Serotonin Syndrome ne Nnuru a Ɛyɛ Den Nkitahodi a Ɛho Hia Ntɛmntɛm¶

Serotonin syndrome ne neuroleptic malignant syndrome (NMS) yɛ nnuru a wɔde di dwuma ntɛm a ɛde nkwa to asiane mu a nnuru a wɔkyerɛw ma obi, nnuru a wɔde siw ɔfe ano a wɔtɔn, nhabannuru a wɔde ka ho, anaa nneɛma a wