Cudurka 'Serotonin syndrome'

Cudurka 'Serotonin Syndrome' (SS) waa fal-celin daroogo oo nolosha khatar gelin karta. Waxay ku keentaa jirka inuu yeesho serotonin aad u badan, kiimiko ay soo saaraan unugyada neerfaha.

SS badanaa waxay dhacdaa marka laba daawo oo saameeya heerka jirka ee serotonin la isla qaato isku waqti. Daawooyinka waxay sababaan serotonin aad u badan in la sii daayo ama ay ku sii nagaadaan aagga maskaxda.

Tusaale ahaan, waad horumarin kartaa cilladan haddii aad qaadato daawooyinka dhanjafka ah ee loo yaqaan 'triptans' oo ay weheliso daawooyinka niyadjabka ee loo yaqaan 'serotonin reuptake inhibitors' (SSRIs), iyo serotonin / norepinephrine reuptake inhibitors (SSNRIs).

SSRI-yada caadiga ah waxaa ka mid ah citalopram (Celexa), sertraline (Zoloft), fluoxetine (Prozac), paroxetine (Paxil), iyo escitalopram (Lexapro). SSNRIs waxaa ka mid ah duloxetine (Cymbalta), venlafaxine (Effexor), Desvenlafaxine (Pristiq), Milnacipran (Savella), iyo Levomilnacipran (Fetzima). Triptans-ka caadiga ah waxaa ka mid ah sumatriptan (Imitrex), zolmitriptan (Zomig), frovatriptan (Frova), rizatriptan (Maxalt), almotriptan (Axert), naratriptan (Amerge), iyo eletriptan (Relpax).

Haddii aad qaadato daawooyinkan, hubi inaad akhrido digniinta ku jirta baakadka. Waxay kaaga sheegeysaa halista ka imaan karta cudurka serotonin syndrome. Si kastaba ha noqotee, ha joojin qaadashada daawadaada. Kala hadal dhakhtarkaaga waxyaabaha aad ka walwasho marka hore.

SS waxay u badan tahay inay ku dhacdo bilawga ama kordhinta daawada.

Dawooyinka lidka ku ah diiqadaha ee loo yaqaan 'monoamine oxidase inhibitors' (MAOIs) ayaa sidoo kale ku keeni kara SS daawooyinka kor lagu soo sheegay, iyo sidoo kale meperidine (Demerol, xanuun baabi'iye) ama dextromethorphan (daawada qufaca).

Daroogooyinka xadgudubka, sida ecstasy, LSD, cocaine, iyo amphetamines ayaa sidoo kale lala xiriiriyay SS.

Calaamaduhu waxay dhacaan daqiiqado ilaa saacado gudahood, waxaana ka mid noqon kara:

• Kicin ama deganaan la'aan
• Dhaqdhaqaaqa indhaha oo aan caadi ahayn
• Shuban
• Garaaca wadnaha oo dhakhso ah iyo dhiig kar
• Hallucinations
• Heerkulka jirka oo kordhay
• Luminta isuduwidda
• Lalabbo iyo matag
• Dareen-celin firfircoon
• Isbeddellada degdegga ah ee cadaadiska dhiigga

Baadhista waxaa badanaa lagu sameeyaa iyadoo qofka la weydiiyo su'aalo ku saabsan taariikhda caafimaadka, oo ay ku jiraan noocyada daawooyinka.

Si lagugu ogaado SS, qofku waa inuu qaadanayay dawo badalaysa heerka serotonin ee jirka (serotonergic drug) oo uu leeyahay ugu yaraan seddex ka mid ah astaamaha ama astaamaha soo socda:

• Kicin
• Dhaqdhaqaaqyada indhaha ee aan caadiga ahayn (clonus ocular, helitaanka muhiimka ah ee sameynta ogaanshaha cudurka SS)
  
• Shuban
• Dhidid culus oo aan sabab u aheyn waxqabadka
• Qandho
• Isbedelada xaalada maskaxda, sida jahwareerka ama hypomania
• Murqaha muruqyada (myoclonus)
• Dareen-celinta firfircoonida (hyperreflexia)
• Gariirid
• Gariir
• Dhaqdhaqaaqyada aan isku xirnayn (ataxia)

SS lama baadho illaa inta kale laga saari karo sababaha kale ee suurtogalka ah. Tan waxaa ka mid noqon kara infekshannada, sakhradda, dhibaatooyinka dheef-shiid kiimikaadka iyo hoormoonka, iyo ka-noqoshada daroogada ama aalkolada. Calaamadaha qaarkood ee SS waxay la mid noqon karaan kuwa ay sabab u tahay xad-dhaafka maandooriyaha cocaine, lithium, ama MAOI.

