Ingabe imithi oyiphuzayo iyisimo esiyingozi? Ake sifunde nge-Serotonin Syndrome?

Namuhla sizokhuluma ngesimo esibucayi kancane, kodwa esingalawulwa kalula uma usazi. Ungase uphuze imithi yokucindezeleka noma esinye isimo. Ngezinye izikhathi le mithi ingabangela izinguquko emizimbeni yethu futhi ibangele izinkinga esingenakuzicabanga. Esinye isimo esinjalo yi-serotonin syndrome.

Iyini i-Serotonin Syndrome?

Kalula nje, i-Serotonin Syndrome iwukusabela kwezidakamizwa okungaba yingozi empilweni ngezinye izikhathi, okwenzeka uma kunekhemikhali eliningi kakhulu elibizwa ngokuthi i-serotonin emzimbeni wakho.

Cabanga ngakho, i-serotonin iyisithunywa samakhemikhali esibaluleke kakhulu esikhiqizwa amangqamuzana ezinzwa ebuchosheni bethu nakwezinye izingxenye zomzimba. Uma sikhuluma iqiniso, iyisithunywa esithwala imiyalezo phakathi kwamangqamuzana ezinzwa. Lokhu sikubiza ngokuthi i-neurotransmitter . Le serotonin ithinta izinto eziningi, njengemizwa yethu, ukulala, kanye nesifiso sokudla.

Iningi labantu lingayithatha ngokuphephile imithi ethinta i-serotonin (i-serotonergic) ngemithamo enconyiwe, njengoba kunqunywe udokotela wabo. Kodwa-ke, i-serotonin syndrome ingenzeka kakhulu uma uqala umuthi omusha noma wandisa umthamo womuthi osuvele uwuthatha, ikakhulukazi uma umuthi ukhulisa amazinga akho e-serotonin. Uma umzimba wakho ushintsha indlela osebenzisa ngayo i-serotonin, noma uma ungakwazi ukubhekana namazinga e-serotonin akhuphukile, ungase ube nezimpawu ze-serotonin syndrome.

Lesi simo singasukela ezimpawini ezincane ezifana nesifo sohudo kanye nesicanucanu kuya ezimpawini ezinzima njengomkhuhlane ophakeme kanye nokuquleka. Kwezinye izimo, i-serotonin syndrome enzima ingaba yingozi empilweni uma ingaqashelwa futhi yelashwe ngokushesha.

Odokotela baqala ukuhlonza i-serotonin syndrome ngawo-1960, ngemuva kokuba imithi yokuqala yokucindezeleka ivunyelwe. Namuhla, njengoba kutholakala imithi eminingi ethinta i-serotonin, amacala e-serotonin syndrome abikwa kaningi.

Ubani ongakuthuthukisa lokhu?

Eqinisweni, noma ubani angakuthola lokhu, kungakhathaliseki ubudala bakhe. Uma usebenzisa noma yimiphi imithi kadokotela, imithi ethengwa ngaphandle kwemithi kadokotela, izithasiselo zamakhambi noma zokudla, noma imithi engekho emthethweni ethinta amazinga akho e-serotonin, usengozini yokuthola i-serotonin syndrome.

Yiziphi izimpawu ezivame kakhulu zalokhu?

Izimpawu kanye nobukhali be-serotonin syndrome kungahlukahluka kumuntu nomuntu. Zingaba mnene, zibe maphakathi, zibe nzima, futhi zibulale.

Uma uthatha umuthi othinta i-serotonin futhi unezinye zalezi zimpawu, shayela udokotela wakho ngokushesha noma uye ekamelweni eliphuthumayo.

Izimpawu ezincane

• Ngizizwa nginovalo futhi ngingakhululekile.
• Ukuzizwa unesicanucanu nokuhlanza.
• Ukuqunjelwa kwesisu (uhudo).
• Izimbotshana ezimnyama emehlweni ziba zinkulu (izimbotshana ezivulekile).
• Ukuzwa sengathi izitho zakho ziyathuthumela (Ukwethuka).

Izimpawu ezimaphakathi

• Ngizizwa ngingakhululekile futhi ngikhathazekile.
• Ukunyakazisa imisipha, ukufinyela kwemisipha okungahleliwe, ukuqaqamba kwemisipha, ukuqina kwemisipha.
• Ukujuluka kakhulu, ukuthuthumela ngenxa yamakhaza.
• Amehlo ahamba ngendlela engavamile ukusuka kolunye uhlangothi kuya kolunye.

Izimpawu ezinzima

• Ukudideka okukhulu, njengokungathi ingqondo iyaphazamiseka, umuntu uyakhohlwa ukuthi ukuphi nokuthi isikhathi sini (Ukudideka, ukudideka, ukuphambana).
• Isilinganiso senhliziyo sikhula kakhulu (isilinganiso senhliziyo esisheshayo).
• Umfutho wegazi ophezulu.
• Izinga lokushisa lomzimba eliphakeme lingaphezu kwama-degree Celsius angu-38.5 (101.3 degrees Fahrenheit).
• Kuza ukuquleka.
• Ukushaya kwenhliziyo kuba okungajwayelekile.
• Ngilahlekelwa ingqondo bese ngiyawa.

Izimpawu zibonakala ngokushesha kangakanani?

Lezi zimpawu zivame ukuqala ukubonakala zingakapheli amahora ambalwa , kungaba ngemva kokuqala umuthi omusha othinta amazinga e-serotonin noma ngemva kokwandisa umthamo womuthi owuthathayo njengamanje. Cishe wonke umuntu uba nezimpawu zingakapheli amahora angama-24 ethatha umuthi noma umkhiqizo othinta i-serotonin.

Kungani lokhu kwenzeka? Yiziphi izizathu?

Imbangela eyinhloko ye-serotonin syndrome ukwanda kwamazinga e-serotonin emzimbeni wakho. Lokhu kungenzeka ezimweni ezinjengalezi:

• Uma usebenzisa imithi engaphezu kweyodwa lokho kuthinta amazinga e-serotonin.
• Uma uqala umuthi omusha okhulisa i-serotonin, noma uma ukhulisa umthamo womuthi owusebenzisayo njengamanje.
• Uma uphuza imithi eminingi ehlobene ne-serotonin, mhlawumbe ngengozi noma ngamabomu.
• Uma usebenzisa izidakamizwa ezithile ezingekho emthethweni, imikhiqizo yamakhambi , noma izidakamizwa ezithengiswa ngaphandle kwemithi ezithinta amazinga e-serotonin.

Yimiphi imithi nezinye izinto ezithinta amazinga e-serotonin?

Manje ake sibone ukuthi yiziphi izinhlobo zemithi ezingathinta amazinga e-serotonin futhi zibangele i-serotonin syndrome.

Imithi yokucindezeleka

Phakathi kwalezi, imithi yokucindezeleka iyona ebaluleke kakhulu. Lena imithi ethinta amazinga e-serotonin kakhulu. Lesi simo sivame ukwenzeka lapho le mithi yokucindezeleka isetshenziswa kanye neminye imithi ethinta i-serotonin, njenge-triptans ye-migraines noma i-opioids yokuqeda ubuhlungu.

Nazi ezinye izigaba zemithi yokucindezeleka kanye nezibonelo:

• `Ama-Selective serotonin reuptake inhibitors (SSRIs): Leli qembu lihlanganisa izidakamizwa ezifana ne-`fluoxetine (Prozac®), `citalopram (Celexa®), `sertraline (Zoloft®), `paroxetine (Paxil®)` kanye ne-`escitalopram (Lexapro®).` Lezi yizona ezisetshenziswa kakhulu futhi ngenxa yalokho ezihlotshaniswa kakhulu ne-serotonin syndrome.
• Ama-Serotonin-norepinephrine reuptake inhibitors (ama-SNRI): Izibonelo zifaka phakathi i-duloxetine (i-Cymbalta®), i-venlafaxine (i-Effexor®), i-desvenlafaxine (i-Pristiq), i-levomilnacipran (i-Fetzima), kanye ne-milnacipran (i-Savella).
• `Ama-antidepressant e-Tricyclic`: Leli qembu lihlanganisa izidakamizwa ezifana ne-`amitriptyline (Elavil®)`, `clomipramine (Anafranil®)`, kanye ne-`nortriptyline (Pamelor®).`
• `Ama-Monoamine oxidase inhibitors (MAOIs): Izidakamizwa ezifana ne-`phenelzine (Nardil®)`, `selegiline (Emsam®)` kanye ne-`tranylcypromine (Parnate®)` zikulesi sigaba.
• Ama-modulator e-Serotonin: njenge-nefazodone kanye ne-trazodone (Desyrel®).
• Isibonelo salokhu yi -`Norepinephrine reuptake inhibitor`: `bupropion (Wellbutrin®).`

