Prikaz primera / Case report
ZASTRUPITEV S CALPOLOM
®– PRIKAZ PRIMERA INTOXICATION WITH CALPOL
®– CASE REPORT
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.OMXþQHEHVHGH]DVWUXSLWHYSDUDFHWDPRORWURNVWDUãL
ABSTRACT
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UVOD
+XGR]DVWUXSOMHQLKRWURNMHPDORSRPHQLMRSDåL- YOMHQMVNR RJURåHQR VNXSLQR NL ]DKWHYD SUDYLOQR QDSRWLWHYVWURNRYHQSUHYR]LQKLWURXNUHSDQMH 3RGURþMHDNXWQLK]DVWUXSLWHYSULRWURFLKMHNRPSOH- NVHQ VNXSHN UD]OLþQLK GHMDYQLNRY ]GUDYVWYHQH LQ VRFLDOQH SUREOHPDWLNH NL VH PHG VHERM SUHSOHWDMR 1DþLQLLQSRWL]DVWUXSLWYHVRSUHNRXVWSUHNRNRåH SUHNRVOX]QLFHRþHVDSUHNRQRVX±LQKDODFLMDSUHNR NRåHVSLNRPåXåHONH
9VHãWXGLMHSRURþDMRGDVRQDMEROMRJURåHQLRWURFL PHGGUXJLPLQWUHWMLPOHWRPVWDURVWL9WHPREGREMX QDVWDQH]DVWUXSLWHYSRQHVUHþL]DUDGLUD]YRMQH]QD- þLOQRVWLRWURNNLVLQDELUDMRL]NXãQMHWDNRGDYVH NDUGRVHåHMRQRVLMRYXVWD
(3,'(0,2/2â.(=1$ý,/1267, ZASTRUPITEV PRI OTROCIH
9VR]DVWUXSLWYHY]URNYVHKVPUWQLKSULPHURY ]DUDGLQH]JRGYUD]YLWLKGUåDYDKLQYYGUåDYDK YUD]YRMX
8PUOMLYRVW]DUDGL]DVWUXSLWHYMHVRUD]PHUQRQL]ND QLåMDRGVPUWQRVWL]DUDGLGUXJLKQHVUHþYRWURãNHP REGREMX
9 ± VR ]DVWUXSLWYH Y]URN YVHK KRVSLWDOL]DFLM SULRWURFLK=QDNL]DVWUXSLWYHVHSRMDYLMROHSUL RGRWURNNLVRVSUHMHWLYEROQLãQLFR]DUDGLQH- QDPHUQH ]DVWUXSLWYH9UK SRMDYQRVWL ]DVWUXSLWHY MH RNURJGUXJHJDOHWDVWDURVWLWRMHYREGREMXNRRWURN SULþQHUD]LVNRYDWLVYRMRRNROLFRLQQRVLWLSUHGPHWHY XVWD2WURFLVWDULPDQMNRWGYHOHWLGRVHåHMRVQRYL NL VR VKUDQMHQH QD WOHK SUHGYVHP þLVWLOD LQ GUXJH VQRYL3RGUXJHPOHWXVWDURVWLNRODKNRRWURNVSOH]D LQGRVHåHSROLFHDOLRGSUHKODGLOQLNVHSULþQHMRSRMD- YOMDWL]DVWUXSLWYH]]GUDYLOL
1DMYHþNUDW SULGH GR QHQDPHUQLK ]DVWUXSLWHY Y GR- PDþHPRNROMXNRVRRWURFLEUH]QDG]RUDY±
9 YHþ NRW SULGH GR ]DVWUXSLWYH Y VWDQR- YDQMX VRURGQLNRY SUHGYVHP VWDULK VWDUãHY NMHU MH PRåQRVW]DVWUXSLWYHYHþMD
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SRWHNDODQD3HGLDWULþQLNOLQLNLY/MXEOMDQLLQMH]DMH- ODSULPHURY]DVWUXSLWHYYREGREMX±
