Lefu la Serotonin

Serotonin syndrome (SS) ke tšebetso e ka behang bophelo kotsing ea lithethefatsi. E etsa hore 'mele o be le serotonin e ngata haholo, khemik'hale e hlahisoang ke lisele tsa methapo.

SS hangata e etsahala ha meriana e 'meli e amang boemo ba' mele ea serotonin e nkoa hammoho ka nako e le 'ngoe. Meriana e etsa hore serotonin e ngata haholo e lokolloe kapa e lule sebakeng sa boko.

Ka mohlala, o ka ba le lefu lena haeba o nka meriana ea migraine e bitsoang triptans hammoho le li-anti-depressing tse bitsoang serotonin reuptake inhibitors (SSRIs), le serotonin / norepinephrine reuptake inhibitors (SSNRIs).

Li-SSRI tse tloaelehileng li kenyelletsa citalopram (Celexa), sertraline (Zoloft), fluoxetine (Prozac), paroxetine (Paxil), le escitalopram (Lexapro). SSNRIs e kenyelletsa duloxetine (Cymbalta), venlafaxine (Effexor), Desvenlafaxine (Pristiq), Milnacipran (Savella), le Levomilnacipran (Fetzima). Li-triptan tse tloaelehileng li kenyelletsa sumatriptan (Imitrex), zolmitriptan (Zomig), frovatriptan (Frova), rizatriptan (Maxalt), almotriptan (Axert), naratriptan (Amerge), le eletriptan (Relpax).

Haeba u noa meriana ena, etsa bonnete ba hore u bala temoso ho sephutheloana. E u joetsa ka kotsi e ka bang teng ea lefu la serotonin. Leha ho le joalo, u se ke oa emisa ho noa moriana oa hau. Bua le ngaka ea hau ka lintho tse u tšoenyang pele.

SS e na le monyetla oa ho etsahala ha o qala kapa o eketsa moriana.

Li-anti-depressing tsa khale tse bitsoang monoamine oxidase inhibitors (MAOIs) le tsona li ka baka SS ka meriana e hlalositsoeng kaholimo, hammoho le meperidine (Demerol, painkiller) kapa dextromethorphan (moriana oa sefuba).

Lithethefatsi tsa tlhekefetso, joalo ka ecstasy, LSD, cocaine le amphetamine le tsona li amahanngoa le SS.

Matšoao a hlaha kamora metsotso e seng mekae feela, 'me a kenyeletsa:

• Ho tsitsinyeha kapa ho hloka botsitso
• Ho sisinyeha ho sa tloaelehang ha mahlo
• Letšollo
• Ho otla ha pelo kapele le khatello e phahameng ea mali
• Litlelase
• Ho eketsa mocheso oa 'mele
• Tahlehelo ea khokahano
• Ho nyekeloa le ho hlatsa
• Maikutlo a fetelletseng
• Liphetoho tse potlakileng khatello ea mali

Hangata lefu lena le etsoa ka ho botsa motho lipotso ka nalane ea bongaka, ho kenyeletsoa mefuta ea lithethefatsi.

Ho fumanoa hore o na le SS, motho eo o tlameha hore ebe o ne a nkile sethethefatsi se fetolang boemo ba 'mele ba serotonin (serotonergic drug) mme bonyane a be le matšoao kapa matšoao a latelang a mararo:

• Moferefere
• Ho sisinyeha ho sa tloaelehang ha mahlo (clonus ea mahlo, e leng senotlolo sa ho fumana tlhahlobo ea SS)
  
• Letšollo
• Ho fufuleloa haholo eseng ka lebaka la tšebetso
• Feberu
• Maemo a kelello a fetoha, joalo ka pherekano kapa hypomania
• Li-spasms tsa mesifa (myoclonus)
• Maikutlo a fetelletseng (hyperreflexia)
• Ho thothomela
• Ho thothomela
• Mekhatlo e sa tsamaellaneng (ataxia)

SS ha e fumanoe ho fihlela lisosa tse ling tsohle tse ka bang teng li felisitsoe. Sena se ka kenyelletsa tšoaetso, botahoa, mathata a ts'oaetso le lihormone, le ho tlohela lithethefatsi kapa joala. Matšoao a mang a SS a ka etsisa a bakoang ke ho noa k'hok'heine, lithium kapa MAOI haholo.

