Serotonin maʻi maʻi

ʻO Serotonin syndrome (SS) kahi hopena lāʻau hoʻoweliweli ola. Hoʻokumu ia i ke kino i ka nui o ka serotonin, kahi kemika i hana ʻia e nā hunaola nerve.

Hana pinepine ʻo SS ke lawe ʻia nā lāʻau lapaʻau ʻelua e hoʻopili i ke kiʻekiʻe o ke kino o serotonin i ka manawa like. Hoʻokumu nā lāʻau i ka serotonin he nui a hoʻokuʻu ʻia paha i ka wahi o ka lolo.

ʻO kahi laʻana, hiki iā ʻoe ke hoʻomohala i kēia maʻi inā lawe ʻoe i nā lāʻau migraine i kapa ʻia ʻo triptans me nā antidepressants i kapa ʻia he selotonin reuptake inhibitors (SSRI), a me nā serotonin / norepinephrine reuptake inhibitors (SSNRIs).

ʻO nā SSRI maʻamau ka citalopram (Celexa), sertraline (Zoloft), fluoxetine (Prozac), paroxetine (Paxil), a me escitalopram (Lexapro). ʻO SSNRIs kahi duloxetine (Cymbalta), venlafaxine (Effexor), Desvenlafaxine (Pristiq), Milnacipran (Savella), a me Levomilnacipran (Fetzima). Loaʻa nā triptans maʻamau sumatriptan (Imitrex), zolmitriptan (Zomig), frovatriptan (Frova), rizatriptan (Maxalt), almotriptan (Axert), naratriptan (Amerge), a me eletriptan (Relpax).

Inā ʻoe e lawe i kēia mau lāʻau, e heluhelu pono i ka ʻōlelo aʻoaʻo ma ka ʻōpala. Hōʻike ia iā ʻoe e pili ana i ka makaʻu o ka serotonin syndrome. Eia naʻe, mai hōʻoki i ka lawe ʻana i kāu lāʻau. E kamaʻilio mua i kāu kauka e pili ana i kāu mau hopohopo.

Kū paha ʻo SS ma ka hoʻomaka a hoʻonui ʻana paha i ka lāʻau.

ʻO nā antidepressants kahiko i kapa ʻia ʻo monoamine oxidase inhibitors (MAOI) hiki ke hana iā SS me nā lāʻau i hōʻike ʻia ma luna, a me meperidine (Demerol, kahi painkiller) a i ʻole dextromethorphan (lāʻau lapaʻau maʻa).

ʻO nā lāʻau lapaʻau hoʻomāinoino, e like me ecstasy, LSD, cocaine, a me nā amphetamines i pili pū me SS.

Hana ʻia nā ʻōuli ma loko o mau minuke i mau hola, a pili pū paha:

• ʻO ka hoʻonāukiuki a hoʻomaha ʻole paha
• Nā neʻe maka ʻole
• Pohā
• ʻO ke kuʻi wikiwiki a me ke kahe kiʻekiʻe
• Nā Haleluʻa
• Hoʻonui i ka mahana o ke kino
• Lilo o ka hoʻohui ʻana
• ʻO Nusea a me ka luaʻi
• Nā reflexes overactive
• Hoʻololi wikiwiki i ke kahe o ke koko

Hana pinepine ʻia ke kuhi ma ka nīnau ʻana i ke kanaka i nā nīnau e pili ana i ka mōʻaukala, e like me nā ʻano o nā lāʻau.

E ʻike ʻia me SS, ua lawe paha ke kanaka i ka lāʻau e hoʻololi i ke kiʻekiʻe o ke serotonin o ke kino (lāʻau lāʻau serotonergic) a ma ka liʻiliʻi he ʻekolu o kēia mau hōʻailona a hōʻailona paha:

• Hoʻoikaika
• ʻO ka neʻe ʻana o ka maka maʻamau (clonus ocular, kahi ʻike nui i ka hoʻokumu ʻana i kahi hōʻailona o SS)
  
• Pohā
• ʻAʻole ka sweating kaumaha ma muli o ka hana
• Fiva
• Hoʻololi ke kūlana noʻonoʻo, e like me ka huikau a hypomania paha
• Nā spasms Muscle (myoclonus)
• ʻO nā reflexes overactive (hyperreflexia)
• ʻO Shivering
• Haʻalulu
• Nā hoʻoneʻe hoʻohuihui ʻole (ataxia)

ʻAʻole ʻike ʻia ʻo SS a hiki i ka wā i kāpae ʻia ai nā kumu kūpono ʻē aʻe. Hiki i kēia ke hoʻopili i nā maʻi, ʻona, metabolic a me nā pilikia hormone, a me ka haʻalele ʻana i ka lāʻau a ʻalekoh paha. Hiki i kekahi mau hōʻailona o SS ke hoʻohālikelike i kēlā mau mea no ka overdose o ka cocaine, lithium, a me kahi MAOI.