MHELORQDMYHþ]DVWUXSLWHY]]GUDYLOL
PARACETAMOL
=GUDYLOR&DOSRO®YVHEXMHSDUDFHWDPRONLMHDQDOJH- WLN]GUDYLORSURWLEROHþLQDPLQDQWLSLUHWLN]GUDYL- OR SURWL ]YLãDQL WHOHVQL WHPSHUDWXUL 3HURUDOQD VX- spenzija Calpol® se uporablja za:
• ]QLåHYDQMHSRYLãDQHWHOHVQHWHPSHUDWXUH
• ODMãDQMHVLPSWRPRYSULEROHþLQVNLKVWDQMLKYQH- WQHJDL]YRUDEROHþLQHYåUHOX
• ODMãDQMH EODJLK GR ]PHUQLK EROHþLQ JODYRER- OD PLJUHQH QHYUDOJLMH KXGD RVWUD ]EDGDMR- þDEROHþLQDNLMHSULVRWQDYUHJLMLNLMRåLYHF RåLYþXMH ]REREROD LQ EROHþLQ SUL L]UDãþDQMX ]REUHYPDWLþQLKEROHþLQWHUEROHþLQYPLãLFDK LQVNOHSLKNLVSUHPOMDMRQHNDWHUHSUHKODGQHLQ YURþLQVNHEROH]QL
1DNOMXþQR ]DXåLWMH SDUDFHWDPROD Y REOLNL VLUX- SD SUL PDOLK RWURFLK ]HOR UHGNR GRVHåH WRNVLþQL RGPHUHN 2GPHUHN PDQMãL NRW PJNJ QH SRY]URþD WRNVLþQHJD XþLQND UD]HQ SUL RWURFLK ] MHWUQRDOLOHGYLþQREROH]QLMR=DVWUXSLWYHVSDUD- cetamolom zdravimo z dajanjem aktivnega oglja.
3RWUHEQR MH GRORþDWL UDYHQ SDUDFHWDPROD Y NUYL ãWLULXUHDOLYHþSR]DXåLWMX=DGDMDQMHDQWLGRWDVH RGORþLMR JOHGH QD LRQRJUDP .RW DQWLGRW VH GDMH 1DFHWLOFLVWHLQ LQWUDYHQVNR &HORWQL RGPHUHN MH PJNJ
3UHVQRYD
3DUDFHWDPROVHSUHVQRYLSULPDUQRYMHWULKNMHUVH YHþMLGHOPROHNXOSUHNRNRQMXJDFLMHSUHQRVVVXO- IDWRP in JOXNXURQVNRNLVOLQR spremeni v neaktiv- QRREOLNR,]ORþDVHVNR]LOHGYLFH/HPDQMãLGHOHå se v jetrih metabolizira z encimom FLWRNURP3 WRNVLþQRVWSDUDFHWDPRODMHSRYH]DQDUDYQR]PDMK- QLPLNROLþLQDPLDONLOLUDQHJDSUHVQRYNDNLQDVWDQH VSRPRþMRWHJDHQFLPD9PDQMãLKRGPHUNLKSULGH GR KLWUHJD UD]VWUXSOMDQMD 1DFHWLOSEHQ]RNLQRQ LPLQD V SRPRþMRJOXWDWLRQD NRQMXJDW VH L]ORþL V VHþHP
7RNVLþQRVW
Paracetamol ima zelo ozek WHUDSHYWVNLLQGHNV. To SRPHQL GD MH UD]OLND PHG RELþDMQLP LQ WRNVLþQLP odmerkom sorazmerno majhna. Pri predoziranju*
ODKNR SULGH GR ]QDWQH SRãNRGEH MHWHU FHOR GRRG- SRYHGL in zato do smrti. Ker je paracetamol na trgu GRVWRSHQEUH]]GUDYQLãNHJDUHFHSWDVHYþDVLKXSR- rablja tudi v VXLFLGDOQH namene.
