Serotonin cov tsos mob

Serotonin syndrome (SS) yog ib qho kev pheej hmoo tuag taus rau tshuaj. Nws ua rau lub cev muaj cov serotonin ntau dhau, ib yam tshuaj lom neeg tsim los ntawm cov leeg hlwb.

SS feem ntau tshwm sim thaum ob yam tshuaj uas cuam tshuam rau lub cev qib ntawm serotonin noj ua ke nyob rau tib lub sijhawm. Cov tshuaj ua rau ntau dhau ntawm serotonin mus rau tso lossis kom nyob hauv thaj chaw hauv lub hlwb.

Piv txwv li, koj tuaj yeem tsim tus mob no yog tias koj noj cov tshuaj migraine hu ua triptans ua ke nrog cov tshuaj tiv thaiv kab mob hu ua xaiv serotonin reuptake inhibitors (SSRIs), thiab xaiv serotonin / norepinephrine reuptake inhibitors (SSNRIs).

Cov SSRIs muaj xws li citalopram (Celexa), sertraline (Zoloft), fluoxetine (Prozac), paroxetine (Paxil), thiab escitalopram (Lexapro). SSNRIs suav nrog duloxetine (Cymbalta), venlafaxine (Effexor), Desvenlafaxine (Pristiq), Milnacipran (Savella), thiab Levomilnacipran (Fetzima). Cov lus sib txawv xws li sumatriptan (Imitrex), zolmitriptan (Zomig), frovatriptan (Frova), rizatriptan (Maxalt), almotriptan (Axert), naratriptan (Amerge), thiab eletriptan (Relpax).

Yog tias koj noj cov tshuaj no, nco ntsoov nyeem cov lus ceeb toom ntawm ntim. Nws qhia koj txog qhov phom sij ntawm cov serotonin syndrome. Txawm li cas los xij, tsis txhob tsum tsis txhob noj koj cov tshuaj. Tham nrog koj tus kws kho mob txog koj cov kev txhawj xeeb ua ntej.

SS qhov tshwm sim muaj ntau dua tshwm sim thaum pib lossis nce cov tshuaj.

Cov tshuaj tiv thaiv laus hu ua monoamine oxidase inhibitors (MAOIs) kuj tseem tuaj yeem ua rau SS nrog rau cov tshuaj uas tau piav saum toj no, nrog rau meperidine (Demerol, tus mob mob siab) lossis dextromethorphan (tshuaj hnoos).

Cov tshuaj tiv thaiv kev tsim txom, xws li ecstasy, LSD, cocaine, thiab amphetamines kuj tau cuam tshuam nrog SS.

Cov tsos mob yuav tshwm sim li ntawm ob peb teev mus rau teev, thiab yuav suav nrog:

• Agitation lossis nyob tsis tswm
• Qhov muag tsis meej
• Zawv plab
• Lub plawv dhia ceev thiab ntshav siab
• Kev Ua Si
• Lub cev kub nce ntxiv
• Plam kev sib koom tes
• Xeev siab thiab ntuav
• Kev ncau ntau dhau
• Hloov ntshav siab ceev ceev

Kev kuaj mob feem ntau yog tsim los ntawm kev nug tus neeg cov lus nug txog keeb kwm kev kho mob, suav nrog cov hom tshuaj.

Txhawm rau kuaj mob nrog tus mob SS, tus neeg yuav tsum tau noj tshuaj uas hloov pauv qib hauv lub cev (cov tshuaj serotonergic) thiab muaj tsawg kawg peb qho ntawm cov cim hauv qab no lossis cov tsos mob:

• Kev ntxhov siab
• Qhov muag tsis pom kev (lub ntsej muag txhaws qa, ib qho tseem ceeb tshawb pom hauv kev teeb tsa kev kuaj mob SS)
  
• Zawv plab
• Kev tawm hws hnyav tsis yog vim los ntawm kev ua si
• Ua npaws
• Kev hloov pauv ntawm lub paj hlwb, xws li tsis meej pem lossis hypomania
• Cov leeg pob txha (myoclonus)
• Kev siv zog ntau dhau (hyperreflexia)
• Kev tshee
• Qhuas
• Kev txav tsis ncaug (ataxia)

SS tsis kuaj pom kom txog thaum tag nrho lwm qhov laj thawj tau raug txiav txim. Qhov no suav nrog kev kis kab mob, qaug cawv, teeb meem metabolic thiab hormone, thiab haus yeeb tshuaj lossis dej cawv. Qee qhov tsos mob ntawm SS tuaj yeem qog cov no vim tias muaj yeeb dawb ntau dhau ntawm cocaine, lithium, lossis MAOI.

