E makaʻala kākou i ka Neuroleptic Malignant Syndrome, kahi maʻi weliweli i hoʻokumu ʻia e nā lāʻau neuroleptic!

ʻO ʻoe a i ʻole kekahi āu i ʻike ai e lawe ana paha i kahi ʻano lāʻau i kapa ʻia ʻo neuroleptic, kahi i hoʻohana ʻia e mālama i kekahi mau kūlana olakino noʻonoʻo. ʻOiai hiki i kēia mau lāʻau ke kōkua nui i nā poʻe he nui, aia nā hihia kakaikahi loa kahi e hiki ai i kēia mau lāʻau ke hoʻoulu i kahi kūlana weliweli, a hiki ke hoʻoweliweli i ke ola. ʻO ia ka mea a mākou e kapa nei ʻo Neuroleptic Malignant Syndrome (NMS). He inoa paʻakikī ia, akā he mea nui e ʻike e pili ana i ia mea.

He aha ka Neuroleptic Malignant Syndrome (NMS)? E hoʻomaopopo maʻalahi kākou!

I ka ʻōlelo maʻalahi, ʻo ka neuroleptic malignant syndrome (NMS) he hopena kakaikahi loa ia a he mea hoʻoweliweli paha i ke ola i kahi papa o nā lāʻau i kapa ʻia ʻo neuroleptics (ʻike ʻia hoʻi he mau lāʻau antipsychotic). Hoʻohana ʻia kēia mau lāʻau lapaʻau e mālama a mālama i nā hōʻailona o nā kūlana olakino noʻonoʻo he nui.

Hiki ke ʻike ʻia kekahi mau hōʻailona nui ma kēia kūlana `NMS`:

• Ke loaʻa nei ke kuni kiʻekiʻe (hyperthermia).
• Lilo nā ʻiʻo o ke kino i paʻa a ʻeha (inā hoʻomau kēia, hiki ke haki nā ʻiʻo).
• Nā loli i ke kūlana noʻonoʻo (e like me ka huikau, ka nalowale o ka hoʻomanaʻo).
• Ka hana ʻole ʻana o ka ʻōnaehana nerve autonomic a i ʻole dysautonomia.

Ua like ko kākou ʻōnaehana nerve autonomic me ka ʻōnaehana hana ponoʻī i loko o ko kākou kino. Hoʻomalu ia i nā mea e like me ke koko a me ka wikiwiki o ka hanu ʻana. Ke hana hewa ia, hiki i ke koko ke piʻi a iho koke, e hoʻoulu i ka hou nui (secondary hyperhidrosis), a hoʻoulu i ka salivation nui.

He pilikia olakino hoʻoweliweli ola ka NMS, e pono ai ke kōkua koke ʻana o ke kauka. No laila, inā ʻike ʻoe i kēia mau hōʻailona, ​​ʻo ka mea maikaʻi loa e hana ai, ʻo ia ke hele koke i ka haukapila.

He aha kēia mau lāʻau lapaʻau neuroleptic?

Hiki ke puʻunaue ʻia nā lāʻau lapaʻau neuroleptic, a i ʻole nā ​​​​lāʻau antipsychotic, i ʻelua mau ʻāpana nui.

1. Nā lāʻau antipsychotics hanauna mua a i ʻole "maʻamau".

2. Nā lāʻau antipsychotics hanauna ʻelua a i ʻole "atypical".

Ua kuhikuhi nā kauka i kēia mau antipsychotics hanauna mua a me ka lua no nā ʻano maʻi noʻonoʻo a me nā maʻi neurological like ʻole. Eia kekahi mau laʻana:

• Nā pilikia pili i ka hana e kū mai ana i ka dementia.
• Maʻi bipolar.
• Kaumaha.
• Nā maʻi ʻai.
• Maʻi hopohopo laulā.
• Hoʻonāukiuki ʻana o ka poʻe geriatric.
• ʻAʻole hiki ke hiamoe.
• Ka maʻi hoʻokaumaha-koʻikoʻi (OCD).
• Nā maʻi pilikino.
• Ka maʻi hoʻoluhi ma hope o ka trauma (PTSD).
Ka maʻi Schizoaffective . ʻO Schizophrenia a me nā maʻi pili.