Haeba motho a sa tsoa qala ho noa kapa ho eketsa litekanyetso tsa tranquilizer (moriana oa methapo ea kutlo), ho tla nahanoa ka maemo a mang a kang neuroleptic malignant syndrome (NMS).

Liteko li ka kenyelletsa:

• Litso tsa mali (ho hlahloba tšoaetso)
• Palo e felletseng ea mali (CBC)
• Tlhatlhobo ea CT ea boko
• Lithethefatsi (toxicology) le skrine ea joala
• Methati ea elektrolyte
• Electrocardiogram (ECG)
• Liteko tsa liphio le sebete
• Liteko tsa mosebetsi oa qoqotho

Batho ba nang le SS ba kanna ba lula sepetlele bonyane lihora tse 24 bakeng sa ho shebeloa ka hloko.

Kalafo e ka kenyelletsa:

• Meriana ea Benzodiazepine, e kang diazepam (Valium) kapa lorazepam (Ativan) ho fokotsa ho ferekana, ho sisinyeha ho kang ho ts'oaroa, le ho satalla ha mesifa
• Cyproheptadine (Periactin), sethethefatsi se thibelang tlhahiso ea serotonin
• Maro a kenang ka har'a methapo (ka methapo)
• Ho emisoa ha meriana e bakileng lefu lena

Maemong a sokelang bophelo, meriana e bolokang mesifa e khutsitse (ho e holofatsa), le phaephe ea nakoana ea ho hema le mochini oa ho hema o tla hlokahala ho thibela tšenyo e ngoe ea mesifa.

Batho ba ka mpefala butle-butle 'me ba ka kula haholo haeba ba sa phekoloe ka potlako. Ha e sa alafshoe, SS e ka ba kotsi. Ka kalafo, hangata matšoao a fela ka nako e ka tlase ho lihora tse 24. Ho ka senyeha setho ka ho sa feleng, leha ho ka phekoloa.

Mekhatlo e sa laoleheng ea mesifa e ka baka mesifa e matla. Lihlahisoa tse hlahisoang ha mesifa e robeha li ntšetsoa maling ebe qetellong li feta liphio. Sena se ka baka tšenyo e matla ea liphio haeba SS e sa tsejoe le ho phekoloa hantle.

Bitsa mofani oa tlhokomelo ea bophelo hang-hang haeba u e-na le matšoao a lefu la serotonin.

Kamehla bolella bafani ba hau hore na ke meriana efe eo u e sebelisang. Batho ba nkang li-triptan tse nang le li-SSRI kapa li-SSNIs ba lokela ho lateloa haufi-ufi, haholo hang kamora ho qala moriana kapa ho eketsa litekanyetso tsa ona.

Hypererotonemia; Lefu la Serotonergic; Chefo ea Serotonin; SSRI - lefu la serotonin; MAO - lefu la serotonin

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MD ea Levine, Ruha AM. Ho imeloa kelellong. Ka: Marako RM, Hockberger RS, Gausche-Hill M, eds. Rosen's Emergency Medicine: Likhopolo le Tloaelo ea Kliniki. La 9th. Philadelphia, PA: Elsevier; 2018: khaolo ea 146.

Meehan TJ. Atamela mokuli ea chefo. Ka: Marako RM, Hockberger RS, Gausche-Hill M, eds. Rosen's Emergency Medicine: Likhopolo le Tloaelo ea Kliniki. La 9th. Philadelphia, PA: Elsevier; 2018: khaolo ea 139.