$@H7! &*!
$%D+.7.7!&*!9$7*7!*%!7$%94*!$4)*4.$+6!+$!'5.0*)4F$!&*!:#+7'6!/''5.0*)4F$6!*)/1!A!4$4$!@*N6!+$!
@*%).+$/.-%!0*/D%./$<!!
J$7!,'7$7!%$7$+*7!A!@F$7!4*7:.4$)'4.$7!7#:*4.'4*7!$A#&$%!$!,.+)4$4!+$7!:$4)F/#+$76!2#*!$A#&$!
$! :4*@*%.4! +$! 0*%'4! *5:'7./.-%! &*! +$7! @F$7! 4*7:.4$)'4.$7<! X+! #7'! &*! +$! 84'%/'7/':.$! *7!
%'40$+0*%)*!.%%*/*7$4.$<!
J$!N'%$!&'%&*!'/#44.-!+$!*5:'7./.-%!:'4!.%3$+$/.-%!&*8*!*7)$4!$&*/#$&$0*%)*!@*%).+$&$!
:$4$!*@.)$4!+$!4**5:'7./.-%!:'4!+$!:*47.7)*%/.$!&*!+'7!9$7*7!)-5./'7<!
!

!
!
!
!

!"#$%&'($#$)"*'+$*',"-.$#/$'.#/&0.-"+&!

!
!

Descontaminacin en caso de inoculacin


!
!

Debidas a picaduras de insectos como abejas o avispas, medusas, peces escorpnidos,


mordeduras de serpientes, etc !
!
Accidentes en granjas o industrias por equipos de inyeccin a presin.!
Es necesario inmovilizar al paciente y proceder a retirar *+! 7$/'! $9#.C-%! A! *+! @*%*%'! /'%!
0$%.:#+$/.-%! 7#$@*! (:'4! *C*0:+'6! :.%N$71! &*7:#H7! &*! #%! *5$0*%! /#.&$&'7'! &*! +$! N'%$!
$,*/)$&$<!
J$7! 0'4&*&#4$7! &*! $%.0$+*7! @*%*%'7'7! %'! &*8*%! 7*4! &*7/'%)$0.%$&$7! :'4! *+!
/.%*0$)'94D,./'!0H)'&'!&*!+$!.%/.7.-%!A!7#//.-%!&*+!@*%*%'!&*!+$!0'4&*&#4$6!%.!)$0:'/'!
7*! &*8*! $:+./$4! /'0:4*7$7! /$+.*%)*7! '! ,4F$7<! J$! $:+./$/.-%! &*+! )'4%.2#*)*! )$08.H%! *7)D!
/'%)4$.%&./$&$<!
Administrar el antdoto, si este est disponible.

Descontaminacin gastrointestinal
!

%
\\GC%-0&*,-/%0/(,$6*?*$!"#$%&'%&'$(#!")*+!)(+,!%-.$"/+()%$+%0)('%!"#$%&$
.%cCBKL%78$%#$%0/(68`(%&-%*'<$#)-]]%
%
!

J$! 4*/'0*%&$/.-%! $! +'7! :4':.*)$4.'7! :$4$! .%./.*%! +$! &*7/'%)$0.%$/.-%! 9$7)4'.%)*7).%$+!


&*8*4D!7*4!/#.&$&'7$0*%)*!7':*7$&$!:'4!*+!/+F%./'6!*%!,#%/.-%!&*+!:*4,.+!&*+!:)':.*)$4.'<!
!
Z*!&*8*!'8)*%*4!&*+!&#*>'!&*+!$%.0$+!#%$!3.7)'4.$!/+F%./$!&*)$++$&$!&'0H7)./'!$%)*7!&*!+$!
.%&#//.-%!&*!+$!*0*7.76!A$!7*$!*%!/$7$!'!*%!+$!/+F%./$!@*)*4.%$4.$<!
a$A! 2#*! )*%*4! :4*7*%)*7! +$7! /'%)4$.%&./$/.'%*7! &*! +$! .%&#//.-%! &*+! @-0.)'! :$4$! *@.)$4!
/'0:+./$/.'%*7! 7*/#%&$4.$7! /'0'! %*#0'%F$! :'4! $7:.4$/.-%6! @-0.)'! :4'+'%9$&'6!
3*0$)*0*7.7! '! +*7.'%*7! /D#7)./$7! '! /'44'7.@$7! :$4$! *+! *7-,$9'6! '4',$4.%9*6! A! )4$/)'!
9$7)4'.%)*7).%$+<!

W-,)(/$#%*?0(/)-')$#%-%,('#*6$/-/%$'%&-%*'68,,*1'%6$%&-%$?$#*#O%
!

o Tiempo transcurrido! J$!.%&#//.-%!&*!*0*7.7!*7)D!.%&./$&$!:$4$!+$!0$A'4F$!


&*!+$7!7#7)$%/.$7!)-5./$7!2#*!3$A$%!7.&'!.%9*4.&$7!3$7)$!K!3'4$!$%)*7<!a$A!$+9#%$7!
*5/*:/.'%*7!(7$+./.+$)'76!':.D/*'76!$%)./'+.%H49./'716!*%!+$7!2#*!+$!:4':.$!7#7)$%/.$!
)-5./$! 4*)4$7$! *+! @$/.$&'! 9D7)4./'<! X%! *7! /'%! *7)$7! )'5.%$7! *7:*/F,./$76! 7*! :#*&*!

!
!
!

!"#$%&'($#$)"*'+$*',"-.$#/$'.#/&0.-"+&!

!
!

.%&#/.4! *+! @-0.)'! 3$7)$! b! 3'4$7! :'7)! .%9*7).-%! 3'4$76! 7.*0:4*! 2#*! *+! :$/.*%)*! 7*!
*%/#*%)4*!$7.%)'0D)./'<!
!
o Pacientes sintomticos! J'7!:$/.*%)*7!2#*!A$!*7)D%!7.%)'0D)./'7!%'!&*8*%!
7*4! 7'0*).&'7! $! +$! .%&#//.-%! &*! +$! *0*7.7<! J'7! :$/.*%)*7! 7.%)'0D)./'7! 2#*! 7'%!
*5/*7.@$0*%)*!)4$%2#.+'7!:#*&*!)*%*4!#%$!&.70.%#/.-%!&*+!4*,+*C'!%$#7*'7'!'!8$C$4!
*+! #084$+! /'%@#+7.@'! A! :#*&*%! 7*4! .%/$:$N! &*! :4')*9*4! 7#7! @F$7! 4*7:.4$)'4.$76!
&$%&'!+#9$4!$!%*#0'%F$!:'4!$7:.4$/.-%<!!
!

o Agentes corrosivos o custicos! J$!.%&#//.-%!&*+!@-0.)'!:#*&*!/$#7$4!


&$>'!$&./.'%$+!$+!*7-,$9'6!'4',$4.%9*6!)4$/)'!9$7)4'.%)*7).%$+!/#$%&'!*7)'7!$9*%)*7!
7'%!*5:#+7$&'7<!

o Hidrocarburos lquidos! Z'%! /'0:#*7)'7! &*! 8$C$! @.7/'7.&$&! 2#*! :#*&*%!


7*4! ,D/.+0*%)*! $7:.4$&'7! *%! *+! 7.7)*0$! 4*7:.4$)'4.'6! &$%&'! +#9$4! $! %*#0'%F$! :'4!
$7:.4$/.-%! &*! /$4D/)*4! 94$@*! (9$7'+.%$6! 2#*4'7*%'6! $/*.)*! &*! 0')'46! +F2#.&'! &*!
)4$%70.7.-%6!/.)4'%*+$6!*)/<1<!!

!
!

;+$,)*S*6-6%6$%&-%*'68,,*1'%6$&%S1?*)(O%
!

J$!*,*/).@.&$&!&*!+$!.%&#//.-%!&*!+$!*0*7.7!7*!8$7$!*%!@$4.'7!,$/)'4*76!.%/+#A*%&';!
o X0H)./'!$9*%)*!#).+.N$&'!
o Q.*0:'!)4$%7/#44.&'!&*7&*!+$!.%9*7).-%!
o J$7!/$4$/)*4F7)./$7!,F7./$7!&*!+$!)'5.%$!.%9*4.&$!
o X,*/)'!Q-5./'!*%!*+!@$/.$&'!9D7)4./'!
o J$!:4*7*%/.$!&*!/'%)*%.&'!9D7)4./'!
"#$%)'! 0D7! 4D:.&$0*%)*! 7*! .%&#/*! *+! @-0.)'! &*7:#H7! &*! +$! .%9*7).-%! 0$A'4! *7! *+!
4*%&.0.*%)'! &*! +$! 4*/#:*4$/.-%! &*+! /'%)*%.&'! 9D7)4./'<! J'7! *7)#&.'7! 3$%! &*0'7)4$&'!
2#*!+$!4*/#:*4$/.-%!&*!/'%)*%.&'!9D7)4./'!&*%)4'!&*!K!3'4$!&*7:#H7!&*!+$!.%9*7).-%!*7!
&*+! KcYUV\Y! (&*:*%&.*%&'! &*+! )-5./'1<! "#$%&'! +$! *0*7.7! .%&#/.&$! ,#*! &*%)4'! &*! #%!
:*4F'&'! &*! ).*0:'! $R%! 0D7! /'4)'! (ST! 0.%#)'716! +$! 0*&.$! &*! 4*/#:*4$/.-%! &*+!
/'%)*%.&'!9D7)4./'!,#*!&*!$:4'5.0$&$0*%)*!bdY!(4$%9'!&*!dY!UcLY1<!
!
J$! *0*7.7! &.,*4.&$! &*7:#H7! &*! K! 3'4$! )'&$@F$! :#*&*! )*%*4! H5.)'6! :*4'! +$! /$%).&$&! &*!
)-5./'!4*/#:*4$&'!@$!4*&#/.H%&'7*!7.9%.,./$).@$0*%)*!$!0*&.&$!2#*!:$7$!*+!).*0:'<!X7!
0#A! .0:4'8$8+*! 2#*! +$! .%&#//.-%! &*! *0*7.7! &*7:#H7! &*! b! 3'4$7! :'7)U.%9*7).-%!
:4'&#N/$%!$+9R%!*,*/)'!8*%*,./.'7'<!