Yog tias ib tus neeg nyuam qhuav pib noj lossis nce ntau npaum li cas ntawm cov tshuaj tua kabmob (tshuaj neuroleptic), yuav muaj lwm yam mob xws li mob neuroleptic malignant syndrome (NMS).

Kev ntsuam xyuas yuav muaj xws li:

• Cov kab lis ntshav (kuaj seb puas kis tau tus mob)
• Ua kom tiav cov ntshav suav (CBC)
• CT scan ntawm lub paj hlwb
• Tshuaj (toxicology) thiab tshuaj ntsuam cawv
• Cov theem hluav taws xob
• Electrocardiogram (ECG)
• Kuaj raum thiab siab ua haujlwm zoo
• Kev ntsuas cov thyroid muaj nuj nqi

Cov neeg nrog SS yuav nyob hauv tsev kho mob tsawg kawg 24 xuaj moos rau kev soj ntsuam kom zoo.

Kev kho mob yuav suav nrog:

• Cov tshuaj Benzodiazepine, xws li diazepam (Valium) lossis lorazepam (Ativan) kom txo qis kev ntxhov siab, qaug dab peg, thiab qoj ib ce.
• Cyproheptadine (Periactin), yog ib yam tshuaj uas thaiv cov serotonin ntau lawm
• Tso dej (los ntawm cov hlab ntshav) kua
• Kev tsum tsis siv cov tshuaj uas ua rau muaj tus mob

Hauv cov xwm txheej hauv lub neej, cov tshuaj uas ua kom cov leeg tseem nyob (ua rau lawv tuag tes tuag taw), thiab yuav tau siv lub tshuab ua pa ib ntus thiab tshuab ua pa kom tiv thaiv cov leeg mob ntxiv.

Tib neeg yuav mob qeeb dua thiab tuaj yeem mob hnyav yog tsis kho sai. Yog tsis kho, SS tuaj yeem yog qhov tuag taus. Nrog kev kho mob, cov tsos mob feem ntau yuav ploj mus tsawg dua 24 teev. Kev puas tsuaj hauv lub cev tas li yuav tshwm sim, txawm hais tias yog kev kho.

Kev tswjfwm tsis zoo uas tsis tuaj yeem ua rau leeg tuaj yeem ua rau mob leeg nqaij. Cov khoom lag luam tsim tawm thaum cov leeg zom zaws tso tawm rau hauv cov ntshav thiab nws mus rau hauv ob lub raum. Qhov no tuaj yeem ua rau lub raum puas tsuaj tau yog tias SS tsis pom tau thiab kho tsis tau kom yog.

Hu rau koj tus kws kho mob sai li sai tau yog tias koj muaj cov tsos mob ntawm serotonin syndrome.

Qhia koj cov kws kho mob ib txwm siv tshuaj twg. Cov neeg uas noj cov tshuaj triptans nrog SSRIs lossis SSNRIs yuav tsum ua raws nraim, tshwj xeeb yog tom qab pib noj tshuaj lossis nce ntxiv nws ntau npaum li cas.

Cov Hyperserotonemia; Serotonergic syndrome; Serotonin mob toxicity; SSRI - serotonin syndrome; MAO - cov leeg serotonin

Fricchione GL, Puam SR, Huffman JC, Bush G, Stern TA. Kev phom sij hauv lub neej hauv kev puas siab puas ntsws: catatonia, neuroleptic malignant syndrome, thiab serotonin syndrome. Hauv: Stern TA, Fava M, Wilens TE, Rosenbaum JF, eds. Massachusetts General Tsev Kho Mob Chaw Kho Mob Chaw Kho Mob Puas Siab NtswsCov. 2nd ed. Philadelphia, PA: Elsevier; 2016: chap 55.

Levine MD, Ruha AM. Cov tshuaj tiv thaiv kab mob. Hauv: Phab Ntsa RM, Hockberger RS, Gausche-Hill M, eds. Rosen's Cov Tshuaj Siv Thaum Muaj Xwm Ceev: Cov Ntsiab Lus thiab Kev Siv TshuajCov. 9le ed. Philadelphia, PA: Elsevier; 2018: chap 146.

Meehan TJ. Mus kom ze rau tus neeg mob lom. Hauv: Phab Ntsa RM, Hockberger RS, Gausche-Hill M, eds. Rosen's Cov Tshuaj Siv Thaum Muaj Xwm Ceev: Cov Ntsiab Lus thiab Kev Siv TshuajCov. 9le ed. Philadelphia, PA: Elsevier; 2018: chap 139.