Eminye Imithi

Ngaphezu kwemithi yokucindezeleka, kuneminye imithi ethinta amazinga e-serotonin emzimbeni. Ingozi iphezulu kakhulu uma ihlanganiswa neminye imithi ethinta ne-serotonin. Le mithi isetshenziselwa:

• Ngobuhlungu obukhulu: Ama-painkiller avela ku-opioid class, njenge-tramadol (Ultram®), i-meperidine (Demerol®), i-tapentadol (Nucynta®), i-hydrocodone (Hysingla ER®), i-oxycodone (Oxycontin®), i-fentanyl (Actiq®), kanye ne-methadone.
• Ukukhwehlela: Eminye imithi yokukhwehlela neyomkhuhlane ethengiswa ngaphandle kwemithi kadokotela (i-OTC), njenge-dextromethorphan, ingathinta amazinga e-serotonin.
• Ngekhanda elibuhlungu elibangelwa yi-migraine: Ama-Triptan ahlanganisa i-almotriptan (Axert®), i-eletriptan (Relpax®), kanye ne-sumatriptan (Imitrex®).
• Nge-HIV/AIDS: `ritonavir (Norvir®)`.
• Ama-antibiotic: i-linezolid (i-Zyvox®).
• Imithi yokucanuzela nokuhlanza: njenge-`metoclopramide (Reglan®)`, `granisetron (Sustol®)`, `ondansetron (Zofran®)`.
• Isiqinisi semizwa: i-lithium (i-Lithobid®).

Eminye Imikhiqizo

Ngaphezu kwemithi, amanye amakhambi endabuko, izithasiselo zokudla, kanye nezidakamizwa ezingekho emthethweni kungathinta amazinga e-serotonin futhi kubangele lesi simo.

• Izithasiselo zemithi: Lokhu kungafaka izinto ezifana ne-ginseng, i-St. John's wort, i-Syrian rue, kanye ne-nutmeg.
• Izidakamizwa ezingekho emthethweni: Izinto ezifana ne-ecstasy, i-LSD, i-cocaine, ama-amphetamine, kanye ne-methamphetamine.
• Isengezo sokudla:I-Tryptophan.

Ochwepheshe bezokwelapha basafunda okuningi nge-serotonin syndrome. Uma unemibuzo mayelana nemithi oyithathayo nokuthi iyayithinta yini i-serotonin, khuluma nodokotela wakho noma nomuntu osekhemisi lapho uthola khona imithi yakho.

Odokotela bakubona kanjani lokhu?

Manje ake sibone ukuthi odokotela bakuthola kanjani lokhu. Empeleni akukho ukuhlolwa okuqondile okuqinisekisa i-serotonin syndrome. Udokotela wakho uvame ukukuthola ngokukuhlola, ukubuza ngezimpawu zakho, nokufunda ngemithi oyiphuzayo ethinta amazinga akho e-serotonin.

Ungasiza udokotela wakho ngokucacisa konke okuthathayo (imithi kadokotela, imithi ethengiswa ngaphandle kwemithi kadokotela, izithasiselo, imithi yamakhambi, ngisho nemithi engekho emthethweni). (Yiba neqiniso, ungesabi. Udokotela ukhona ukukusiza, hhayi ukukwahlulela.)