9 WHUDSHYWVNLK RGPHUNLK MH SDUDFHWDPRO PHG YDU- QHMãLPL DQDOJHWLNL 3UL SUHGR]LUDQMX VH SRYHþD NR- OLþLQDWRNVLþQHJDSUHVQRYND1DFHWLOSEHQ]RNLQRQ LPLQD =DUDGL SRYLãDQH NRQFHWUDFLMH UD]VWUXSOMDQMH ]JOXWDWLRQRPQLYHþGRYROMKLWURLQRPHQMHQLSUH- VQRYHNUHDJLUDVFHOLþQLPLVHVWDYLQDPLSUHGYVHP]
PHPEUDQDPLLQSRY]URþLDNXWQRQHNUR]R. Posle- GLFDMHODKNRVPUW
SUHGR]LUDQMHRYHUGRVH±SRVOHGLFD]DXåLWMDSUH- YHOLNHNROLþLQH]GUDYLOD
SUHRGPHUMDQMH ± SUHYHOLN RGPHUHN ]GUDYLOD NL JD GRELEROQLNYGRORþHQHPREGREMX
VRSTE ZASTRUPITVE
*OHGH QD þDV YQDãDQMD VWUXSD ORþLPR DNXWQH ]D- VWUXSLWYH ] HQNUDWQLP YQRVRP VQRYL LQ NURQLþQH ]DVWUXSLWYH ] YHþNUDWQLP YQRVRP PDQMãH NROLþLQH VQRYL3ULDNXWQLK]DVWUXSLWYDKMHEROQLNRYRåLYOMH- QMHODKNRQHSULþDNRYDQRQHQDGRPDRJURåHQR]QDNL ]DVWUXSLWYHSDVREXUQL3ULNURQLþQL]DVWUXSLWYLSD VHEROQLNRYR]GUDYVWYHQRVWDQMHSRþDVLVODEãD]QDNL QLVRWDNRRSD]QLEROQLNRYRåLYOMHQMHSDMHVþDVRPD ODKNRSUDYWDNRRJURåHQR
2NROLãþLQHYNDWHULKMHSULãORGR]DVWUXSLWYHQDþLQ YVWRSD VWUXSD Y WHOR LQ NROLþLQD VWUXSD VR L]UHGQR SRPHPEQLSRGDWNLSUL]GUDYOMHQMX]DVWUXSLWYH1DM- SRPHPEQHMHMHVWUXSSUHSR]QDWLWMXJRWRYLWLNDWH- UDVQRYMHSRY]URþLOD]DVWUXSLWHY+LWUDSUHSR]QDYD VWUXSDQDPHVWX]DVWUXSLWYHSRRVWDQNLKHPEDODåH DOLRNROLãþLQDKMHãHSRVHEQRSRPHPEQDSULQH]D- YHVWQLK]DVWUXSOMHQFLKNLMLPPRUDPRNDUQDMKLWUHMH QXGLWLXþLQNRYLWRSRPRþ
ZNAKI ZASTRUPITVE
2GORþLOQR ]D XVSHãQR SUYR SRPRþ MH GD åH SUYH ]QDNH VSUYD QHMDVQHJD SRVODEãDQMD ]GUDYVWYHQHJD VWDQMDSRYHåHPR]PRUHELWQR]DVWUXSLWYLMR7RQDP RPRJRþLGDVHSRVWDYLQDGDOMQMDGLDJQR]DLQGDVH pravilno pomaga. Prav pri zastrupitvah pa to ni pre- SURVWRVDM]QDNLQLVRYHGQRHQDNL=QDNL]DVWUX- SLWYHVRODKNRSRSROQRPDQHVSHFL¿þQLNDUSRPHQL GDSRNOLQLþQLVOLNLPQRJRNUDWQHPRUHPRGRORþLWL NDWHUDVQRYMHSRY]URþLOD]DVWUXSLWHY
1DMSRPHPEQHMãL]QDNLVHJDMRRGVODERVWLEUXKDQMD WUHEXãQLK EROHþLQ GULVNH REOLYDQMD ]QRMD PRWHQM GLKDQMD LQ NUYQHJD REWRND YUWRJODYLFH NUþHY LQ motenj zavesti pa vse do zastoja dihanja in krvnega obtoka.
