Isifo se-Serotonin

I-Serotonin syndrome (SS) iyindlela engaba yingozi empilweni yezidakamizwa. Kubangela ukuthi umzimba ube ne-serotonin eningi kakhulu, ikhemikhali elakhiwe ngamangqamuzana ezinzwa.

I-SS ivame ukwenzeka lapho imithi emibili ethinta izinga lomzimba le-serotonin ithathwa ndawonye ngasikhathi sinye. Imithi idala ukuthi i-serotonin eningi kakhulu ikhishwe noma ihlale endaweni yobuchopho.

Isibonelo, ungaba nale syndrome uma uthatha imithi ye-migraine ebizwa nge-triptans kanye ne-anti-depressants ebizwa nge-serotonin reuptake inhibitors (SSRIs) ekhethiwe, kanye ne-serotonin / norepinephrine reuptake inhibitors (SSNRIs) ekhethiwe.

Ama-SSRI ajwayelekile afaka phakathi i-citalopram (Celexa), i-sertraline (i-Zoloft), i-fluoxetine (i-Prozac), i-paroxetine (i-Paxil), ne-escitalopram (i-Lexapro). Ama-SSNRIs afaka i-duloxetine (Cymbalta), venlafaxine (Effexor), Desvenlafaxine (Pristiq), Milnacipran (Savella), ne-Levomilnacipran (Fetzima). Ama-triptan ajwayelekile afaka i-sumatriptan (Imitrex), zolmitriptan (Zomig), frovatriptan (Frova), rizatriptan (Maxalt), almotriptan (Axert), naratriptan (Amerge), ne-eletriptan (Relpax).

Uma uthatha le mithi, qiniseka ukuthi ufunda isexwayiso esisepaketheni. Ikutshela ngengozi engaba khona ye-serotonin syndrome. Kodwa-ke, ungayeki ukuthatha umuthi wakho. Khuluma nodokotela wakho mayelana nokukhathazeka kwakho kuqala.

I-SS kungenzeka kakhulu ukuthi yenzeke ekuqaleni noma ekwandiseni umuthi.

Ama-anti-depressants amadala abizwa ngokuthi yi-monoamine oxidase inhibitors (MAOIs) nawo angadala i-SS ngemithi echazwe ngenhla, kanye ne-meperidine (Demerol, i-painkiller) noma i-dextromethorphan (umuthi wokukhwehlela).

Izidakamizwa zokuhlukumeza, njenge-ecstasy, i-LSD, i-cocaine, ne-amphetamines nazo zihlotshaniswa ne-SS.

Izimpawu zenzeka kungakapheli imizuzu kuya emahoreni, futhi zingafaka:

• Ukuyaluza noma ukungahlaliseki
• Ukunyakaza kwamehlo okungajwayelekile
• Uhudo
• Ukushaya kwenhliziyo okusheshayo nomfutho wegazi ophakeme
• Ukusangana
• Ukushisa komzimba okwandisiwe
• Ukulahlekelwa kokuxhumana
• Isicanucanu nokuhlanza
• Izimo ezisebenza ngokweqile
• Izinguquko ezisheshayo kumfutho wegazi

Ukuxilongwa kuvame ukwenziwa ngokubuza umuntu imibuzo ngomlando wezokwelapha, kufaka phakathi izinhlobo zemithi.

Ukuze atholakale ene-SS, umuntu kufanele ngabe ubephuza umuthi oguqula izinga le-serotonin yomzimba (isidakamizwa se-serotonergic) futhi okungenani abe nalezi zimpawu noma izimpawu ezintathu ezilandelayo:

• Ukuyaluza
• Ukuhamba kwamehlo okungavamile (i-clonus ye-ocular, ukutholakala okubalulekile ekutholeni ukuxilongwa kwe-SS)
  
• Uhudo
• Ukujuluka okukhulu hhayi ngenxa yomsebenzi
• Imfiva
• Izinguquko zesimo sengqondo, ezifana nokudideka noma i-hypomania
• Ukuphazamiseka kwemisipha (myoclonus)
• Izimo ezisebenza ngokweqile (hyperreflexia)
• Ukuqhaqhazela
• Ukuthuthumela
• Ukunyakaza okungahambisani (ataxia)

I-SS ayitholakali kuze kukhishwe zonke ezinye izimbangela. Lokhu kungafaka ukutheleleka, ukudakwa, izinkinga ze-metabolic ne-hormone, nokuhoxiswa kwezidakamizwa noma kotshwala. Ezinye izimpawu ze-SS zingalingisa lezo ngenxa yokweqisa i-cocaine, i-lithium, noma i-MAOI.