He aha nā lāʻau lapaʻau e hiki ai ke hana i ka neuroleptic malignant syndrome (NMS)?

Aia kekahi mau ʻano lāʻau lapaʻau e hiki ai ke hoʻoulu i ka `NMS`. E nānā kākou i ko lākou ʻano.

Nā lāʻau lapaʻau neuroleptic (antipsychotic) maʻamau:

• ʻO Bromperidol
• ʻO Chlorpromazine `(Chlorpromazine)`
• ʻO Clopenthixol
• ʻO Fluphenazine `(Fluphenazine)`
• Haloperidol `(Haloperidol)`
• ʻO Loxapine
• ʻO Promazine
• ʻO Thioridazine `(Thioridazine)`
• ʻO Tiothixene
• ʻO Trifluoperazine `(Trifluoperazine)`

Nā lāʻau lapaʻau neuroleptic atypical (antipsychotic):

• ʻAmisulpride
• ʻAripiprazole
• ʻO Clozapine
• ʻOlanzapine
• ʻO Quetiapine
• ʻO Risperidone
• Ziprasidone
• ʻO Zotepine

ʻO kekahi mau lāʻau antiemetic:

• ʻO Domperidone
• Droperidol `(Droperidol)`
• ʻO Metoclopramide
• ʻO Prochlorperazine `(Prochlorperazine)`
• ʻO Promethazine

Nā lāʻau lapaʻau Dopaminergic (Parkinson) (ma ka hoʻōki koke ʻana i kēia mau mea):

• ʻAmantadine
• Nā agonists Dopamine
• ʻO Levodopa
• Tolcapone

Mai hopohopo i kēia papa inoa. ʻAʻole nā ​​​​kānaka a pau e lawe ana i kēia mau lāʻau lapaʻau e loaʻa iā NMS. He maʻi laha ʻole kēia. Akā inā ʻoe e lawe ana i kēia mau lāʻau lapaʻau, he mea nui e makaʻala i kēia.

He aha ka ʻokoʻa ma waena o ka NMS a me ka malignant hyperthermia?

Ua lohe paha ʻoe i kahi maʻi i kapa ʻia ʻo malignant hyperthermia. He hopena koʻikoʻi a kakaikahi hoʻi ia. Akā, ua hana ʻia ia e nā lāʻau lapaʻau anesthesia laulā a me nā mea hoʻomaha ʻiʻo .

Hiki iā ia ke hana i ka ʻoʻoleʻa o nā ʻiʻo, ka emi ʻana o nā reflexes (hyporeflexia), a me nā loli o ka ʻili (polū, ʻulaʻula). Hiki ke like kēia mau hōʻailona me nā hōʻailona o NMS. Eia nō naʻe, hiki i nā kauka ke hoʻokaʻawale i nā mea ʻelua ma ka nānā ʻana i ka mōʻaukala olakino o ka mea maʻi. ʻO ia hoʻi, inā ua loaʻa iā lākou ka anesthesia i hala koke nei a i ʻole ua lawe lākou i kahi lāʻau neuroleptic.

He aha ka ʻokoʻa ma waena o ka NMS a me ka Serotonin Syndrome?

ʻO ka maʻi Serotonin kekahi ʻano huikau. Hoʻokumu ʻia ia e nā lāʻau lapaʻau e pili ana i ka papa serotonergic, e like me kekahi mau antidepressants, amphetamines, antihistamines, a me nā mea hoʻopaʻa manaʻo. I ka ʻōlelo maʻalahi, hana ia i ka wā e nui loa ai kahi kemika i loko o ke kino i kapa ʻia ʻo serotonin.

ʻO nā hōʻailona o ka maʻi serotonin e komo pū me ka paʻakikī o nā ʻiʻo, ka hyperreflexia, ka maʻi diarrhea, ka hou ʻana, ka ʻūlū ʻana o nā ʻiʻo (myoclonus), a me nā loli o ke kūlana noʻonoʻo. Eia nō naʻe , ʻoi aku ka liʻiliʻi o ke kuni a me ka paʻakikī o nā ʻiʻo i ka maʻi serotonin ma mua o ka NMS.