]%$!*5/*:/.-%!+$!/'%7).)#A*%!+$!:4*7*%/.$!&*!/'%/4*/.'%*7!&*!$9*%)*7!)-5./'76!$!0'&'!
&*! 8*N'$4*76! /'0'! :#*&*! '/#44.4! /'%! $+9#%$7! 7#7)$%/.$7! /'0'! /3./+*76! 94$%&*7!
/$%).&$&*7!&*!/3'/'+$)*6!#@$7!A!:$7$76!)$8+*)$7!&*!3.*44'!2#*!).*%&*%!$!$&3*4.47*!$!+$7!
:$4*&*7!&*+!*7)-0$9'6!:.+$7!A!/#*4:'7!*5)4$>'7!*%!9*%*4$+<!
!

!
!
!

!"#$%&'($#$)"*'+$*',"-.$#/$'.#/&0.-"+&!

!
!

B;DCF;GEKD5CG;L%AKBK%PK%5GEIDD5NG%DKL;BK%
E;P%ZNF5HC%

;&%d'*,(%$?e)*,(%(/-&%78$%#$%/$,(?*$'6-%$#%$&%-<8-%(9*<$'-6-%-&%4f%
%
R!g=%?&h3<%#*'%$9,$6$/%&(#%=i%?&%$'%)()-&U%
!!
!

G/)#$+0*%)*! *5.7)*%! %#0*4'7'7! e$%)F&')'7e! A! e*0H)./'7e! &.7:'%.8+*7! *%! I%)*4%*)6! A! +'7!


:4':.*)$4.'7!&*!+'7!$%.0$+*7!:#*&*%!*%/'%)4$4!A!#).+.N$4!.%,'40$/.-%!.%$&*/#$&$<!!
!
Q$08.H%! *5.7)*%! %#0*4'7$7! /4**%/.$7! :':#+$4*7! /'%! 0#A! :'/$! 8$7*! /.*%)F,./$! 2#*!
4*/'0.*%&$%! *+! #7'! &*! 94$7$6! /*%.N$76! ).*44$6! $/*.)*! @*9*)$+6! +*/3*6! :$%6! *)/`6! /#A$!
$&0.%.7)4$/.-%!$+!:$/.*%)*!.%)'5./$&'6!+*C'7!&*!7*4!8*%*,./.'7$6!:#*&*!3$/*4!2#*!$#0*%)*!
+$!)$7$!&*!$87'4/.-%!&*+!)-5./'<!
!
Z.! 4*/.8.0'7! #%$! /'%7#+)$! )*+*,-%./$! A! /'%'/*0'7! $+! :4':.*)$4.'! A! %'7! f,.$0'7g! &*! *+6!
:'&*0'7! .%&./$4+*! 2#*! :4'@'2#*! *+! @-0.)'6! &$&'! 2#*! *+! ,$/)'4! ).*0:'! C#*9$! *%! /'%)4$!
%#*7)4$<!
P*!%'!7*4!$7F!:#*&*!7*4!/'%)4$:4'&#/*%)*!A!/'%7#0.4!#%!).*0:'!0#A!@$+.'7'!A!+'!0*C'4!*7!
4*/'0*%&$4+*! 2#*! +'! )4$.9$! #49*%)*0*%)*! $! +$! /+F%./$! @*)*4.%$4.$<! J'7! :4':.*)$4.'7! :'4!
*C*0:+'! :#*&*%! #7$4! #%$! &'7.7! .%$&*/#$&$! 7'84*! +$! 8$7*! &*! #%! :*7'! *7).0$&'! &*+!
:$/.*%)*6! 4*7#+)$%&'! *%! #%$! &'7.7! .%*,./$N! '! *5/*7.@$6! :4'@'/$%&'! *,*/)'7! 7*/#%&$4.'7!
/'0'! @-0.)'7! :4'+'%9$&'7! '! 3*0$)*0*7.7<! [! 8.*%! %'! &.7:'%*4! &*! $9#$! '5.9*%$&$! A!
:*4&*4! #%! ).*0:'! @$+.'7'! A*%&'! $! /'0:4$4+$6! '! %'! @$+'4$4! $&*/#$&$0*%)*! *+! %.@*+! &*!
/'%7/.*%/.$!&*+!$%.0$+!A!:4'@'/$4!#%$!$7:.4$/.-%!&*!0$)*4.$+!@'0.)$&'<!='4!)'&'!*++'!3$A!
2#*!.%7.7).4!*%!2#*!&*8*!7*4!*+!@*)*4.%$4.'!*+!2#*!)4$7!3$8+$4!/'%!*+!:4':.*)$4.'!4*/'0.*%&*!
+$!$:+./$/.-%!&*!#%!*0H)./'!*%!/$7$!$%)*7!&*!)4$*4+'!$!+$!/'%7#+)$!'!%'<!!

!
!

Agua oxigenada al 3%
!

X+! :*4-5.&'! &*! 3.&4-9*%'! *7! *+! R%./'! *0H)./'! 4*/'0*%&$&'! :$4$! :4'@'/$4! *+! @-0.)'! *%!
/$7$<![)4'7!3$8.)#$+0*%)*!4*/'0*%&$&'7!/'0'!+$!7$+!/'0R%!'!+'7!&*)*49*%)*7!+$@$@$C.++$7!
7'%!8$7)$%)*!0D7!.%*,./$/*7!A!:#*&*%!)*%*4!*,*/)'7!7*/#%&$4.'7<!!
!
X7! .0:'4)$%)*! &*7)$/$4! 2#*! 7-+'! :#*&*! #).+.N$47*! $9#$! '5.9*%$&$! $+! SY6! A$! 2#*!
/'%/*%)4$/.'%*7!0$A'4*7!:#*&*%!:4'@'/$4!9$7)4.).7!7*@*4$7<!

!
!
!

!"#$%&'($#$)"*'+$*',"-.$#/$'.#/&0.-"+&!

!
!

X+!$9#$!'5.9*%$&$!*7!.%*,./$N!*%!+'7!9$)'7!A!%'!*7!4*/'0*%&$8+*!#7$4+$!*%!*7)$!*7:*/.*6!A$!
2#*! +*7! :4'&#/*! %$#7*$7! A! 7$+.@$%! *%! $8#%&$%/.$6! *%! 4$4$7! '/$7.'%*7! @'0.)$%6! A! :#*&*%!
&*7$44'++$4! #%$! 9$7)4.).7! 7*@*4$<! J'7! 9$)'7! 2#*! 3$%! .%9*4.&'! :4'&#/)'7! )-5./'7! &*8*%! 7*4!
++*@$&'7!&.4*/)$0*%)*!$+!@*)*4.%$4.'!:$4$!+$!.%&#//.-%!&*!+$!*0*7.7!8$C'!7#:*4@.7.-%<!
X+!$9#$!'5.9*%$&$!:4'&#/*!*+!@-0.)'!*%!#%'7!KT!0.%#)'7!:'4!.44.)$/.-%!9D7)4./$!&.4*/)$<!J$!
&'7.7!*7!&*!KUL0JhW9!:'4!@F$!'4$+6!7.%!*5/*&*4!+'7!LT!0+!*%!:*44'7<!X%!/$7'!&*!%'!:4'&#/.4!
*+!@-0.)'!+$!&'7.7!:#*&*!4*:*).47*<!
X+!$9#$!'5.9*%$&$!,#%/.'%$!0*C'4!/'0'!*0H)./'!7.!*+!*7)-0$9'!*7)$!:$4/.$+0*%)*!++*%'<!X+!
:4':.*)$4.'!&*8*!&$4+*!$+!:*44'!$+9#%$7!9'+'7.%$7!'!#%$!:*2#*>$!/$%).&$&!&*!:.*%7'!$%)*7!
&*!+$!.%&#//.-%!&*!+$!*0*7.7<!!
!

!
!
!

!"#$%&'($#$)"*'+$*',"-.$#/$'.#/&0.-"+&!

!
!

;FYH5DCL%E;%ILC%Z;H;B5GKB5C%
!
!
!

Apomorfina (tabletas, cpsulas o inyectada)


!

;?e)*,(%6$%$&$,,*1'%$'%0$//(#%
%
i"i.gi"i:%?<h3<%5Z%(%5F%(%Q*$'%-0&*,-,*1'%6$%8'-%)-Q&$)-%$'%$&%#-,(%
#8Q,('`8')*S-&%
!
!