=ODVWLRWURNHMHWUHEDSRJRVWR]HORSRWUSHåOMLYRL]- SUDãHYDWLGDRGNULMHPRSUDYLY]URNQHMDVQHJDVWD- QMD
ZDRAVLJENJE
=DXVSHãQR]GUDYOMHQMHMHSRWUHEQRXJRWRYLWLNDWHUD VQRYMHSRY]URþLOD]DVWUXSLWHYRGNULWLSRNDWHULSRWL MH SULãHO VWUXS Y WHOR GRORþLWL þDV QDVWDQND ]DVWUX- SLWHYGRORþLWLþDVQDVWDQND]DVWUXSLWYHLQSUHSUHþLWL SRVODEãDQMH]DVWUXSLWYH]DEVRUSFLMRãHQHDEVRUELUD- QHJDVWUXSD
9HþLQD]DVWUXSLWHYSULRWURFLKQLåLYOMHQMVNRRJURåX- MRþLKLQQHSRWUHEXMHQREHQLKDOLOHPDQMãHXNUHSH 5HVQRVW]DVWUXSLWYHVHODKNRRFHQLãHOHNRVH]EH- UHMRLQRFHQLMRYVHLQIRUPDFLMHLQL]YLGL=DSOHWHQL LQåLYOMHQMVNRQHYDUQLSULPHULVHPRUDMRSUHGVWDYLWL GUåDYQHPX&HQWUX]D]DVWUXSLWYH
3RGDWNLNLVHSRVUHGXMHMR&HQWUX]D]DVWUXSLWYHVR VWDURVW WHåD RWURND þDV RG ]DXåLWMD R]LURPD VWLND VVWUXSRPYVHELQDR]LURPDRSLVVWUXSDLQNROLþLQD VWUXSDWHUVWDQMHEROQLNDYLWDOQHIXQNFLMH 8NUHSLSUL]DVWUXSOMHQHPRWURNX
3UL YVDNL WHåML ]DVWUXSLWYL VH RWURN VSUHMPH Y ERO- QLãQLFR ýH MH RGPHUHN QHNH VQRYL ]DQHVOMLYR RFHQMHQNRWQHãNRGOMLYRWURNQHSRWUHEXMHQREHQLK XNUHSRYýHVHSDRGPHUHNGRORþHQHVQRYLRFHQLV
SRWHQFLDOQRYLVRNRVPUWQRVWMRLQþHQMLKRYDQDWDQþ- QDVWUXNWXUDQL]QDQDVHPRUDXNUHSDWLGDVH]PDQM- ãDR]LURPDPLQLPDOL]LUDNRQFHQWUDFLMDYNUYL
$NWLYQRRJOMH
Pri obravnavi predoziranja se navadno daje DNWLYQR RJOMHNLYSUHEDYQLFHYLQDVYRMRSRYUãLQRDGVRUELUD PROHNXOHSDUDFHWDPRODLQWDNRSUHSUHþLGDEL]DãOH vNUYQLREWRN$NWLYQRRJOMHMHSRWUHEQR]DXåLWLSR QDMYHþãWLULKXUDKRG]DXåLWMDSUHYHOLNHJDRGPHUND SDUDFHWDPROD .DVQHMH MH QDPUHþ YHþLQD SDUDFH- WDPROD åH SUHãOD Y NUYQL REWRN 9 WHP SULPHUX MH potrebno dati SURWLVWUXS RELþDMQR 1DFHWLOFLVWHLQ
$NWLYQRRJOMHMHQHVSHFL¿þQDVQRYNLYþUHYHVMXQD VYRMLSRYUãLQLYHåHGUXJHVQRYLDOLGHOFHþUHYHVQL DGVRUEHQW LQ MH VSRVREHQ YH]DWL ãWHYLOQH VWUXSHQH VQRYL þHSUDY MH QHNDM VQRYL NL SD MLK QH DVRUELUD HWDQROOLWLMFLDQLGåHOH]R$NWLYQRRJOMHWXGL]HOR GREUR YHåH QDVH SOLQH DQWLÀDWXOHQW Y SUHEDYLOLK 3UHKDMDVNR]LåHORGHFLQSULWHPQH]PDQMãDNLVOR- VWLåHORGþQHNLVOLQH$NWLYQRRJOMHVHQHYVUNDLQQH SUHVQRYL Y SUHEDYLOLK ,]ORþD VH QHVSUHPHQMHQR ] EODWRPNLJDREDUYDþUQR8SRUDEDDNWLYQHJDRJOMD VHQHSULSRURþDSULRWURFLKPODMãLKRGOHW