Haddii qofku hadda bilaabay inuu qaato ama kordhiyo qiyaasta xasilloonida (daawada neerfaha), xaalado kale sida neuroleptic malignant syndrome (NMS) ayaa la tixgelin doonaa.

Tijaabooyinka waxaa ka mid noqon kara:

• Dhaqamada dhiigga (si loo hubiyo infekshanka)
• Tirinta dhiigga oo dhameystiran (CBC)
• CT iskaanka maskaxda
• Daroogada (sunta sunta) iyo shaashadda aalkolada
• Heerarka korantada
• Qalabka korontada (ECG)
• Baaritaanka kilyaha iyo beerka
• Tijaabooyinka shaqada tayroodhka

Dadka qaba SS waxay u badan tahay inay sii joogi doonaan cisbitaalka ugu yaraan 24 saacadood si ay ugu kuur galaan.

Daaweynta waxaa ka mid noqon kara:

• Daawooyinka Benzodiazepine, sida diazepam (Valium) ama lorazepam (Ativan) si loo yareeyo kacsanaanta, dhaqdhaqaaqyada suuxdinta u eg, iyo murqaha oo adkaada
• Cyproheptadine (Periactin), waa dawo xannibaya wax soo saarka serotonin
• Xididdada xididka (xididka)
• Joojinta daawooyinka sababay cilladda

Xaaladaha nolosha halista ku ah, daawooyinka muruqyada sii daaya (curyaamiya iyaga), iyo tuubo neefsasho ku meel gaar ah iyo mashiinka neefsashada ayaa looga baahan doonaa si looga hortago dhaawac muruqa ah oo dheeraad ah.

Dadku si tartiib tartiib ah ayey uga sii darayaan oo si daran ayey u jiran karaan haddii aan si dhakhso ah wax looga qaban SS aan la daaweynin Daaweynta, astaamuhu badanaa waxay ku baxaan wax ka yar 24 saacadood. Dhaawaca xubnaha joogtada ah ayaa laga yaabaa inuu ka dhasho, xitaa daaweyn.

Muruqyada oo aan la xakamayn waxay sababi karaan burburka murqaha oo daran. Waxsoosaarka la soo saaro marka muruqyadu jabaan ayaa lagu sii daayaa dhiigga aakhirkana waxay maraan kelyaha. Tani waxay sababi kartaa dhaawac daran oo kilyaha ah haddii SS aan la aqoonsan oo aan si sax ah loo daaweyn.

Wac daryeel caafimaad bixiyahaaga isla markiiba haddii aad leedahay calaamadaha cudurka serotonin syndrome.

Had iyo jeer u sheeg bixiyeyaashaada dawooyinka aad qaadato. Dadka qaata daawooyinka loo yaqaan 'Triptans' ee leh SSRIs ama SSNRIs waa in si dhow loola socdaa, gaar ahaan isla marka ay bilaabaan dawo ama ay kordhiyaan qiyaasta ay leeyihiin.

Hypererotonemia; Cudurka 'Serotonergic syndrome'; Sunta sunta; SSRI - serotonin syndrome; MAO - xanuunka serotonin

Fricchione GL, Beach SR, Huffman JC, Bush G, Stern TA. Xaaladaha naf-gooyada ah ee maskaxda: catatonia, neuroleptic malignant syndrome, iyo serotonin syndrome. Gudaha: Stern TA, Fava M, Wilens TE, Rosenbaum JF, eds. Isbitaalka Guud ee Massachusetts Isbitaalka Guud ee Caafimaadka Maskaxda. 2aad ed. Philadelphia, PA: Elsevier; 2016: cutubka 55.

Levine MD, Ruha AM. Dawooyinka lidka ku ah diiqadda. Gudaha: Walls RM, Hockberger RS, Gausche-Hill M, eds. Daawada Degdega ah ee Rosen: Fikradaha iyo Tababarka Caafimaadka. 9aad. Philadelphia, PA: Elsevier; 2018: cutubka 146.

Meehan TJ. U dhowaanshaha bukaanka sumoobay. Gudaha: Walls RM, Hockberger RS, Gausche-Hill M, eds. Daawada Degdega ah ee Rosen: Fikradaha iyo Tababarka Caafimaadka. 9aad. Philadelphia, PA: Elsevier; 2018: cutubka 139.