Inā ua hoʻomaka kahi kanaka e lawe a hoʻonui paha i nā mea o ka tranquilizer (lāʻau neuroleptic), e noʻonoʻo ʻia nā ʻano ʻē aʻe e like me neuroleptic malignant syndrome (NMS).

E komo pū paha nā hoʻāʻo:

• ʻO nā moʻomeheu koko (e nānā i ka maʻi)
• Helu piha koko (CBC)
• CT scan o ka lolo
• Laau ʻona (toxicology) a me ka pale ʻalekohola
• Nā pae uila
• Electrocardiogram (ECG)
• Nā hoʻāʻo ʻana o ka hakuʻala a me ke ake
• Nā hoʻāʻo ʻana o ka hana thyroid

E noho paha ka poʻe me SS ma ka haukapila no 24 mau hola no ka nānā pono ʻana.

Hiki ke hoʻopili ʻia i ka mālama ʻana:

• ʻO nā lāʻau Benzodiazepine, e like me diazepam (Valium) a i ʻole lorazepam (Ativan) e hoʻēmi i ka hoʻonāukiuki, ka neʻe ʻana e like me nā neʻe, a me ka ʻāʻī puʻupuʻu
• ʻO Cyproheptadine (Periactin), kahi lāʻau e ālai ana i ka hana serotonin
• Hoʻopili (ma o ka aa) nā wai
• Ka hoʻopau ʻana i nā lāʻau i kumu i ka maʻi maʻi

I nā hihia hoʻoweliweli i ke ola, nā lāʻau lapaʻau e mālama mau i nā mākala (paralyze iā lākou), a me kahi ʻōnaehana hanu manawa ʻole a me ka mīkini hanu e pono ai e pale i ka hōʻino hou ʻana o nā mākala.

E hele lohi paha ka ʻino o nā kānaka a hiki ke maʻi nui inā ʻaʻole e mālama koke ʻia. ʻAʻole mālama ʻia, SS hiki ke make. Me ka lapaʻau ʻana, hele pinepine nā ʻōuli ma lalo o 24 mau hola. Hiki paha ke hopena i nā hōʻino kino paʻa, ʻoiai me ka lāʻau.

Hiki i nā spasms mākala i kaohi ʻole ʻia ke hōʻemi i ka nāwaliwali o nā mākala. Hoʻopuka nā huahana i ka wā e wāwahi ai nā mākala i loko o ke koko a hele i waena o nā puʻupaʻa. Hiki i kēia ke kumu i ka hōʻino ʻana i nā puʻupaʻa koʻikoʻi inā ʻaʻole ʻike ʻia a mālama maikaʻi ʻia ʻo SS.

Kāhea koke i kāu kauka mālama inā loaʻa nā ʻōuli o ka serotonin syndrome.

E haʻi mau i kāu poʻe lawelawe i nā lāʻau āu e lawe ai. ʻO ka poʻe e lawe triptans me SSRI a i ʻole SSNRIs e pono e ukali pono ʻia, keu hoʻi ma hope pono o ka hoʻomaka ʻana i kahi lāʻau a hoʻonui paha i kāna ana.

Hyperserotonemia; Serotonergic maʻi pale; Serotonin ʻino; SSRI - maʻi maʻi serotonin; MAO - maʻi maʻi serotonin

ʻO Fricchione GL, Kahakai SR, Huffman JC, Bush G, Stern TA. ʻO nā kūlana hoʻoweliweli ola i psychiatry: catatonia, neuroleptic malignant syndrome, a me serotonin syndrome. I: Stern TA, Fava M, Wilens TE, Rosenbaum JF, eds. ʻO ka haukapila laulima ʻo Massachusetts General Hospital. ʻElua ed. Piladelapia, PA: Elsevier; 2016: chap 55.

ʻO Levine MD, Ruha AM. Nā Antidepressants. I: Nā paia RM, Hockberger RS, Gausche-Hill M, nā ʻaoʻao. ʻO Rosen's Emergency Medicine: Nā Manaʻo Manaʻo a me ka hana lapaʻau. 9th ed. Piladelapia, PA: Elsevier; 2018: chap 146.

Meehan TJ. Hele i ka mea maʻi ʻona. I: Nā paia RM, Hockberger RS, Gausche-Hill M, nā ʻaoʻao. ʻO Rosen's Emergency Medicine: Nā Manaʻo Manaʻo a me ka hana lapaʻau. 9th ed. Piladelapia, PA: Elsevier; 2018: chap 139.