!
!

J$! $:'0'4,.%$! *7! #%! *0H)./'! 0#A! *,./$N! A! $+)$0*%)*! 4*/'0*%&$8+*6! 2#*! $/)R$!
&.4*/)$0*%)*!7'84*!*+!/*%)4'!&*+!@-0.)'!*%!*+!ZO"<!G(%#$%/$,(?*$'6-%$'%<-)(#!
P'7.7;! :*44'76! T<T\UT<Tb09hW9! IE! '! I_<! J$! $:'0'4,.%$! .%A*/)$8+*! )$08.H%! :#*&*!
$&0.%.7)4$47*! Z"6! :*4'! %'! 7*! 7#*+*! 4*/'0*%&$4! *7)$! 4#)$! :'42#*! :4'&#/*! #%! 4*)4$7'!
4*)4$7'!*%!*+!.%./.'!&*!$//.-%!A!#%$!&#4$/.-%!:4'+'%9$&$!&*+!*,*/)'<!!
[)4$!@F$!0#A!R).+!*7!+$!$:+./$/.-%!&*!+$!$:'0'4,.%$!*%!)$8+*)$76!&*:'7.)$%&'!#%$!)$8+*)$!*%!
*+!7$/'!7#8/'%C#%).@$+<!=#*&*!7*4!#%!:'/'!0'+*7)'!:$4$!*+!$%.0$+6!7.!8.*%!).*%*!+$!@*%)$C$!
&*!2#*!:#*&*!7*4!4*).4$&$6!.44.9$%&'!*+!'C'!#%$!@*N!2#*!7*!3$!:4'&#/.&'!*+!@-0.)'<!
J$!*0*7.7!7*!:4'&#/*!*%!bUV!0.%#)'7<!Z.!)4$%7/#44.&'!*7)*!:*4.'&'!%'!7*!:4'&#/*!*+!@-0.)'!
7*!:#*&*!#).+.N$4!#%$!7*9#%&$!&'7.7!&*!4*,#*4N'<!X7)$!&'7.7!&*8*!7*4!0*%'4!2#*!+$!#).+.N$&$!
(:'4! *C*0:+'6! +$! 0.)$&! &*! #%! /'0:4.0.&'1<! Z.! $R%! $7F! %'! 7*! :4'&#/*! *+! @-0.)'! ($+9#%'7!
)-5./'7!.%3.8*%!+$!*0*7.71!7*!:#*&*!#).+.N$4!#%$!&'7.7!'4$+!&*!:*4-5.&'!&*!3.&4-9*%'!$+!SY<!
J$!$:'0'4,.%$!*7!#%!':.D/*'!A!:'4!)$%)'!&*8*!)*%*47*!/#.&$&'!/'%!*+!#7'!7.0#+)D%*'!&*!
$%$+9H7./'7! '! 7*&$%)*7! &*+! 94#:'! &*! +'7! ':.D/*'76! :'4! +$! :'7.8.+.&$&! &*! :4'&#/.4! #%$!
7*&$/.-%!7*@*4$<!
Z.! #%! :$/.*%)*! :4*7*%)$4$! *5/*7'! &*! 7*&$/.-%! '! &*:4*7.-%! 4*7:.4$)'4.$! (:'7.8+*! /'%! +'7!
':.D/*'71! &*7:#H7! &*! +$! $&0.%.7)4$/.-%! $:'0'4,.%$6! :#*&*! #7$47*! %$+'5'%$! /'0'!
$%)F&')'<!J$!&'7.7!&*!%$+'5'%$!*7!T6TK!$!T6Tb!09hW96!IE6!I_!'!Z"<!!
J$! %$+'5'%$! %'! 4*@.*4)*! *+! *,*/)'! *0H)./'! &*! +$! $:'0'4,.%$! &*8.&'! $! 2#*! $/)R$%! 7'84*!
4*/*:)'4*7!&.,*4*%)*7<!

!
!
!

!"#$%&'($#$)"*'+$*',"-.$#/$'.#/&0.-"+&!

!
!

Xilacina
;?e)*,(%6$%$&$,,*1'%$'%<-)(#%
%
i"::g!%?<h3<%5F%(%LD%
!

!
!

J$!5.+$/.%$!*7!*+!*0H)./'!&*!*+*//.-%!*%!+'7!9$)'76!$#%2#*!)$08.H%!:#*&*!7*4!#).+.N$&'!*%!
:*44'7<!
!
G/)R$!:'4!#%!0*/$%.70'!/*%)4$+6!*7).0#+$%&'!+'7!4*/*:)'4*7!$+,$\U$&4*%H49./'7<!!
Z*!#).+.N$!$!#%$!&'7.7!&*!T<bUK!09hW9!:'4!@F$!I_!'!Z"<!
J$!.%&#//.-%!&*!+$!*0*7.7!7*!:4'&#/*!%'40$+0*%)*!&*%)4'!&*!+'7!KT!0.%#)'7!:'7)*4.'4*7!$!
+$!$&0.%.7)4$/.-%6!:*4'!%'!7.*0:4*!*7!*,./$N<!
a$A!2#*!)*%*4!*%!/#*%)$!2#*!+$!5.+$N.%$!*7!#%!$9*%)*!#7$&'!*%!:4*$%*7)*7.$!:'4!7#!*,*/)'!
7*&$%)*6! :'4! +'! 2#*! *+! :4.%/.:$+! *,*/)'! $&@*47'! *7! +$! :'7.8.+.&$&! &*! :4'@'/$4! &*:4*7.-%!!
:4',#%&$! &*+! ZO"! A! &*:4*7.-%! 4*7:.4$)'4.$<! J'7! 9$)'7! &*8*%! 7*4! 0'%.)'4.N$&'7!
/#.&$&'7$0*%)*!:$4$!*@.)$4!*,*/)'7!7*/#%&$4.'7!*5/*7.@'7<!
X%!/$7'!&*!7'84*&'7.,./$/.-%!:#*&*%!#7$47*!&'7!$%)$9'%.7)$7;!
o i'3.08.%$;!T6K!09hW9!I_6!Z"!'!IE!+*%)$0*%)*!
o G).:$0*N'+!(G%).7*&$%1;!\LULTj9hW96!IE!'!I_!

Jarabe de ipecacuana al 7%
F8@%$+$,)*S(%-8'78$%6$%$&$S-6-%,-/6*()(9*,*6-6"%G(%/$,(?$'6-6(%
%
!g.%?&h3<%$'%0$//(#%@%4"=%?&h3<%$'%<-)(#T%S>-%(/-&%
!
!

X+!C$4$8*!&*!.:*/$/#$%$!3$!7.&'!&#4$%)*!&H/$&$7!*+!*0H)./'!&*!:4.0*4$!*+*//.-%!)$%)'!*%!
0*&./.%$! 3#0$%$! /'0'! *%! @*)*4.%$4.$! :'4! 7#! *5)4$'4&.%$4.$! *,*/).@.&$&<! O'! '87)$%)*! A$!
%'! 7*! 4*/'0.*%&$! 7#! #7'! :'42#*! *7! 0#A! +*%)'! (*%! '/$7.'%*7! )$4&$! 3$7)$! #%$! 3'4$1! A!
$&*0D7!:4*7*%)$!#%$!*+*@$&$!/$4&.')'5./.&$&<!
!

!
!
!

!"#$%&'($#$)"*'+$*',"-.$#/$'.#/&0.-"+&!

!
!

X7! #%! :4'&#/)'! %$)#4$+! 2#*! 7*! '8).*%*! $! :$4).4! &*! +$! 4$FN! &*! #%$! :+$%)$! '4.9.%$4.$! &*!
Z#&$0H4./$6! +$! 1$,2"$*.3' .,$-"-4"#2"6! 2#*! /'%).*%*! +'7! :4.%/.:.'7! $/).@'7! *0*).%$! A!
/*,$+.%$<!!
!
X+! 0*/$%.70'! :'4! *+! 2#*! :4'&#/*! *+! @-0.)'! *7! #%$! /'08.%$/.-%! &*! .44.)$/.-%!
9$7)4'.%)*7).%$+! &.4*/)$! A! *7).0#+$/.-%! &*! +'7! 2#.0.'44*/*:)'4*7! +'/$+.N$&'7! *%! *+! /#$4)'!
@*%)4F/#+'!&*+!/*4*84'<!!
J$!&'7.7!4*/'0*%&$&$!*7!&*!KU\!0+hW9!:'4!@F$!'4$+!*%!:*44'7!A!&*!S<L!0+hW9!*%!9$)'7<!X%!
%.%9R%!/$7'!7*!&*8*!*5/*&*4!+$!&'7.7!&*!KL!0+!(&'7.7!)')$+1<!J$!&'7.7!:#*&*!4*:*).47*!#%$!
@*N<!!
X7!0#A!*,./$N6!:4'&#/.*%&'!*+!@-0.)'!*%!*+!dLY!&*!+'7!/$7'76!7.!8.*%!*7!$+9'!+*%)'!*%!7#!
*,*/)'6! A$! 2#*! 7.! 8.*%! *%! +$! 0$A'4! :$4)*! &*! +'7! /$7'7! *7! *,./$N! $%)*7! &*! ST! 0.%#)'76! *%!
'/$7.'%*7!:#*&*!4*)4$7$47*!3$7)$!#%$!3'4$!<!
J$7!/'0:+./$/.'%*7!:')*%/.$+*7!&*!+$!$&0.%.7)4$/.-%!&*!C$4$8*!&*!.:*/$/#$%$!.%/+#A*%;!
o
o
o
o
o

X,*/)'!4*)$4&$&'<!
^$+)$!&*!*,*/).@.&$&!*%!$:4'5.0$&$0*%)*!*+!LTY!&*!+'7!9$)'7<!
Z$8'4!0#A!&*7$94$&$8+*!2#*!3$/*!&.,F/.+!7#!$&0.%.7)4$/.-%!(7'84*!)'&'!$!+'7!9$)'71<!
E-0.)'7!:4'+'%9$&'76!3*0$)*0*7.76!+*)$49'6!&.$44*$6!&*:4*7.-%!
=')*%/.$+!&*!$//.-%!$44.)0'9H%./$!(/$4&.')'5./.&$&1!
!

