Isifo seSerotonin

I-Serotonin syndrome (i-SS) yindlela esongela ubomi yokusabela kweziyobisi. Ibangela ukuba umzimba ube ne-serotonin eninzi kakhulu, ikhemikhali eveliswa ziiseli zemithambo-luvo.

I-SS ihlala isenzeka xa amayeza amabini achaphazela inqanaba lomzimba we-serotonin athathwa kunye ngaxeshanye. Amayeza abangela ukuba i-serotonin eninzi ikhutshwe okanye ihlale kwingingqi yengqondo.

Umzekelo, unokuyiphuhlisa le syndrome ukuba uthatha amayeza e-migraine abizwa ngokuba yi-triptans kunye ne-anti-depressants ebizwa ngokuba yi-serotonin reuptake inhibitors (SSRIs) ekhethiweyo, kunye ne-serotonin / norepinephrine reuptake inhibitors (SSNRIs).

Ii-SSRI eziqhelekileyo zibandakanya i-citalopram (Celexa), sertraline (Zoloft), fluoxetine (Prozac), paroxetine (Paxil), kunye ne-escitalopram (Lexapro). Ii-SSNRIs zibandakanya i-duloxetine (Cymbalta), venlafaxine (Effexor), Desvenlafaxine (Pristiq), Milnacipran (Savella), kunye neLevomilnacipran (Fetzima). Ii-triptan eziqhelekileyo zibandakanya is sumatriptan (Imitrex), zolmitriptan (Zomig), frovatriptan (Frova), rizatriptan (Maxalt), almotriptan (Axert), naratriptan (Amerge), kunye ne-eletriptan (Relpax).

Ukuba uthatha la mayeza, qiniseka ukuba uyasifunda isilumkiso kwiphakheji. Ikuxelela ngomngcipheko weserotonin syndrome. Nangona kunjalo, sukuyeka ukuthatha amayeza akho. Thetha nogqirha wakho malunga neenkxalabo zakho kuqala.

I-SS inokwenzeka ukuba yenzeke ekuqaleni okanye ekwandiseni iyeza.

Izidakamizwa ezindala ezibizwa ngokuba yi-monoamine oxidase inhibitors (MAOIs) nazo zingabangela i-SS kunye namayeza achazwe ngasentla, kunye ne-meperidine (iDemerol, i-painkiller) okanye i-dextromethorphan (iyeza lokukhwehlela)

Iziyobisi zokuxhatshazwa, ezinje nge-ecstasy, i-LSD, icocaine, kunye neamphetamines nazo zinxulunyaniswa ne-SS.

Iimpawu zenzeka kwimizuzu ukuya kwiiyure, kwaye zinokubandakanya:

• Ukuphazamiseka okanye ukungazinzi
• Ukuhamba kwamehlo okungaqhelekanga
• Urhudo
• Ukubetha kwentliziyo okukhawulezayo kunye noxinzelelo lwegazi
• Ukuba nemibono
• Ukwanda kobushushu bomzimba
• Ukuphulukana nolungelelwaniso
• Isicaphucaphu nokugabha
• Ingqondo egqithisileyo
• Utshintsho olukhawulezileyo kuxinzelelo lwegazi

Ukuxilongwa kuhlala kwenziwa ngokubuza umntu imibuzo malunga nembali yezonyango, kubandakanya iintlobo zamachiza.

Ukuze afunyaniswe ene-SS, umntu kufuneka ukuba uthatha ichiza eliguqula inqanaba lomzimba le-serotonin (ichiza le-serotonergic) kwaye ubuncinci kwezi mpawu zilandelayo:

• Ukuphazamiseka
• Ukuhamba kwamehlo okungaqhelekanga (i-ocular clonus, into ebalulekileyo ekufumaneni ukuxilongwa kwe-SS)
  
• Urhudo
• Ukubila okunzima hayi ngenxa yomsebenzi
• Ifiva
• Ukutshintsha kwemeko yengqondo, njengokudideka okanye i-hypomania
• Ukuxhamla kwezihlunu (myoclonus)
• Iimpawu ezigqithileyo (hyperreflexia)
• Ukuqhaqhazela
• Ukungcangcazela
• Ukuhamba okungahambelaniyo (ataxia)