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$FHWLOFLVWHLQSR]QDQWXGLNRW1DFHW\OF\VWHLQHDOL1- DFHW\O/F\VWHLQHR]1$&MHDFHWLOLUDQDREOLNDåYH- SORYHJDDQWLRNVLGDFLMVNHJDDPLQRNLVOLQVNHJDFLVWHLQD NLJDWHORQDMODåMHDEVRUELUDLQSUHVQDYOMD-HQDMEROMãL SUHGKRGQLNJOXWDWLRQDJODYQHJDDQWLRNVLGDQWDNLJD SURL]YDMDMR þORYHãNH FHOLFH SUHGYVHP Y MHWULK -H XþLQNRYLWSURWLVWUXSSUL]DVWUXSLWYLVSDUDFHWDPRORP þHVHXSRUDEL]QRWUDMXUSR]DVWUXSLWYL
35(35(ý(9$1-(=$67583,7(935, OTROCIH
3UHSUHþHYDQMH]DVWUXSLWHYMHPRåQRQDãWHYLOQLKUDY- QHK 3RPHPEQR MH GD VR VWUXSHQH VQRYL XVWUH]QR LQ MDVQR R]QDþHQH XYDMDMR SD QDM VH PDQM VWUXSH- QLLQYDUQHMãLL]GHONL6WUXSHQHVQRYLQDMQHELELOH podobnega videza kot prehranski izdelki. Doma je nujno varno shranjevanje strupenih snovi na otroku QHGRVWRSQLKPHVWLK
Tako mesto mora biti suho in ne sme biti izpostavlje- QRQHQHSRVUHGQLVYHWORELQLWLQHWRSORWL6HYHGD MHNOMXEWHPXNUHSRPãHYHGQRHGHQQDMSRPHPEQHM- ãLKXNUHSRYVWDOQLQDG]RUQDGRWURNRP8JRWRYOMHQ je tudi vpliv okolja na pojavnost zastrupitev pri otro- FLK ± WDNR VR V SRYHþDQR LQFLGHQFR ]DVWUXSLWHY SUL RWURFLKSRYH]DQLEUH]SRVHOQRVWVWDUãHYQL]HNVRFLDO- QRHNRQRPVNLVWDWXVVWUHVQHVLWXDFLMHYGUXåLQL
ZDRAVSTVENA VZGOJA STARŠEV IN OTROK
3R]QDPR UD]OLþQH QDþLQH NRPXQLFLUDQMD Y ]GUD- YVWYHQLQHJL]EROQLPRWURNRPYUD]OLþQLKVWDURVWQLK obdobjih. Otrok v zdravstveni obravnavi mora biti HQDNRYUHGHQ þODQ NRPXQLNDFLMH ]DWR MH SRWUHEQR SR]QDWL RWURNRYH QDþLQH NRPXQLFLUDQMD Y UD]OLþQLK starostnih obdobjih. Predvsem moramo biti pozorni QD RWURNRYR QHYHUEDOQR NRPXQLNDFLMR VDM WD YHOL- NRNUDWSRNDåHRWURNRYRUHVQLþQRVWDQMH0HGLFLQVND VHVWUDYHOLNGHOVYRMHJDþDVDNRPXQLFLUD]RWURNRP LQVWDUãL1DWDNQDþLQODåMHVSUHPOMDKRVSLWDOL]LUD- QHJD RWURND LQ VWDUãH WHU SRPDJD QD RWURNRYL SRWL GR]GUDYMD.RPXQLNDFLMDMHYLWDOQDDNWLYQRVWNLMH izjemno pomembna za vzpostavitev stika z bolnim RWURNRPLQQMHJRYLPLVWDUãLWHURPRJRþD]DGRYROMH- vanje potreb vsakega posameznika.
Potreba po ustrezni komunikaciji in informiranosti MHSULEROQHPRWURNXLQQMHJRYLKVWDUãLKYVHYHþMD 0HGLFLQVNDVHVWUDNLL]YDMD]GUDYVWYHQRQHJRSR- VWDYOMDRWURNDLQVWDUãHYRVSUHGMH2WURNXLQVWDUãHP MHSRWUHEQRLQIRUPDFLMHSRVUHGRYDWLQDWDNQDþLQGD QDVERGRVHYHGDUD]XPHOLLQWDNRLPHOLPRåQRVWGH- MDYQRVRGHORYDWLYREUDYQDYL
PRIKAZ PRIMERA
OHWQD2$MHELODVHSWHPEUDVSUHMHWDQD JDVWURHQWHURORãNLRGGHOHN]DUDGL]DVWUXSLWYHVSDUD- cetamolom.