!
!
!

!"#$%&'($#$)"*'+$*',"-.$#/$'.#/&0.-"+&!

!!

!
!

PKZKEC%JjLHB5DC%
!

G(%0/-,)*,-/%&-S-6(%<[#)/*,(%)/-'#,8//*6-#%?[#%6$%.%2(/-#%6$%&-%*'<$#)*1'%%

X+! '8C*).@'! &*+! +$@$&'! 9D7)4./'! *7! +$! *+.0.%$/.-%! :'4! .44.9$/.-%! &*! +$! 7#7)$%/.$! )-5./$!
:4*7*%)*!*%!*+!*7)-0$9'<!!
!
X7!*+!:4'/*&.0.*%)'!&*!*+*//.-%!7.!+$!*0H7.7!*7!.%*,*/).@$!'!*7)D!/'%)4$.%&./$&$<!X+!,$/)'4!
).*0:'!@$!*%!/'%)4$!&*!+$!*,./$/.$!&*+!:4'/*&.0.*%)';!$!0$A'4!).*0:'!)4$7/#44.&'!&*7&*!+$!
.%9*7).-%! &*+! )-5./'6! 0*%'4! *7! +$! *,./$/.$! &*+! :4'/*&.0.*%)'<! ='4! +'! 9*%*4$+! 7.! 3$%!
)4$7/#44.&'!0D7!&*!\!3'4$7!&*7&*!+$!.%9*7).-%6!*+!:4'/*&.0.*%)'!*7!&*!0#A!:'/$!#).+.&$&<!

Procedimiento

=$4$! +$! 4*$+.N$/.-%! &*! #%! +$@$&'! 9D7)4./'! *+! :$/.*%)*! &*8*! *7)$4! .%/'%7/.*%)*! '!
-'$#)$#*-6(<!
!!
X+!$%.0$+!&*8*!7*4!*')8Q-6(!7.*0:4*!(:4')*//.-%!&*!@F$7!$H4*$71<!!
Z*!&*8*!/'+'/$4!*%!6$,dQ*)(%&-)$/-&%6$/$,2(!/'%!+$!/$8*N$!3$/.$!$8$C'!A!+$!0*7$!.%/+.%$&$!
#%'7!\Tk!(%'!0$A'46!A$!2#*!+$!:4*7.-%!&*+!*7)-0$9'!4*++*%'!&*!+F2#.&'!:'&4F$!&.,./#+)$4!+$!
4*7:.4$/.-%1<!!
Z*! .%)4'&#/*! #%$! #('6-% 0(/% $&% $#1+-<(! 3$7)$! $+/$%N$4! *+! *7)-0$9'! ()'0$4! /'0'!
4*,*4*%/.$!*+!*5)4*0'!/$#&$+!&*!+$!$:-,.7.7!5.,'.&*71<!X+!:$/.*%)*!&*8*!/'+'/$47*!!
X+!+$@$&'!9D7)4./'!7*!4*$+.N$!0*&.$%)*!+$!.%,#7.-%!&*!7#*4'!,.7.'+-9./'!:'4!94$@*&$&!$!4$N-%!
&*!KT!0+hW9<!P*8*0'7!*@.)$4!4*$+.N$4!*+!+$@$&'!9D7)4./'!/'%!$9#$!:'4!*+!4.*79'!&*!:4'&#/.4!
&*7*2#.+.84.'7!3.&4'*+*/)4'+F)./'7!*%!*+!$%.0$+<!!

P*8*0'7!/$+/#+$4!*+!@'+#0*%!:$4$!$S*)-/% 0/(68,*/% 8'-% #(Q/$6*#)$'#*1'!&*+!*7)-0$9'<!


X+! 94$&'! &*! &.7)*%7.-%! 9D7)4./$! :#*&*! @$+'4$47*! :4*7.'%$%&'! +.9*4$0*%)*! /'%! +$! 0$%'!
7'84*!*+!$8&'0*%<!!

!
!
!
!

!"#$%&'($#$)"*'+$*',"-.$#/$'.#/&0.-"+&!

!
!

X7!/'%@*%.*%)*!2#*!*+!,+#.&'!#).+.N$&'!:$4$!*+!+$@$&'!9D7)4./'!7*$!-)$?0$/-6(!()*0:+$&'1!
/'%! +$! &'8+*! ,.%$+.&$&! &*! 4$+*%).N$4! *+! @$/.$&'! 9D7)4./'! :'4! #%! +$&'! A! *@.)$! +$! 3.:')*40.$!
:'4!')4'<!!
Z*!4*$+.N$4D!#%!?-#-`$% 6$&% $#)1?-<(!0.*%)4$7!*+!+F2#.&'!@$!7.*%&'!$7:.4$&'<!X+!/./+'!&*!
+$@$&'!&*8*!4*:*).47*!(%'40$+0*%)*!@$4.$7!@*/*71!3$7)$!2#*!*+!+F2#.&'!2#*!7*!4*/#:*4$!7*$!
/+$4'!(7.0.+$4!$+!.%)4'&#/.&'1<!!
a$A!2#*!7*>$+$4!2#*!*+!+$@$&'!9D7)4./'!*7!#%!:4'/*&.0.*%)'!*%9'44'7'!2#*!.0:+./$!*+!#7'!
&*! 94$%&*7! /$%).&$&*7! &*! +F2#.&'<! a$8.)#$+0*%)*! 7*! %*/*7.)$%! KLU\T! /./+'7! &*! +$@$&'<! X+!
,+#.&'!'8)*%.&'!)4$7!*+!:4.0*4!+$@$&'!&*8*!7*4!9#$4&$&'!7.!7*!:4*)*%&*!7'+./.)$4!$%$+F)./$!
)'5./'+-9./$<! a$8.)#$+0*%)*! 7*! 4*/'0.*%&$! $&0.%.7)4$4! #%$! 7#7:*%7.-%! &*! /$48-%! $/).@'!
$%)*7!&*!4*$+.N$4!*+!+$@$&'!9D7)4./'<!J$!,.%$+.&$&!*7!,'40$4!#%!/'0:+*C'!*%)4*!+$!7#7)$%/.$!
)-5./$!A!*+!/$48-%!$/).@'!2#*!&*)*%9$!7#!$87'4/.-%<!='7)*4.'40*%)*!/'%!*+!+$@$&'!9D7)4./'!
7*! 4*).4$4$4D! )'&'! *+! /$48-%! $/).@'6! 3$7)$! 2#*! *+! +F2#.&'! &*! +$@$&'! 7$+9$! )4$%7:$4*%)*<!
G&./.'%$+0*%)*6! #%$! @*N! )*40.%$&'! *+! +$@$&'! 9D7)4./'! 7*! :#*&*! @'+@*4! $! $&0.%.7)4$4!
/$48-%!$/).@'6!&*CD%&'+'!$/)#$4<!

!
!
!

!"#$%&'($#$)"*'+$*',"-.$#/$'.#/&0.-"+&!

!
!

X+!+$@$&'!9D7)4./'!*7!0#A!8*%*,./.'7'!*%!*+!/$7'!&*!*5:'7./.-%!$!&'7.7!)-5./$7!&*!7#7)$%/.$7!
2#*! 4*)4$7$%! *+! @$/.$&'! 9D7)4./'6! /'0'! +'7! 7$+./.+$)'76! +'7! $%)./'+.%H49./'76! '! +'7!
$%).&*:4*7.@'7!)4./F/+./'7<!!
J$7!:4.%/.:$+*7!/'0:+./$/.'%*7!&*+!+$@$&'!9D7)4./'!7'%;!
o O*#0'%F$!:'4!$7:.4$/.-%!
o J$4.%9'*7:$70'!
o a.:'5.$!
o a.:*4/$:%.$!
o P*7*2#.+.84.'7!3.&4'*+*/)4'+F)./'7!
o P$>'!0*/D%./'!&*!9$49$%)$6!*7-,$9'!A!*7)-0$9'<!
]%$! @$4.$%)*! &*! +$! )H/%./$! (0D7! /'0:+*)$1! *7! *+! +$@$&'! *%)*4'9D7)4./'6! *%! *+! 2#*! *+!
:4'/*&.0.*%)'! &*7/4.)'! 7*! /'0:+*)$! /'%! #%! *%*0$! 4*)4-9$&'<! Q$08.H%! *7! :'7.8+*! +$!
.44.9$/.-%! /'0:+*)$! &*! .%)*7).%'! $&0.%.7)4$%&'! #%! *%*0$! &*! 94$%! @'+#0*%! &*! #%$!
7'+#/.-%! *+*/)4'+F)./$0*%)*! 8$+$%/*$&$! &*! :'+.*).+H%9+./'+6! /'%! *+! '8C*).@'! &*! @$/.$4!
/'0:+*)$0*%)*!*+!/'%)*%.&'!&*+!.%)*7).%'<!
!