Uma umuntu esanda kuqala ukuthatha noma ukwandisa umthamo we-tranquilizer (umuthi we-neuroleptic), kuzobhekwa ezinye izimo ezifana ne-neuroleptic malignant syndrome (NMS).

Ukuhlolwa kungafaka:

• Amasiko egazi (ukuhlola ukutheleleka)
• Qedela ukubalwa kwegazi (CBC)
• I-CT scan yobuchopho
• Izidakamizwa (i-toxicology) nesikrini sotshwala
• Amazinga e-Electrolyte
• I-Electrocardiogram (ECG)
• Ukuhlolwa kokusebenza kwezinso nesibindi
• Ukuhlolwa komsebenzi we-thyroid

Abantu abane-SS cishe bazohlala esibhedlela okungenani amahora angama-24 ukuze babhekwe.

Ukwelashwa kungafaka:

• Imithi ye-Benzodiazepine, efana ne-diazepam (i-Valium) noma i-lorazepam (i-Ativan) yokwehlisa ukuxokozela, ukunyakaza okufana nokubanjwa, nokuqina kwemisipha
• ICyproheptadine (Periactin), umuthi ovimba ukukhiqizwa kwe-serotonin
• Okungenayo (ngokusebenzisa umthambo) oketshezi
• Ukuyekiswa kwemithi edale lesi sifo

Ezimweni ezisongela impilo, kuzodingeka imithi egcina imisipha inganyakazi (iyikhubaze), kanye nethambo lokuphefumula lesikhashana nomshini wokuphefumula okuzodingeka ukuvimbela ukulimala okuqhubekayo kwemisipha.

Abantu bangakhula kancane kancane futhi bangagula kakhulu uma bengalashwa ngokushesha. Ingelashwa, i-SS ingaba yingozi. Ngokwelashwa, izimpawu zivame ukuphela ngaphansi kwamahora angama-24. Ukulimala kwesitho unomphela kungahle kwenzeke, noma ngabe kwelashwa.

Ukungqubuzana kwemisipha okungalawulwa kungadala ukuwohloka okukhulu kwemisipha. Imikhiqizo ekhiqizwa lapho imisipha iphuka ikhishelwa egazini futhi ekugcineni idlule ezinso. Lokhu kungadala ukulimala okukhulu kwezinso uma i-SS ingaziwa futhi yelashwa kahle.

Shayela umhlinzeki wakho wezokunakekelwa kwezempilo ngokushesha uma unezimpawu ze-serotonin syndrome.

Hlala utshela abahlinzeki bakho ukuthi imiphi imithi oyiphuzayo. Abantu abathatha ama-triptan anama-SSRI noma ama-SSNRIs kufanele alandelwe eduze, ikakhulukazi ngemuva nje kokuqala umuthi noma ukwandisa umthamo wawo.

I-Hyperserotonemia; Isifo se-Serotonergic; Ubuthi beSerotonin; I-SSRI - i-serotonin syndrome; I-MAO - i-serotonin syndrome

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ULevine MD, uRuha AM. Izidambisamagciwane. Ku: Walls RM, Hockberger RS, Gausche-Hill M, ama-eds. Imithi Ephuthumayo yaseRosen: Imiqondo kanye Nokuzijwayeza Komtholampilo. Umhlaka 9. IPhiladelphia, PA: Elsevier; 2018: isahluko 146.

UMeehan TJ. Sondela esigulini esinobuthi. Ku: Walls RM, Hockberger RS, Gausche-Hill M, ama-eds. Imithi Ephuthumayo yaseRosen: Imiqondo kanye Nokuzijwayeza Komtholampilo. Umhlaka 9. IPhiladelphia, PA: Elsevier; 2018: isahluko 139.