E hoʻokaʻawale kāu kauka ma waena o kēia mau kūlana ʻelua ma ka hoʻolohe ʻana i kāu mau hōʻailona a me nā lāʻau lapaʻau āu e lawe nei.

ʻO wai ka mea e loaʻa ana i ka neuroleptic malignant syndrome (NMS)?

Hiki ke loaʻa ka NMS i kekahi mea e lawe ana i nā lāʻau neuroleptic (antipsychotic).

ʻOiai ua manaʻo ʻia aia ma kahi o ʻelua hapakolu o nā hihia NMS i loko o ka pule mua o ka hoʻomaka ʻana o ka lāʻau neuroleptic, he mea nui e hoʻomanaʻo e hiki ke hana ʻia kēia ʻano i kēlā me kēia manawa i ka wā o ka mālama ʻana.

Pehea ka maʻamau o kēia kūlana `NMS`?

ʻO kaʻoiaʻiʻo, he maʻi laha ʻole ka neuroleptic malignant syndrome (NMS). Loaʻa ia ma waena o 0.01% a me 3.2% o ka poʻe e lawe ana i nā lāʻau neuroleptic.

Eia nō naʻe, ʻo ka nūhou maikaʻi, ke emi nei ka nui o nā hōʻike o NMS ma muli o ka hoʻolauna ʻana o nā lāʻau lapaʻau hou i emi iho ka pilikia o ke kumu ʻana o NMS, a me ka ʻike o nā kauka a me nā mea maʻi e pili ana i kēia kūlana.

He aha nā hōʻailona o ka maʻi neuroleptic malignant (NMS)?

ʻO ka maʻamau, hoʻomaka nā hōʻailona o ka `NMS` e ʻike ʻia i loko o hoʻokahi a ʻekolu mau lā . ʻO nā hōʻailona nui:

• Ke kuni kiʻekiʻe loa (102 a 104 kekelē Fahrenheit - 38.9 a 40 kekelē Celsius).
• Nā ʻano hewa o ka manawa o ka puʻuwai (arrhythmia).
• Hoʻonui ʻia ka helu o ka puʻuwai (tachycardia).
• Hoʻonui ʻia ka nui o ka hanu ʻana (tachypnea).
• ʻOʻoleʻa/ʻoʻoleʻa o nā ʻiʻo `(ʻoʻoleʻa o nā ʻiʻo)`.
• Nā loli i ke kūlana noʻonoʻo (e like me ka huikau, ka hoʻonāukiuki, ka nalowale o ka ʻike).
• Ke koko kiʻekiʻe a i ʻole ke koko haʻahaʻa.
• Ka hou nui ʻana.

Inā loaʻa iā ʻoe kekahi a ʻoi aku paha o kēia mau hōʻailona, ​​ʻoiai inā ʻoe e lawe ana i ka lāʻau neuroleptic, e ʻoluʻolu e kelepona i ka 911 a i ʻole e hele koke i ka haukapila kokoke loa. He pilikia olakino kēia.

Pehea e hoʻoulu ai ka lāʻau lapaʻau neuroleptic i ka 'NMS'?

Hoʻokumu ʻia ke ʻano `NMS` e ka lāʻau neuroleptic (antipsychotic).Hiki ke hana me kahi mahele hoʻokahi, me ka hoʻonui ʻia o ka mahele, a i ʻole me ka hoʻomau ʻana o ka hoʻohana ʻana i ka mahele like. ʻOiai ʻo NMS e pili nui ana me nā antipsychotics hanauna mua, hiki nō hoʻi ke hana, i kahi liʻiliʻi, me ka hoʻopau koke ʻana o nā antipsychotics hanauna ʻelua, kekahi mau antiemetics, a me nā lāʻau dopaminergic i hoʻohana ʻia no ka maʻi Parkinson.