!
!
!

!"#$%&'($#$)"*'+$*',"-.$#/$'.#/&0.-"+&!

!
!

!!
!
!
!

DKBVNG%KDH5ZKEC%
!

!"#$%&%'()*+$'+,+$,%-)+$-%$-%#'+.(/,)./')0.$12%$3/$%,%#)#$+$
!"#"$%$&'#()*+,-.'#%
%
.g=%<h3<%$'%#8#0$'#*1'%$'%-<8-%-&%.if%
!
!

X+! carbn activo! *7! #%$! 7#7)$%/.$! 2#*! 7*! ,$84./$! /$48'%.N$%&'! :#+:$! &*! 0$&*4$! $!
dTTk"6!2#*!:'7)*4.'40*%)*!*7!+$@$&$!/'%!D/.&'7!'49D%./'7!(f$/).@$/.-%g1!A!7*/$&$<!!
!
X7! *+! $&7'48*%)*! 0D7! ,4*/#*%)*0*%)*! #).+.N$&'6! &*! ,'40$! 2#*! 3$! 7.&'! &*%'0.%$&'! *+!
f$%)F&')'! #%.@*47$+g! (*%! 4*$+.&$&! %'! *7! #%! $%)F&')'! 7.%'6! /'0'! 3*0'7! &./3'6! #%!
$&7'48*%)*1<!!
!
J$!:4.%/.:$+!/$4$/)*4F7)./$!&*+!/$48-%!$/).@'!*7!7#!*%'40*!7#:*4,./.*!&*!$87'4/.-%<!"'0'!
0*&.$!7*!/$+/#+$!2#*!#%!94$0'!&*!/$48-%!$/).@'!4*:4*7*%)$!#%$!7#:*4,./.*!&*!$87'4/.-%!&*!
#%'7!KTTT!0\6!2#*!*53.8*!94$%!/$%).&$&!&*!+#9$4*7!&*!#%.-%!/'%!&.,*4*%)*!$,.%.&$&!:$4$!
7#7)$%/.$7!2#F0./$7<!!
J$! $&7'4/.-%! &*! 7#7)$%/.$7! $+! /$48-%! $/).@'! *7! #%! :4'/*7'! .%*7:*/F,./'! 2#*! $+/$%N$! *+!
*7)$&'!&*!*2#.+.84.'!*%!#%'7!ST!0.%#)'7<!P*7:#H7!&*!$+/$%N$&'!*+!*2#.+.84.'!*7!:'7.8+*!2#*!
'/#44$! #%! /.*4)'! 94$&'! &*! &*7'4/.-%! /'%! +'! 2#*! &.70.%#A*! +$! *,./$/.$<! ='4! *7)$! 4$N-%!
0#/3'7! $#)'4*7! 4*/'0.*%&$%! 2#*! C#%)'! /'%! *+! /$48-%! $/).@'! 7*! $&0.%.7)4*! #%! /$)D4)./'!
(3$8.)#$+0*%)*!7'48.)'+16!/'%!*+!,.%!&*!$/*+*4$4!*+!)4D%7.)'!.%)*7).%$+!A!&.70.%#.4!*+!).*0:'!
&*! :*40$%*%/.$! &*+! /$48-%! $/).@'! *%! *+! .%)*7).%'6! +.0.)$%&'! +$! &*7'4/.-%! &*! +$! 7#7)$%/.$!
$&7'48.&$!7'84*!H+<!
G+!.9#$+!2#*!/'%!+'7!0H)'&'7!$%)*4.'4*76!*+!,$/)'4!).*0:'!*7!&*)*40.%$%)*!:$4$!+$!*,./$/.$!
&*+! )4$)$0.*%)'! /#$%)'! $%)*7! 7*! $&0.%.7)4*! 0D7! *,./$N! 7*4D<! P*! )'&$7! ,'40$7! *7!
.%/#*7).'%$8+*! *+! 94$%! @$+'4! 2#*! ).*%*! *+! #7'! &*! /$48-%! $/).@'! *%! *+! :$/.*%)*! .%)'5./$&'!

!
!
!

!"#$%&'($#$)"*'+$*',"-.$#/$'.#/&0.-"+&!

!
!

$9#&'6! :$4)./#+$40*%)*! *%! *+! /$7'! &*! .%9*7).-%! &*! 7#7)$%/.$7! %'! :'+$4*7! (+$7! 0D7!
+.:'7'+#8+*71<!
!

J$! &'7.7! &*:*%&*4D! &*! +$! :4*7*%)$/.-%! &*+! /$48-%! $/).@'<! Z.! +'! 2#*! @$0'7! $! #7$4! *7! *+!
:4'&#/)'!:#4'!(4*/'0*%&$&'16!:4*:$4$4*0'7!#%$!7#7:*%7.-%!$+!\TY!*%!$9#$!(K!94$0'hL!
0+!$9#$16!A!$&0.%.7)4$4*0'7!*%!)')$+!#%'7!\UL!9!hW9<!Z.!$&0.%.7)4$0'7!/'%C#%)$0*%)*!*+!
7'48.)'+!/'0'!/$)D4)./'6!+'!$>$&.4*0'7!$+!:4*:$4$&'!$%)*4.'4<!!
X%!9*%*4$+!*+!/$48-%!$/).@'!7*!$&0.%.7)4$!#%$!7'+$!@*N6!7$+@'!2#*!*+!)-5./'!.0:+./$&'!*7)H!
7'0*).&'!$!#%$!.%)*%7$!/.4/#+$/.-%!*%)*4'3*:D)./$6!*%!/#A'!/$7'6!+$!$&0.%.7)4$/.-%!/$&$!bU
V!3'4$7!&#4$%)*!\US!&F$7!*7)$4F$!.%&./$&$<!!
"#$%&'! 7*! #).+./*%! &'7.7! 0R+).:+*7! &*! /$48-%! $/).@'! *7! %*/*7$4.'! 2#*! *+! :$/.*%)*! 7*$!
$&*/#$&$0*%)*! 4*3.&4$)$&'6! :$4$! :4*@*%.4! +$! /'%7).:$/.-%! 2#*! :#*&*! :4'&#/.47*<! J$!
4*&'7.,./$/.-%!&*!/$48-%!$/).@'!&*8*!3$/*47*!7.%!*+!/$)D4)./'6!A$!2#*!#%!$8#7'!&*+!7'48.)'+!
:'&4F$!3$/*4!2#*!*+!$%.0$+!7#,4.*4$!3.:')*%7.-%!.%)*%7$!*!.%/+#7'!73'/W!3.:'@'+H0./'<!

!
J$7! resinas de intercambio inico!).*%*%!*+!0.70'!'8C*).@'!2#*!*+!/$48-%!$/).@';!
$&7'48*4! +$! 7#7)$%/.$! )-5./$! *%! +$! +#N! &*+! .%)*7).%'! A! :4*@*%.4! $7F! 7#! $87'4/.-%<! J'7! 0D7!
#).+.N$&'7! 7'%! +$! /'+*7).4$0.%$! A! *+! /'+*7).:'+! (.%)*4/$08.'! $%.-%./'1! 2#*! 7*! #%*%! $! +$7!
+.:':4')*F%$7!A!$!+'7!D/.&'7!8.+.$4*76!:4*@.%.*%&'!$7F!+$!$87'4/.-%!.%)*7).%$+!&*!+'7!/'0:#*7)'7!
2#*! 7*! $87'48*%! :'4! *7)*! 7.7)*0$<! J$7! 4*7.%$7! &*! .%)*4/$08.'! .-%./'! 7'%! 0#A! R).+*7! :$4$!
.%)*44#0:.4! +$! $87'4/.-%! :'4! +$! /.4/#+$/.-%! *%)*4'3*:D)./$6! $&0.%.7)4$&$7! $! 4$N-%! &*! LTUcL!
09hW9!&*!#%$!7#7:*%7.-%!&*+!:'+@'!*%!$9#$!'!N#0'!&*!,4#)$<!G+9#%'7!&*!+'7!/'0:#*7)'7!:$4$!
+'7! /#$+*7! 7#! #7'! *7! $&*/#$&'! 7'%;! :*%)'8$48.)$+6! )*)4$/./+.%$6! :*%./.+.%$6! $%)./'$9#+$%)*7!
'4$+*76! ).4'5.%$6! &.9.)'5.%$6! 8*)$U8+'2#*$%)*76! 0#/3'7! :*7)./.&$7! A! /'0:#*7)'7! 0#A!
+.:'7'+#8+*76!'!+$!)'5.%$!)*40'*7)$8+*!&*!X<!/'+.<!
!
!

