Serotonin chirwere

Serotonin syndrome (SS) inogona kutyisidzira hupenyu kuita zvinodhaka. Zvinokonzera kuti muviri uve neserotonin yakawandisa, kemikari inogadzirwa nemaseru etsinga.

SS inowanzoitika kana mishonga miviri inokanganisa mwero wemuviri weserotonin inotorwa pamwechete panguva imwe chete. Mishonga inoita kuti serotonin yakawandisa isunungurwe kana kuramba iri munzvimbo yehuropi.

Semuenzaniso, unogona kuvandudza chirwere ichi kana ukatora mishonga yemigraine inonzi triptans pamwe neanodzvinyirira anonzi anosarudza serotonin reuptake inhibitors (SSRIs), uye anosarudza serotonin / norepinephrine reuptake inhibitors (SSNRIs).

Kazhinji SSRIs inosanganisira citalopram (Celexa), sertraline (Zoloft), fluoxetine (Prozac), paroxetine (Paxil), uye escitalopram (Lexapro). SSNRIs inosanganisira duloxetine (Cymbalta), venlafaxine (Effexor), Desvenlafaxine (Pristiq), Milnacipran (Savella), uye Levomilnacipran (Fetzima). Matriptans akajairika anosanganisira sumatriptan (Imitrex), zolmitriptan (Zomig), frovatriptan (Frova), rizatriptan (Maxalt), almotriptan (Axert), naratriptan (Amerge), uye eletriptan (Relpax).

Kana iwe ukatora mishonga iyi, ita shuwa kuti uverenge yambiro iri muhomwe. Iyo inokuudza iwe nezve ingangoita njodzi yeserotonin syndrome. Nekudaro, usamire kutora mushonga wako. Taura nachiremba wako nezve zvaunonetseka kutanga.

SS inowanzoitika mukutanga kana kuwedzera mushonga.

Zvidzvinyiriri zvekare zvinonzi monoamine oxidase inhibitors (MAOIs) zvinogona kukonzera SS nemishonga inotsanangurwa pamusoro, pamwe ne meperidine (Demerol, painkiller) kana dextromethorphan (mushonga wekukosora).

Zvinodhaka zvekushungurudzwa, senge ecstasy, LSD, cocaine, uye amphetamines zvakabatanawo neSS.

Zviratidzo zvinoitika mukati memaminitsi kusvika maawa, uye zvinogona kusanganisira:

• Kusagadzikana kana kusagadzikana
• Kufambisa kwemaziso kusingaite
• Manyoka
• Kukurumidza kurova kwemoyo uye neBP
• Hallucinations
• Kuwedzera kwekushisa kwemuviri
• Kurasikirwa kwekubatana
• Kusvotwa uye kurutsa
• Kuwedzeredza mafungiro
• Kukurumidza kuchinja mukumanikidza kweropa

Iko kuongororwa kunowanzoitwa nekubvunza munhu mibvunzo nezve nhoroondo yezvekurapa, kusanganisira mhando dzemishonga.

Kuti aonekwe aine SS, munhu wacho anofanira kunge anga achitora mushonga unoshandura mwero weserotonin yemuviri (serotonergic drug) uye ane matatu kana matatu ezviratidzo kana zviratidzo zvinotevera:

• Kusagadzikana
• Asina kujairika kufamba kweziso (ocular clonus, kiyi yekutsvaga mukumisikidza kuongororwa kweSS)
  
• Manyoka
• Kuwedzera kudikitira kwete nekuda kwekuita
• Kupindwa nechando
• Mamiriro epfungwa anochinja, senge kuvhiringidzika kana hypomania
• Tsandanyama mhasuru (myoclonus)
• Kuwedzeredza mafungiro (hyperreflexia)
• Kubvunda
• Kudedera
• Kufambisa kusingaenzanisike (ataxia)

SS haiwanikwe ichionekwa kudzamara zvimwe zvikonzero zvingave zvabviswa. Izvi zvinogona kusanganisira hutachiona, kudhakwa, metabolic uye mahormone matambudziko, uye kubvisa zvinodhaka kana doro. Zvimwe zviratidzo zveSS zvinogona kutevedzera izvo nekuda kwekuwedzeredza kwecocaine, lithiamu, kana MAOI.