'UXåLQVNDDQDPQH]D negativna.
Osebna anamneza: rojena je bila kot prvi otrok po QRUPDOQR SRWHNDMRþL QRVHþQRVWL 'R WHGDM UHVQHMH EROQD QL ELOD GRND]DQLK DOHUJLM QLPD 2G RWURãNLK bolezni je prebolela norice.
$QDPQH]DREVSUHMHPXVHSWHPEUDMHYSR- SROGDQVNLKXUDKWRåLOD]DJODYRERORPLQEROHþLQD- PLYWUHEXKX=YHþHUVRQDPHULOLSRYLãDQRWHOHVQR WHPSHUDWXURGR&SRGSD]GXKR3UHMHODMHDQ- WLSLUHWLNVHSWHPEUDMHELODYYDUVWYXSULRVWDUHOL EDELFLRGGRXUH2þHMHSULSUDYLOVWHNOHQLþNR paracetamola (Calpol® VLUXS QD RNHQVNL SROLFL LQ GHNOLFLGHMDOGDODKNRREEROHþLQDK]DXåLMHåOLFL SDUDFHWDPROD'HNOLFDMHSRSLODSULEOLåQRWULþHWUWLQH VWHNOHQLþNHSDUDFHWDPRODSULEOLåQRPO=DWHP MHWRåLOD]DEROHþLQDPLYWUHEXKXQDWRNUDWEUXKD- OD'ULVNHQLLPHODRGYDMDODMHQRUPDOQRIRUPLUDQR EODWR=MXWUDMMHãHHQNUDWEUXKDODLQWRåLOD]DEROH- þLQDPLYWUHEXKX
VHSWHPEUD RE VSUHMHPX MH ELOD QHSUL]DGHWD XWUXMHQHJDYLGH]DDIHEULOQD2GY]HWDMLMHELODNUL XJRWRYOMHQL VR ELOL SRYLãDQL MHWUQL WHVWL ELOLUXELQ LQ åH ]PDQMãDQD VLQWHWVND IXQNFLMD MHWHU 2EVWDMDOD MHYHOLNDQHYDUQRVWDNXWQHRGSRYHGLMHWHUäHPHG KRVSLWDOL]DFLMR VR ELOL VWDUãL VH]QDQMHQL ] UHVQRVWMR NOLQLþQHJDVWDQMDWHUYHOLNRPRåQRVWMRDNXWQHMHWUQH RGSRYHGL9HV þDV VR ELOL QD RGGHONX Y VWLNX V WR- NVLNRORJRPSRQMHJRYHPQDVYHWXVPRXYHGOL]GUD- YOMHQMH]1±DFHWLOFLVWHLQRP
'YDGQLSRVSUHMHPXVRVHMHWUQLWHVWLãH]YLãHYDOL SRWHP SD ]DþHOL XSDGDWL VHSWHPEUD VH MH QRU- PDOL]LUDO WXGL þDV VWUMHYDQMD NUYL RG WDNUDW WXGL QL YHþLPHODEROHþLQYWUHEXKXVHSWHPEUDVRELOL MHWUQLWHVWLYXSDGDQMXNOLQLþQRMHELODEUH]WHåDYLQ SRGRJRYRUXVWRNVLNRORJRPMHãODGHNOLFD]DþDVQR domov.
'QHVHSWHPEUDVHMHVVWDUãLSRJRYRULOSUHGVWRM- nik oddelka in jih ponovno opozoril na resno ogro- åHQRVWGHNOLFHþHELVHSRGREQLGRJRGNLSRQRYLOL 2ESRJRYRUXMHELORUD]YLGQRGDVHVWDUãLãHYHGQR
QH]DYHGDMRUHVQRVWLSUREOHPD]DWRVRPRUDOLRSUD- YLWLSRJRYRUãHVVRFLDOQRGHODYNRWHUSVLKRORJLQMR NL SD VWD ELOL PQHQMD GD QH SRWUHEXMHMR QDGDOMQMH obravnave.
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