!
!
!

!"#$%&'($#$)"*'+$*',"-.$#/$'.#/&0.-"+&!

!!

!
!

PKZKEC%;%5BB5JKD5NG%5GH;LH5GKP%
!

K6?*'*#)/-,*1'%(/-&%6$%0(&*$)*&$'<&*,(&%-%/-b1'%6$%.=g:i%?&h3<%%
!

!
!
!
!

!"#$% &'('% ")*#+,-% &,.(/0/!"#$ %&'()*+&('$ ,()$ -%)*.!$ %-"+/%&($ ($ 01#$ '#$ &+2+#)#!$
+*%)$0*%)*<!
!
X+! '8C*).@'! &*! +$! .44.9$/.-%! .%)*7).%$+! *7! +$! +.0:.*N$! &*+! )4$/)'! 9$7)4'.%)*7).%$+! .%,*4.'4!
0*&.$%)*!+$!*+.0.%$/.-%!&*!)'&'!7#!/'%)*%.&'!()-5./'!l!/'%)*%.&'!%'40$+1<!
Z*! 3$/*! 0*&.$%)*! +$! $&0.%.7)4$/.-%! '4$+! 0*&.$%)*! 7'%&$! &*! 94$%&*7! /$%).&$&*7! &*!
7'+#/.-%!*+*/)4'+F)./$!&*!:'+.*).+*%9+./'+!3$7)$!2#*!*+!*,+#*%)*!*7!/+$4'<!
!"#$#%&'( ")*+( ,&-+./-"'#0+( +( ,&-+1-+2/.#0+( 3&45#,#-"'&0#6,( 0+,"#,)&( 41( -+$)0#+,1-( 41(
=X?1<!
X%!:$/.*%)*7!.%/'%7/.*%)*7!'!$%*7)*7.$&'7!*7!%*/*7$4.$!+$!!"#$%&'!(")*"+,#-&.$*&/0!
J$! &'7.7! &*! *7! \LUbT0JhW9<! Z*! :#*&*! $&0.%.7)4$4! *%! .%,#7.-%! /'%).%#$! $! 4$N-%! &*! T<L!
0+hW9h3'4$6!'!8.*%!$&0.%.7)4$%&'!)'&$!+$!/$%).&$&!/$&$!\!3'4$7<!
J$7!3*/*7!7#*+*%!:4'&#/.47*!&*7:#H7!&*!\Ub!3'4$76!A!7*!4*/'0.*%&$!2#*!7*!/'%).%R*!/'%!*+!
+$@$&'! .%)*7).%$+! &#4$%)*! $:4'5.0$&$0*%)*! mUK\! 3'4$76! 3$7)$! 2#*! +$7! &*:'7./.'%*7! 7*$%!!
/+$4$7<!
=#*&*!7*4!%*/*7$4.'!*+!#7'!&*!$%).*0H)./'7<!J$!0*)'/+':4$0.&$!(T<\UT<L09hW96!Z"1!:'&4F$!
7*4! #%$! 8#*%$! *+*//.-%! &*8.&'! $! 7#7! *,*/)'7! $%).*0H)./'7! A! &*! $/*+*4$/.-%! &*+! @$/.$&'!
9D7)4./'<!
J$7!/'0:+./$/.'%*7!&*+!+$@$&'!.%)*7).%$+!.%/+#A*%!%D#7*$76!@-0.)'76!&.7)*%7.-%!$8&'0.%$+6!
0$+*7)$4!$8&'0.%$+!.%)*%7'!A!+$!:'7.8.+.&$&!&*!%*#0'%F$!:'4!$7:.4$/.-%<!
X+! +$@$&'! .%)*7).%$+! *7)D! /'%)4$.%&./$&'! *%! +$! '87)4#//.-%! :'4! /#*4:'7! *5)4$>'76! F+*'!
:$4$+F)./'6!:*4,'4$/.-%!.%)*7).%$+6!73'/W6!*0*7.7!4*,4$/)$4.$!'!3*0'44$9.$!9$7)4'.%)*7).%$+<!

!
!
!

!"#$%&'($#$)"*'+$*',"-.$#/$'.#/&0.-"+&!

!
!

DKHjBH5DCL%
!!

;&%(Q`$)*S(%$#%-,$&$/-/%$&%)/['#*)(%*')$#)*'-&%@%$&%?[#%8)*&*b-6(%$#%
$&%#(/Q*)(&%
%
!g.%?&h3<%6$%8'-%#(&8,*1'%$'%-<8-%-&%kif%
!
!

[)4$! $:4'5.0$/.-%! :'7.8+*! $! +$! &*7/'%)$0.%$/.-%! )'5./'+-9./$! *7! *+! #7'! &*! 7'+#/.'%*7!
/$)D4)./$7! /'%! *+! ,.%! &*! $/*+*4$4! *+! )4D%7.)'! &*+! )-5./'! :'4! *+! )4$/)'! 9$7)4'.%)*7).%$+6!
&.70.%#A*%&'!$7F!*+!).*0:'!&#4$%)*!*+!2#*!7*!:#*&*!:4'&#/.4!7#!$87'4/.-%<!!
!
J'7! /$)D4)./'7! 7$+.%'7! $/)R$%! $#0*%)$%&'! +$! ,#*4N$! '70-)./$! *%! *+! .%)*4.'4! &*! +$! +#N! &*+!
.%)*7).%'6! +'! /#$+! $)4$*! $9#$! 3$/.$! *+! .%)*4.'46! $#0*%)$%&'! &*! *7)$! ,'40$! +$! 0').+.&$&! A!
$/*+*4$%&'!+$!*5:#+7.-%!&*+!/'%)*%.&'<!!
J'7! /$)D4)./'7! 7'%! :$4)./#+$40*%)*! R).+*7! :$4$! +$! *+.0.%$/.-%! &*! +'7! )-5./'7! 7-+.&'7<! J'7!
*7)#&.'7! &*0#*7)4$%6! %'! '87)$%)*6! 2#*! *+! #7'! &*! /$)D4)./'7! /'0'! R%./$! 0*&.&$! &*!
&*7/'%)$0.%$/.-%! %'! $:'4)$! %.%9#%$! @*%)$C$<! P*8*%! 7*4! #).+.N$&'7! :#*7! /'0'! $:'A'! &*!
')4$7!0*&.&$7!(*0H7.76!$&7'48*%)*7!/'0'!*+!/$48-%!$/).@'6!+$@$&'!9D7)4./'6`1<!
J'7! /$)D4)./'7! '70-)./'7! 0D7! #).+.N$&'7! :*4)*%*/*%! $! \! /$)*9'4F$7;! 7'+#/.'%*7! 7$+.%$7! A!
:'+.7$/D4.&'7<! J'7! /$)D4)./'7! 7$+.%'7! 0D7! #).+.N$&'7! 7'%! *+! 7#+,$)'! 7-&./'6! *+! 7#+,$)'!
0$9%H7./'!A!*+!/.)4$)'!0$9%H7./'<!"'%!4*7:*/)'!$!+'7!:'+.7$/D4.&'76!*+!0D7!#).+.N$&'!*7!*+!
7'48.)'+<! [)4'! /$)D4)./'! )4$&./.'%$+0*%)*! #).+.N$&'! 3$! 7.&'! *+! $/*.)*! 0.%*4$+! ($/*.)*! &*!
:$4$,.%$16!:*4'!7#!#7'!%'!7*!4*/'0.*%&$!*%!$87'+#)'!*%!:*44'7!A!9$)'76!&*8.&'!$+!*+*@$&'!
4.*79'!&*!$7:.4$/.-%!2#*!:4*7*%)$!(*7!#%!3.&4'/$48#4'1<!
P*!)'&'7!+'7!/$)D4)./'7!*+!0D7!:')*%)*!A!*,*/).@'!*7!*+!7'48.)'+<!Z*!$&0.%.7)4$!*%!7'+#/.-%!$+!
cTY!$!#%$!&'7.7!&*!KU\!0+hW9<!=$4$!2#*!+$!/$)$47.7!7*$!4*$+0*%)*!*,*/).@$!*%!+$!4*).4$&$!
&*+!)-5./'6!&*8*!7*4!$&0.%.7)4$&$!&#4$%)*!+'7!:4.0*4'7!VT!0.%#)'7!)4$7!+$!*5:'7./.-%<!!
J$! 4*&'7.,./$/.-%! /'%! /$)D4)./'! :#*&*! 7*4! :*+.94'7$! A! :#*&*! .%)*%7.,./$4! +'7! *,*/)'7!
7*/#%&$4.'7;! @-0.)'7! (:4.%/.:$+0*%)*! *%! :*44'7! A! /'%! 7'+#/.'%*7! 0#A! /'%/*%)4$&$716!
%$#7*$76!/$+$084*7!$8&'0.%$+*76!&*73.&4$)$/.-%!A!:'7.8+*!3.:')*%7.-%<!!

!
!
!
!

!
!
!

!"#$%&'($#$)"*'+$*',"-.$#/$'.#/&0.-"+&!

!
!

E5IB;L5L%WCBlKEK%m%KHBKAKF5;GHC%5NG5DC%
!!
!

Diuresis forzada!!