Udokotela wakho angase futhi enze izivivinyo ezifana nalezi:

• Ukuhlolwa kwegazi nomchamo ukuhlola amazinga emithi oyiphuzayo.
• Ukuhlolwa ukuze kubonakale ukuthi ezinye izitho zakho zisebenza kahle yini.
• Ukuhlolwa ukuze kubonakale ukuthi kukhona yini ukutheleleka emzimbeni, mhlawumbe ngisho nokumpompa komgogodla.
• Kungenziwa i-X-ray yesifuba noma i-CT scan ukuqinisekisa ukuthi azikho ezinye izimo (ezinezimpawu ezifanayo) noma ukuhlola ezinye izinkinga.

Kuphathwa kanjani lokhu?

Ukwelashwa okutholayo kuzoncika ekutheni izimpawu zakho zimbi kangakanani.

• Izimpawu ezincane: Uma izimpawu zincane, ukuyeka umuthi noma ukushintsha umthamo kuvame ukuxazulula izimpawu zingakapheli amahora angama-24 kuya kwangama-72 . Uma izimpawu zingapheli ngokushesha, umuthi ovimba i-serotonin njenge-cyproheptadine (Periactin®) unganikezwa.
• Izimpawu ezimaphakathi: Uma izimpawu zakho zimaphakathi, uzogcinwa esibhedlela okungenani amahora angama-24 ukuze ubone ukuthi izimpawu zakho ziyathuthuka yini ngokwelashwa.
• Izimpawu ezibucayi: Uma izimpawu zinzima kakhulu, uzolaliswa e-Intensive Care Unit (ICU) lapho umzimba wakho kanye nokusebenza kwezitho zomzimba kuzoqashwa khona ngokucophelela.

Kuye ngezimpawu, ukwelashwa okulandelayo kunganikezwa:

• Umuthi wokudambisa njenge-benzodiazepine unganciphisa izimpawu ezifana nokucasuka, ukuqina kwemisipha, kanye nokuxhuzula.
• I-Saline `(IV fluids)` inikezwa ukunciphisa ukugcinwa koketshezi kanye nomkhuhlane, kanti i-oxygen inikezwa nge-`(mask)` ebusweni ukuze kuthuthukiswe izinga le-oxygen egazini.
• Umuthi wokulawula ukushaya kwenhliziyo kanye nomfutho wegazi.
• Ukuze kuncishiswe umkhuhlane ophezulu kakhulu (41.1 degrees Celsius / 106 degrees Fahrenheit), kufakwa ipayipi lokuphefumula ngenxa yobunzima bokuphefumula, kunikezwe umuthi wokudambisa ukuphefumula, bese kunikezwa imithi yokuphumula imisipha.
• Uma ezinye izindlela zokwelapha zinganikezi impumuzo esheshayo, kunikezwa umuthi wokuvimbela i-serotonin obizwa ngokuthi i-cyproheptadine.

Uma i-serotonin syndrome yakho ibangelwe umuthi wokucindezeleka, kungathatha amasonto ambalwa ukuthi umuthi uphume ngokuphelele emzimbeni wakho nokuthi izimpawu zakho zinyamalale ngokuphelele.

Okubaluleke kakhulu: Ungayeki ukuthatha noma yimuphi umuthi noma ushintshe umthamo ngaphandle kokukhuluma nodokotela wakho. Kodwa-ke, uma unezimpawu ezinzima noma uma izimpawu zakho ziba zimbi kakhulu, funa usizo lwezokwelapha oluphuthumayo ngokushesha. I-Serotonin syndrome ingaba yingozi empilweni.

Yiziphi izinkinga ezingaba khona?

Uma ingelashwa, i-serotonin syndrome ingaholela ezinkingeni ezifana nalezi:

• Ukuquleka.
• Ubunzima bokuphefumula.
• Ukwehluleka kwezinso. Lapho imikhiqizo yokuqhekeka kwemisipha iqoqana egazini futhi ihlungwa yizinso, kungabangela umonakalo omkhulu wezinso uma kungelashwa.
• Isimo se-Coma.
• Ngisho nokufa kungenzeka.

Sisindiswa kanjani kulokhu?