I-SS ayifumaneki de kube zonke ezinye izizathu ezinokubakho ziyekisiwe. Oku kunokubandakanya usulelo, ukunxila, iingxaki ze-metabolic kunye ne-hormone, kunye nokuyeka iziyobisi okanye utywala. Ezinye iimpawu ze-SS zinokulinganisa ezo ngenxa yokudlula kwi-cocaine, i-lithium, okanye i-MAOI.

Ukuba umntu sele eqalile ukuthatha okanye ukunyusa idosi ye-tranquilizer (ichiza le-neuroleptic), ezinye iimeko ezinje nge-neuroleptic malignant syndrome (NMS) ziya kuqwalaselwa.

Uvavanyo lunokubandakanya:

• Iinkcubeko zegazi (ukujonga usulelo)
• Gcwalisa ubalo lwegazi (CBC)
• Ukuvavanywa kwe-CT kwengqondo
• Iziyobisi (inetyhefu) kunye nescreen sotywala
• Amanqanaba e-Electrolyte
• I-Electrocardiogram (ECG)
• Uvavanyo lwezintso kunye nesibindi
• Uvavanyo lomsebenzi we-thyroid

Abantu abane-SS banokuhlala esibhedlele okungenani iiyure ezingama-24 ukuze bajongwe.

Unyango lunokubandakanya:

• Amayeza e-benzodiazepine, anje nge-diazepam (Valium) okanye i-lorazepam (Ativan) ukunciphisa ukucaphuka, intshukumo efana nokuhlutha, kunye nokuqina kwemisipha
• ICyproheptadine (Periactin), ichiza elithintela imveliso ye-serotonin
• Ukufakwa ngaphakathi (ngokusebenzisa umthambo) ulwelo
• Ukupheliswa kwamayeza abangele isifo

Kwiimeko ezisongela ubomi, amayeza agcina izihlunu zithe cwaka (azikhubaze), kunye netyhubhu yokuphefumla yethutyana kunye nomatshini wokuphefumla kuya kufuneka ukuthintela ukonakala okungaphezulu kwemisipha.

Abantu banokuba mandundu kancinci kancinci kwaye banokugula kakhulu ukuba abanyangwa ngokukhawuleza. Ukunganyangwa, i-SS inokubulala. Ngonyango, iimpawu zihlala zihamba kungaphelanga iiyure ezingama-24. Ukonakala kwamalungu okusisigxina kunokubangela, kwanonyango.

Ukungalawuleki kwezihlunu kunokubangela ukonakala kwemisipha. Iimveliso eziveliswayo xa izihlunu zisaphuma zikhutshelwa egazini kwaye ekugqibeleni zingene kwizintso. Oku kunokubangela ukonzakala okukhulu kwezintso ukuba i-SS ayaziwa kwaye inyangwa ngokufanelekileyo.

Shayela umboneleli wakho wezempilo ngokukhawuleza ukuba unempawu ze-serotonin syndrome.

Soloko uxelela ababoneleli bakho ukuba ngawaphi amayeza owasebenzisayo. Abantu abathatha ii-triptans ezine-SSRI okanye ii-SSNIs kufuneka zilandelwe ngokusondeleyo, ngakumbi emva kokuqalisa iyeza okanye ukonyusa idosi.

Hypererotonemia; Isifo seSerotonergic; Ityhefu yeSerotonin; Isifo se-SSRI-serotonin syndrome; Isifo se-MAO-serotonin

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Meehan TJ. Indlela yesigulana esinetyhefu. Ku: Iindonga RM, iHockberger RS, iGausche-Hill M, ii-eds. Unyango lukaRosen oluNgxamisekileyo: iikhonsepthi kunye nokuziqhelanisa neklinikhi. Umhla we-9. IPhiladelphia, PA: Elsevier; Ngo-2018: isahluko 139.