X7! #%$! )H/%./$! &*! &*:#4$/.-%! 2#*! 3$! 7.&'! #7$&$! &*! ,'40$! *5/*7.@$! *! .%$:4':.$&$6! *%!
'/$7.'%*7!/'%!/'%7*/#*%/.$7!,$)$+*7<!Z#7!.%&./$/.'%*7!7*!3$%!.&'!+.0.)$%&'!3$7)$!'/#:$46!
$/)#$+0*%)*6!#%!:$:*+!0#A!4*7)4.%9.&'!*%!*+!)4$)$0.*%)'!&*!+$7!.%)'5./$/.'%*7!$9#&$7<!
X+!4.>-%!*7!#%!-49$%'!0#A!@$7/#+$4.N$&'6!2#*!4*/.8*!K<\TT!0J!&*!7$%94*!:'4!0.%#)'6!A!2#*!
/$&$! 0.%#)'! 9*%*4$! #%! ,.+)4$&'! &*! K\L! 0J! (c<LTT! 0Jh3'4$16! /#A$! /'0:'7./.-%! *7!
:4D/)./$0*%)*!.9#$+!$!+$!&*+!7#*4'6!*5/*:)'!:'4!+$!$#7*%/.$!&*!:4')*F%$7!'!/#$+2#.*4!')4$!
0'+H/#+$!2#*!)*%9$!#%!:*7'!0'+*/#+$4!7#:*4.'4!$!cT<TTT!&$+)'%<!!
Z.%!*08$49'6!+$!4*$87'4/.-%!)#8#+$4!&*!$9#$!A!&*!0#/3'7!.'%*7!A!7#87)$%/.$7!&.7#*+)$7!(A!
:'4!)$%)'!)$08.H%!+'7!)-5./'71!*7!0#A!$+)$!(3$7)$!#%!ddY16!:'4!+'!2#*!*+!$/+$4$0.*%)'!,.%$+!
&*! +$7! 7#87)$%/.$7! &.7#*+)$7! *%! *+! :+$70$! :#*&*! 7*4! 0#A! @$4.$8+*! (KbT! 0Jh0.%! :$4$! +$!
/4*$).%.%$6!cT!0Jh0.%!:$4$!+$!#4*$6!K\!0Jh0.%!:$4$!*+!:')$7.'6!Tnd!0Jh0.%!:$4$!*+!7'&.'6!
T!0Jh0.%!:$4$!+$!9+#/'7$6!*)/1<!!
!
J$! &.#4*7.7! ,'4N$&$! 7*! 8$7$! *%! $#0*%)$4! *+! ,.+)4$&'! 9+'0*4#+$4! &*+! )-5./'6! *%! .%)*%)$4!
&.70.%#.4! 7#! 4*$87'4/.-%! )#8#+$4! *6! 3.:')H)./$0*%)*6! *%! $#0*%)$4! +$! *5/4*/.-%! )#8#+$4<!
=$4$! /'%7*9#.4! *+! :4.0*4! '8C*).@'6! 7*! 9*%*4$! #%$! 7.)#$/.-%! &*! 3.:*4@'+*0.$! $! +$! /#$+6! *%!
4*7:#*7)$! ,.7.'+-9./$6! *+! 9$7)'! /$4&F$/'! :#*&*! /$7.! &#:+./$47*6! +'! 2#*! $#0*%)$! *%! ,'40$!
$+9'! 0*%'7! :4':'4/.'%$+! *+! ,.+)4$&'! 9+'0*4#+$46! $+! ).*0:'! 2#*! 7*! .%3.8*! +$! 3'40'%$!
$%).&.#4H)./$! (A! :'4! *++'! &.70.%#A*! +$! 4*$87'4/.-%! )#8#+$41o! *+! 8$+$%/*! ,.%$+! *7! :#*7! 0D7!
,.+)4$&'! 9+'0*4#+$46! 0*%'7! 4*$87'4/.-%! 4*+$).@$! *%! *+! )R8#+'! A6! *%! /'%7*/#*%/.$6! 0D7!
&.#4*7.7<! Z*! 3$8+$! &*! &.#4*7.7! ,'4N$&$! /#$%&'! 7*! 9*%*4$! #%$! &.#4*7.7! 7#:*4.'4! $! S!
0Jhp9h3'4$<!
!
O'! '87)$%)*! +$! &.#4*7.7! ,'4N$&$6! 7.! 8.*%! *7! 8*%*,./.'7$! :'42#*! $/*+*4$! +$! *+.0.%$/.-%! &*+!
)-5./'6!)$08.H%!).*%*!7#7!.%/'%@*%.*%)*7;!*5.7)*!#%!4.*79'!&*!.$)4'9*%.$!(*&*0$!:#+0'%$46!
*&*0$! /*4*84$+6! &.7*+*/)4'+.)*0.$76! $+)*4$/.'%*7! &*+! :a! 7$%9#F%*'16! %*/*7.)$! /'%)4'+*7!
(=E"6! .'%'94$0$6! :a! *%! 7$%94*! A! '4.%$16! 94$%! :$4)*! &*+! )-5./'! ,.+)4$&'! :#*&*! 7*4!
4*$87'48.&'!*%!*+!)R8#+'!(3$7)$!#%!dd!Y16!+$!.%7#,./.*%/.$!4*%$+!:4*@.$!'!$/)#$+6!'49D%./$!'!
,#%/.'%$+6!+.0.)$!7#!#).+.&$&!(A!&*!3*/3'6!/'%)4$.%&./$!+$!)H/%./$1<!
!

Atrapamiento inico.!

"'%7.7)*!*%!+$!0$%.:#+$/.-%!&*+!:a!&*!+$!+#N!)#8#+$4!($/.&.,./D%&'+'!'!$+/$+.%.ND%&'+'16!+'!
/#$+! 9*%*4$! /$08.'7! *%! +$! 7'+#8.+.&$&! &*! $+9#%$7! 7#87)$%/.$7! )-5./$76! &.,./#+)$%&'! ($+!
$#0*%)$4!7#!94$&'!&*!.'%.N$/.-%1!+$!4*$87'4/.-%!A!,$/.+.)$%&'6!:'4!)$%)'6!7#!*+.0.%$/.-%<!G!

!
!
!

!"#$%&'($#$)"*'+$*',"-.$#/$'.#/&0.-"+&!

!
!

*7)$!0$%.:#+$/.-%!.%)*%/.'%$&$!&*+!:a!&*!+$!'4.%$!*7!$!+'!2#*!&*%'0.%$0'7!!$)4$:$0.*%)'!
.-%./'
!
X5.7)*%! /#$)4'! 0'&$+.&$&*7! &*! &*:#4$/.-%! 4*%$+! 2#*! 7*! 3$%! $:+./$&'! *%! )'5./'+'9F$;!
&.#4*7.7! ,'4N$&$! %*#)4$! (P^O16! &.#4*7.7! ,'4N$&$! $+/$+.%$! (P^G+16! &.#4*7.7! ,'4N$&$! D/.&$! A!
&.#4*7.7!$+/$+.%$!(PG+1<!!
J'7!:4.%/.:$+*7!)-5./'7!2#*!:#*&*%!8*%*,./.$47*!&*!+$!PM!7'%!+$7!$0$%.).%$7!'!$0$)'5.%$76!
+.).'6! )$+.'6! 84'0'6! :$4$2#$)! (/'%! +$! P^O16! +'7! 8$48.)R4./'7! &*! $//.-%! +$49$! (/'0'! *+!
,*%'8$48.)$+16! *+! \6bU&./+'4',*%'5.$/H)./'! A! *+! 0*)')4*5$)'! (/'%! +$! P^G+1! A! +'7! 7$+./.+$)'7!
(/'%! +$! PG+1<! J'7! 7$+./.+$)'7! 7'%! #%! /$7'! :*/#+.$4! *%! *+! 2#*! +$! /$:$/.&$&! &*! ,4*%'! &*!
4*$87'4/.-%!)#8#+$4!(0*&.$%)*!#%$!$+/$+.%.N$/.-%!#4.%$4.$1!7#:*4$!$0:+.$0*%)*!$+!*,*/)'!
2#*! 7*! /'%7.9#*! $#0*%)$%&'! +$! &.#4*7.76! :'4! +'! 2#*! *%! *7)$! .%)'5./$/.-%! 3$A! 2#*! 3$8+$4!
0D7!&*!e&.#4*7.7!$+/$+.%$e!2#*!&*!e&.#4*7.7!,'4N$&$e<!!G#%2#*!+$!&.#4*7.7!,'4N$&$!D/.&$!*7!
,$40$/'+-9./$0*%)*! *,./$N! :$4$! $#0*%)$4! +$! *5/4*/.-%! #4.%$4.$! &*! $+9#%$7! 7#87)$%/.$7!
($%,*)$0.%$! A! ')4$7! &4'9$7! &*! &.7*>'6! ,*%/./+.&.%$6! ,*%,+#4$0.%$6! 2#.%.%$6! *7)4./%.%$6!
.7'%.$N.&$16! *+! 2#*! *%! *7)$7! .%)'5./$/.'%*7! %'! 7*! 7#*+$%! 4*#%.47*! +'7! /4.)*4.'7! /+F%./'7! &*!
&*:#4$/.-%6! C#%)'! $+! 3*/3'! &*! 2#*! +$! 4$8&'0.-+.7.76! 2#*! ,4*/#*%)*0*%)*! $/'0:$>$! $! +$7!
0.70$76! /'08.%$&$! /'%! #%$! &.#4*7.7! D/.&$6! :#*&*! ,$@'4*/*4! +$! .%7#,./.*%/.$! 4*%$+! $9#&$6!
:'4!+'!2#*!%'!*7)$4F$!.%&./$&$<!
P.@*47$7!:$#)$7!&*!3.&4$)$/.-%!A!$+/$+.%.N$/.-%!3$%!7.&'!:4':#*7)$7!:$4$!:4$/)./$4!#%$!PM;!
E5IB;L5L%WCBlKEK%KPDKP5GKO%
!
KTT!0J!&*!8./$48'%$)'!K!_6!*%!:*4,#7.-%!/'%)F%#$!&#4$%)*!S!3'4$7!
LTT!0J!&*!9+#/'7$&'!LY!l!KT!0X2!"+p6!&#4$%)*!+$!Kq!3'4$!
LTT!0J!&*!7$+.%$!TndY!l!KT!0X2!"+p6!&#4$%)*!+$!\q!3'4$!
LTT!0J!&*!0$%.)'+!KTY!l!KT!0X2!"+p6!&#4$%)*!+$!Sq!3'4$!
!
M*:*).4!*7)*!/./+'!+$7!@*/*7!2#*!7*$!%*/*7$4.'6!$>$&.*%&'!8'+#7!&*!\T!0X2!&*!8./$48'%$)'!
7-&./'6!/#$%&'!*+!:a!*%!'4.%$!7*$!r!cnL<!!
!
E5IB;L5L%WCBlKEK%G;IHBKO%
!
LTT!0J!&*!7$+.%$!TndY!l!KT!0X2!"+p6!+$!Kq!3'4$!
LTT!0J!9+#/'7$&'!LY!l!KT!0X2!"+p6!+$!\q!3'4$!
LTT!0J!&*!7$+.%$!TndY!l!KT!0X2!"+p6!+$!Sq!3'4$!
LTT!0J!&*!0$%.)'+!KTY6!+$!bq!3'4$!
!
M*:*).4! *7)*! /./+'! +$7! @*/*7! 2#*! 7*$! %*/*7$4.'6! *7! &*/.46! 3$7)$! 2#*! &*C*%! &*! /#0:+.47*! +'7!
/4.)*4.'7!/+F%./'7!:'4!+$!2#*!7*!.%&./-<!!
!
E5IB;L5L%KPDKP5GKO%
!
\LT!0J!&*!8./$48'%$)'!K!_!$!:*4,#%&.4!&#4$%)*!V!3'4$7<!