Ke hoʻāʻo nei nā kānaka ʻepekema e hoʻomaopopo pono i ke kumu o ka NMS. ʻO ke kumumanaʻo o kēia manawa, ua hoʻokumu ʻia ia e ka antagonism dopamine D2 receptor . He neurotransmitter ʻo Dopamine i loko o ko kākou lolo. He kemika ia e lawe ana i nā leka ma waena o nā cell. Hana nā lāʻau neuroleptic ma ke kāohi ʻana i kēia ʻelele dopamine mai ke komo ʻana i nā cell ma o nā receptors kikoʻī.

Ke ālai ʻia nā mea loaʻa dopamine i loko o kou hypothalamus a/a i ʻole ke kaula spinal, piʻi aʻe ka ʻūlū o nā ʻiʻo. Eia kekahi, ʻo ka hoʻopilikia ʻana o nā mea loaʻa dopamine i loko o ka hypothalamus ke kumu o ke kuni nui a me nā loli nui o ke koko i ʻike ʻia ma NMS.

Pehea e ʻike ʻia ai ka maʻi neuroleptic malignant syndrome (NMS)?

I mea e ʻike ai nā kauka i ka NMS, pono ʻoe e loaʻa i kēia mau hōʻailona a i ʻole nā ​​kūlana a pau :

• Ke lawe nei ʻoe i ka lāʻau neuroleptic a ua hoʻōki koke paha i ka lawe ʻana i ka lāʻau dopaminergic.
• He ʻeha nui kou mau ʻiʻo (hiki i kēia ke alakaʻi i ka haki ʻana o nā ʻiʻo).
• He wela nui kou.
• Aia kahi loli i kou kūlana noʻonoʻo.

Eia kekahi, pono e loaʻa ma ka liʻiliʻi ʻelua o nā ʻano ma lalo nei :

• Ka hou nui a ʻano ʻē paha.
• Paʻakikī ke ale ʻana.
• ʻAʻole hiki ke kāohi i ka mimi a i ʻole ka ʻōpala (incontinence).
• Hoʻonui ʻia ka helu o ka puʻuwai (tachycardia).
• ʻAʻole hiki ke kamaʻilio koke.
• Hoʻonui a pinepine paha nā loli i ke koko.
• Hoʻonui ʻia ka nui o nā sela koko keʻokeʻo (leukocytosis).
• Hoʻonui ʻia ka nui o ka creatine phosphokinase (CPK) ma muli o ka haki ʻana o nā ʻiʻo.
• Nā reflexes lohi a palena paha (hyporeflexia).

He aha nā hoʻokolohua e hana ʻia no ka ʻike ʻana i ka `NMS`?

Inā manaʻo kāu kauka he NMS kou, hiki iā lākou ke kauoha i nā hoʻokolohua e like me:

• Papa metabolic piha.
• Ka nānā ʻana i ka mimi.
• Hoʻāʻo kinoea koko arterial a venous paha.
• Hoʻāʻo koko Creatine phosphokinase (CPK).

Pehea e mālama ʻia ai ka neuroleptic malignant syndrome (NMS)?

He pilikia olakino ka NMS. No laila he mea nui e ʻike i ke kūlana a hoʻomaka koke i ka mālama ʻana. Inā loaʻa iā ʻoe ka NMS, pono paha ʻoe e lawe ʻia i ka haukapila.Pono ʻoe e loaʻa i ka lāʻau lapaʻau ma kahi keʻena mālama koʻikoʻi (ICU).

I nā hihia a pau o ka `NMS`, e hoʻōki koke nā kauka i ka lāʻau neuroleptic (antipsychotic) i hoʻokumu i ka `NMS`. Eia kekahi, e mālama lākou i nā hōʻailona o ka `NMS` a hana i nā hana e pale aku ai i nā pilikia hiki. Hiki i kēia mau lāʻau ke komo pū me:

• Ka mālama ʻana i ke kūpaʻa o ka puʻuwai a me ka hanu me ka hoʻohana ʻana i ka mechanical ventilation, nā lāʻau antiarrhythmic, a me/a i ʻole nā ​​pacemakers.
• Ka mālama ʻana i ke kaulike electrolyte i loko o ke kino ma o ka lawelawe ʻana i nā wai intravenous (IV fluids).
• Ke hoʻohaʻahaʻa nei i ka mahana o ke kino me ka hoʻohana ʻana i nā pākeke hoʻomaʻalili, ka wai hau, a me/a i ʻole nā ​​ʻeke hau.
• Inā kiʻekiʻe ke koko, e kāohi iā ia me ka lāʻau lapaʻau.
• Ke hāʻawi ʻana i nā lāʻau lapaʻau e like me ka heparin e pale ai i ke kāpili ʻana o ke koko.
• Ke lawelawe ʻana i nā lāʻau lapaʻau e hiki ai ke hoʻihoʻi i nā pae dopamine haʻahaʻa o ke kino.
• Ke hāʻawi nei i nā lāʻau hoʻomaha ʻiʻo a iwi paha.

He aha nā kumu pilikia no ka hoʻomohala ʻana i ka `NMS`?

Aia kekahi mau kumu e hoʻonui ai i ka pilikia o ka hoʻomohala ʻana i ka neuroleptic malignant syndrome (NMS):

• Ke hoʻomaka nei i kahi lāʻau neuroleptic (antipsychotic) hou a i ʻole ka hoʻonui ʻana i ka dosage.
• Ke hoʻohana nei i nā lāʻau lapaʻau neuroleptic ma mua o hoʻokahi a i ʻole ka hoʻohana ʻana i ka lāʻau lithium.
• Hoʻopau koke ʻia kahi lāʻau dopaminergic no ka maʻi o Parkinson.

Pehea ka lōʻihi e ho'ōla ai mai ka `NMS`? (Wānana)

Inā ʻike koke ʻia ka NMS a mālama pono ʻia, hoʻōla ka hapa nui o ka poʻe i loko o ʻelua pule a 14 mau lā.

Eia nō naʻe, inā hoʻopaneʻe ʻia ka mālama ʻana, hiki ke loaʻa nā pilikia koʻikoʻi e hoʻopilikia ai i nā ʻiʻo, nā puʻupaʻa, ka puʻuwai, a me/a i ʻole nā ​​​​māmā.

Inā ʻaʻole i mālama koke ʻia, hiki i ka NMS ke make. ʻO ka nui o ka make no ka NMS mai 5% a 20%. Eia nō naʻe, ua hoʻemi ka ʻike nui ʻana i ka NMS a me ka hoʻohana ʻana i nā lāʻau antipsychotic hou i kēia nui o ka make i nā makahiki he ʻumi i hala iho nei.

He nui ka poʻe, ma lalo o ke alakaʻi ʻana a ke kauka, hiki iā lākou ke hoʻomaka hou me ka holomua i ka lāʻau neuroleptic (antipsychotic).

He aha nā pilikia o ka neuroleptic malignant syndrome (NMS)?

ʻO ka mea pōʻino, he mea maʻamau a koʻikoʻi nā pilikia o ka NMS. Hoʻokumu ʻia kekahi mau pilikia e nā hōʻailona maʻamau o ka NMS a me ka hana ʻole o ka ʻōnaehana nerve autonomic, aʻo nā mea ʻē aʻe, ʻoiai nā maʻi, hiki ke hana ʻia e ka noho lōʻihi ʻana ma ka ʻāpana mālama koʻikoʻi (ICU).

ʻO kekahi o nā pilikia o ka NMS:

• ʻO Rhabdomyolysis (ka haki ʻana o nā ʻōpū uaua - ʻo ia ka pilikia maʻamau).
• Ka maloʻo ʻana o ka wai.
• Ka hāʻule ʻana o ka puʻupaʻa.
• Ka hāʻule ʻana o ka hanu koʻikoʻi.
• Nā maʻi epilepsy/ nā hopu ʻana .
• Ka maʻi ʻōpū o ka puʻuwai.
• Ke kāpili ʻana o ke koko ma ke kino holoʻokoʻa (Disseminated intravascular coagulation).
• Ka hemahema o ke akepaʻa.
• Pneumonia.
• Sepsis (ke komo ʻana o nā germs i ke koko).
• ʻO ka maʻi ʻaʻai mimi (UTI).
• ʻO ka embolism pulmonary.