Kana munhu achangotanga kutora kana kuwedzera muyero weiyo tranquilizer (neuroleptic drug), mamwe mamiriro senge neuroleptic malignant syndrome (NMS) inozotariswa.

Miedzo inogona kusanganisira:

• Tsika dzeropa (kutarisa hutachiona)
• Yakazara kuverenga ropa (CBC)
• CT scan yehuropi
• Zvinodhaka (toxicology) uye doro screen
• Electrolyte mazinga
• Electrocardiogram (ECG)
• Itsvo uye chiropa chinoshanda bvunzo
• Utachiona hwebasa

Vanhu vane SS vangangogara muchipatara kwemaawa makumi maviri nemana ekunyatso tarisisa.

Kurapa kunogona kusanganisira:

• Benzodiazepine mishonga, yakadai se diazepam (Valium) kana lorazepam (Ativan) kudzikisira kushungurudzika, kufambisa-senge kufamba, uye kuomarara kwemhasuru
• Cyproheptadine (Periactin), mushonga unovhara kugadzirwa kweserotonin
• Inopinza (kuburikidza nemutsinga) zvinwiwa
• Kurega kwemishonga yakakonzera iyo syndrome

Muzviitiko zvinotyisidzira hupenyu, mishonga inochengetedza tsandanyama dzakamira (kuomesa mitezo), uye pombi yekufema kwechinguva uye muchina wekufema unozodiwa kudzivirira kumwe kukuvara kwemhasuru.

Vanhu vanogona kuwedzera kukurumidza uye vanogona kurwara zvakanyanya kana vakasakurumidza kurapwa. Isina kurapwa, SS inogona kuuraya. Nokurapwa, zviratidzo zvinowanzoenda mukati maawa asingasviki makumi maviri nemana. Kukuvara kwehupenyu zvachose kunogona kukonzera, kunyangwe nekurapwa.

Kusadzora tsandanyama mhasuru kunogona kukonzera kukomba mhasuru kuparara. Zvigadzirwa zvinogadzirwa kana mhasuru dzikatsemuka zvinoburitswa muropa uye pakupedzisira zvichipinda nemuitsvo. Izvi zvinogona kukonzera kukuvara kwakanyanya kweitsvo kana SS isingazivikanwe uye kurapwa mushe.

Fonera wako mupi wezvehutano ipapo kana iwe uine zviratidzo zve serotonin syndrome.

Gara uchiudza vanopa vako kuti ndeipi mishonga yaunotora. Vanhu vanotora matriptan ane SSRIs kana SSNRIs vanofanirwa kuteverwa zvakanyanya, kunyanya vachangotanga mushonga kana kuwedzera iwo madosi.

Hypererotonemia; Serotonergic chirwere; Serotonin chepfu; SSRI - chirwere cheserotonin; MAO - chirwere cheserotonin

Fricchione GL, Gungwa SR, Huffman JC, Bush G, Stern TA. Mamiriro ehupenyu anotyisidzira mune zvepfungwa: catatonia, neuroleptic malignant syndrome, uye serotonin syndrome. Mune: Stern TA, Fava M, Wilens TE, Rosenbaum JF, eds. Massachusetts General Hospital Yakakwana Clinical Psychiatry. 2nd ed. Philadelphia, PA: Elsevier; 2016: chits. 55.

Levine MD, Ruha AM. Zvinodzvinyirira. Mune: Masvingo RM, Hockberger RS, Gausche-Hill M, eds. Rosen's Emergency Medicine: Concepts uye Clinical Practice. 9th ed. Philadelphia, PA: Elsevier; 2018: chitsiko 146.

Meehan TJ. Kusvika kumurwere ane muchetura. Mune: Masvingo RM, Hockberger RS, Gausche-Hill M, eds. Rosen's Emergency Medicine: Concepts uye Clinical Practice. 9th ed. Philadelphia, PA: Elsevier; 2018: chits. 139.