!
!
!

!
!

!"#$%&'($#$)"*'+$*',"-.$#/$'.#/&0.-"+&!

!
!

X7)$!:*4,#7.-%!7*!.%/4*0*%)$6!7*!4*&#/*!'!7*!4*:.)*!*%!,#%/.-%!&*!+$!*@'+#/.-%!/+F%./$!A!&*+!
:a!*%!'4.%$6!2#*!&*8*!*7)$4!:'4!*%/.0$!&*!cnL6!A!/'%!+$!/'%)4$.%&./$/.-%!&*+!&*7$44'++'!&*!
#%$!$+/$+'7.7!0*)$8-+./$!7*@*4$<!
"#$+2#.*4! )4$)$0.*%)'! &*! PM! &*8*! /'%)4'+$47*! 0#A! 4*9#+$40*%)*! :'4! +$! :'7.8+*!
9*%*4$/.-%! &*! #%! 8$+$%/*! 3F&4./'! :'7.).@'6! &.7*+*/)4'+.)*0.$76! $+/$+'7.7! 0*)$8-+./$! Ah'! +$!
$:$4./.-%! &*! 7.9%'7! /+F%./'7! &*! .%7#,./.*%/.$! 4*7:.4$)'4.$! :'4! *&*0$! :#+0'%$4! (*%! *7)*!
R+).0'! /$7'! 7*! &*8*4D! $&0.%.7)4$4! ,#4'7*0.&$! A! 7#7:*%&*4! +$! )H/%./$1<! X+! &*)*4.'4'!
%*#4'+-9./'!'!+$!$:$4./.-%!&*!/'%@#+7.'%*7!:'&4F$!/'44*7:'%&*4!$!#%!*&*0$!/*4*84$+6!:'4!
+'! 2#*6! *%! *7)*! /$7'6! 3$84D! &*! @$+'4$47*! )$08.H%! +$! 7#:4*7.-%! &*! *7)*! )4$)$0.*%)'<! J$!
4*7:#*7)$!&.#4H)./$!:#*&*!%'!7*4!+$!*7:*4$&$<!X++'!)4$&#/*!3$8.)#$+0*%)*!#%$!7.)#$/.-%!&*!
3.:'@'+*0.$! '! 3.:')*%7.-%! 2#*! %'! 3$84F$%! 7.&'! /'44*9.&$7! :4*@.$0*%)*o! *%! *7)*! /$7'! 7*!
$>$&.4D! 0D7! @'+#0*%<! J$! 3.:')*%7.-%! 0$%)*%.&$! /'%! %'40'@'+*0.$! .%&./$4F$! *+! #7'! &*!
&':$0.%$<! G+9#%'7! $#)'4*7! 3$%! :4':#*7)'! *+! #7'! 7.7)*0D)./'! &*! &':$0.%$<! Z.! /'%! )'&'7!
*7)'7! ,$/)'4*7! /'44*9.&'7! :*47.7)*! +$! '+.9#4.$! 4*+$).@$! '! $87'+#)$6! *%7$A$4! +'7! 8'+#7! &*!
,#4'7*0.&$!(bT!091!A!7.!%'!3$A!4*7:#*7)$6!3$A!2#*!:4*@*4!+$!7#7:*%7.-%!&*!+$!)H/%./$!(*+!
:$/.*%)*!*7)D!&*7$44'++$%&'!#%$!.%7#,./.*%/.$!4*%$+16!A!2#.ND7!+$!$:+./$/.-%!&*!#%$!PXM<!!
"'%)4'+$4! /$&$! /#$)4'! 3'4$7! *+! .'%'94$0$! A! *+! *2#.+.84.'! D/.&'! 8$7*! *%! :+$70$o! +$!
3.:':')$7*0.$6! 3.:*4%$)4*0.$6! 3.:*4'70'+$4.&$&! A! $+/$+'7.7! 0*)$8-+./$6! 7'%! +'7!
&*7*2#.+.84.'7! 0D7! ,4*/#*%)*0*%)*! '87*4@$&'76! A! 3$%! &*! 7*4! /'44*9.&'7<! J$! )H/%./$! 7*!
$:+./$4D!0.*%)4$7!:*47.7)$%!+$7!/'%&./.'%*7!2#*!+$!3./.*4'%!.%./.$46!:*4'!3$8.)#$+0*%)*!%'!
7*!:4'+'%9$!0D7!&*!\bUSV!3'4$7<!
!

!
!
!

!"#$%&'($#$)"*'+$*',"-.$#/$'.#/&0.-"+&!

!
!

V5VP5CJBKWpK%
!!
!
!
X%!+$!*+$8'4$/.-%!&*!*7)$!9#F$!7*!3$%!#).+.N$&'!/'0'!,#*%)*7!8.8+.'94D,./$7;!
!
!
L?-&&% K'*?-&% H(9*,(&(<@% R.'6% $6*)*('U"! _./3$*+! X<! =*)*47'%6! =$)4./.$! G<! Q$+/'))<! s<t<!
Z$#%&*47!(*&7<16!=3.+$&*+:3.$6!\TTL<!
!
Z$)$/*'-/@% H(9*,(&(<@O% Q-#*,% -'6% ,&*'*,-&% 0/*',*0&$#"!M$0*73!"<!?#:)$<!X+7*@.*4!(*&7<16!
G07)*4&$0!\TTc<!
!
c-'6Q((3%(+%#?-&&%-'*?-&%)(9*,(&(<@%-'6%0(*#('*'<#%R.'6%$6*)*('U"%M'9*4!s<!?,*++*46!
Z3$u%!=<!_*7'%.*4!(*&7<1<!_'78A6!Z)<!J'#.76!_.77'#4.6!\TTb<!
!
V&-,3n$&&o#% W*S$g?*'8)$% Z$)$/*'-/@% D('#8&)% D&*'*,-&% D(?0-'*('O% L?-&&% K'*?-&%
H(9*,(&(<@"! [7u*.+*4! ?<P<6! JA%%! M<6! a'A&$! J<M<6! t4#)+$96! G<a<6! J**! v<G<! (*&7<1<! s.++*AU
t+$/Wu*++<!
!
K08')$#% #(Q/$% 8/<$',*-#% )(9*,(&1<*,-#% $'% -'*?-&$#% 6$% ,(?0-a>-O% 6*-<'1#)*,(% @%
)/-)-?*$')("% Z*4@./.'! &*! Q'5./'+'9F$! A! E*)*4.%$4.$! ^'4*%7*<! P*:$4)$0*%)'! &*! ".*%/.$7!
Z'/.'7$%.)$4.$7<!]%.@*47.&$&!&*!_#4/.$<!\TTL!

You might also like