Ma muli o ke koʻikoʻi o kēia mau pilikia a me ka hoʻoweliweli i ke ola, he mea nui loa ia e kāhea koke i ka 911 a hele i ka haukapila kokoke loa no ka mālama olakino inā loaʻa iā ʻoe nā hōʻailona o NMS. Eia hou, he pilikia hoʻoweliweli ke ola o NMS a pono paha e mālama ʻia ma ka Intensive Care Unit (ICU).

Āhea wau e ʻike ai i kaʻu kauka?

Inā ʻoe e lawe ana i hoʻokahi a ʻoi aku paha nā lāʻau neuroleptics (antipsychotics), antiemetics, a/a i ʻole dopaminergic (Parkinson's), he mea nui e ʻike pinepine i kāu kauka e hōʻoia i ka hana pono ʻana iā ʻoe. Eia kekahi, e nīnau i kāu kauka e pili ana i nā hopena ʻaoʻao o nā lāʻau āu e lawe nei a me nā hōʻailona āu e pono ai e makaʻala.

Pono anei au e hele i ka ʻOihana Pilikia (ETU) inā loaʻa iaʻu nā hōʻailona o ka 'NMS'?

Inā loaʻa iā ʻoe nā hōʻailona o ka neuroleptic malignant syndrome (NMS), e like me ke kuni kiʻekiʻe loa a me ka ʻoʻoleʻa o nā ʻiʻo, he mea nui e kāhea koke i ka 911 a hele paha i ka haukapila kokoke loa. Pono ka NMS i ka mālama lapaʻau koke. Inā ʻaʻole mālama koke ʻia a kūpono hoʻi, hiki iā ia ke alakaʻi i ka make.

He maʻi koʻikoʻi a hoʻoweliweli i ke ola ka maʻi neuroleptic malignant (NMS). No laila, inā loaʻa iā ʻoe nā hōʻailona, ​​​​he mea nui e ʻimi koke i ke kōkua lapaʻau. ʻOi aku ka maʻalahi o ka mālama ʻana i ka NMS inā loaʻa koke. ʻOiai he mea kakaikahi ka NMS, inā ʻoe e lawe ana i ka lāʻau neuroleptic (antipsychotic), e kamaʻilio me kāu kauka a kauka lāʻau paha e pili ana i nā hopena ʻaoʻao a me nā hōʻailona e makaʻala ai. Aia lākou ma laila e kōkua iā ʻoe.

ʻO nā mea nui a mākou i aʻo ai mai kēia ʻatikala (Leka Lawe-Home)

ʻAe, e hoʻomanaʻo kākou iā ʻoe i kekahi o nā mea nui e hoʻomanaʻo ai mai nā mea a mākou i kamaʻilio ai ma kēia `NMS`:

• He kūlana kakaikahi ka NMS, akā he maʻi hoʻoweliweli paha i ke ola i hoʻokumu ʻia e nā lāʻau neuroleptic.
• ʻO ke kuni nui, ka ʻehaʻeha o nā ʻiʻo, a me ka huikau o ka noʻonoʻo nā hōʻailona nui.
• Inā ʻike ʻoe i kekahi o kēia mau hōʻailona, ​​e ʻimi koke i ke kōkua lapaʻau. Mai hoʻokaʻulua.
• Inā ʻoe e lawe ana i ka lāʻau neuroleptic, e kamaʻilio me kāu kauka e pili ana i ka lāʻau a me kona mau hopena ʻaoʻao. Mai makaʻu e nīnau.
• Hiki ke ho'ōla loa ʻia ka NMS inā ʻike ʻia a mālama ʻia i ka wā mua.

Ke lana nei ko mākou manaʻo ua hoʻomaopopo ʻia ʻoe e kēia ʻike. E noho olakino!

ʻO ka Neuroleptic Malignant Syndrome, NMS, nā lāʻau lapaʻau noʻonoʻo, nā hopena ʻaoʻao, ke kuni nui, ka ʻoʻoleʻa o nā ʻiʻo