• Kubaluleke kakhulu ukunaka kakhulu noma yimuphi umuthi owuthathayo. Funda zonke izixwayiso ezisephaketheni lemithi noma ephepheni lolwazi elihambisana nayo. Izokutshela ukuthi kukhona yini ingozi ye-serotonin syndrome.
• Ungayeki noma yimiphi imithi ngaphandle kokukhuluma nodokotela wakho.
• Hlala unolwazi ngodokotela bonke abakwelaphayo ngayo yonke imithi oyithathayo (imithi kadokotela, imithi ethengiswa ngaphandle kwemithi kadokotela, amakhambi endabuko, izithasiselo, ngisho nemithi engekho emthethweni).
• Uma uthatha i-triptan ye-migraines kanye nemithi yokucindezeleka (ikakhulukazi ama-SSRI noma ama-SNRI), udokotela wakho kufanele akuqaphe eduze. Ingozi kucatshangwa ukuthi incane kakhulu, mhlawumbe ayikho nhlobo. Kodwa khumbula, unesibopho: Uma uhlangabezana nanoma yiziphi izimpawu ezishiwo kulesi sihloko, shayela udokotela wakho ngokushesha.
• Ukulandela lezi zinyathelo zokuqapha kuzokusiza wena nodokotela wakho ukuthi nibone izimpawu ze-serotonin syndrome kusenesikhathi. Ukutholwa kusenesikhathi kungasiza ekuvimbeleni izimpawu ezinzima.

Yini okufanele siyilindele kulesi simo?

Uma ziqashelwa futhi zelashwa ngokushesha, izimpawu zabantu abaningi zizophela ngokuphelele zingakapheli amahora angama-24 kuya kwangama-72.

Ngemva kokululama, udokotela wakho angase:

• Nciphisa umthamo womuthi obangele lesi simo ube umthamo ophansi kakhulu osebenzayo.
• Yeka ukunikeza imithi emibili equkethe umthamo ophezulu ethinta i-serotonin ndawonye.
• Shintshela komunye umuthi ongathinti i-serotonin.

Kufanele ngishayele nini udokotela wami ucingo?

• Uma unezimpawu ze-serotonin syndrome (noma izimpawu eziya ziba zimbi kakhulu), shayela udokotela wakho ngokushesha noma uye egumbini lezimo eziphuthumayo. Qaphela kakhulu uma usuqalile umuthi omusha, wandise umthamo womuthi okhona njengamanje, noma uthatha imithi owaziyo ukuthi ithinta amazinga e-serotonin.
• Ungayeki ukuphuza imithi noma ushintshe umthamo ngaphandle kokukhuluma nodokotela wakho.
• Qiniseka ukuthi bonke odokotela bakho bayazi ngayo yonke imithi oyiphuzayo.
• Funda izixwayiso namapheshana olwazi ahambisana nomuthi wakho ngokucophelela.
• Funda ngezimpawu ze-serotonin syndrome. Qaphela kakhulu lezi zimpawu uma uthatha imithi yokucindezeleka.
• Uma unemibuzo mayelana nemithi noma izimpawu zakho, buza udokotela wakho noma usokhemisi.
• Uma ubona izimpawu, noma uma izimpawu zakho ziba zimbi kakhulu, ungakhohlwa ukushayela udokotela wakho ucingo ngokushesha noma uye ekamelweni lezimo eziphuthumayo.

Yimuphi umyalezo esifuna ukuwuthatha ekhaya kule ndaba?

• I-Serotonin Syndrome yisimo esingaba sibi kakhulu, kodwa singelapheka uma siphathwa kahle.
• Khuluma nodokotela wakho ngokukhululekile nganoma yimiphi imithi oyithathayo, ikakhulukazi uma uqala omusha noma ushintsha umthamo.
• Qaphela izimpawu. Uma unemibuzo , funa iseluleko sezokwelapha ngaphandle kokuchitha isikhathi.
• Khumbula, uyazi impilo yakho kangcono, ngakho-ke kubalulekile ukuqaphela noma yiziphi izinguquko.

I- Serotonin syndrome, i-serotonin, ama-antidepressants, imiphumela emibi yezidakamizwa, amakhemikhali obuchopho, ama-neurotransmitters, ukusabela kwezidakamizwa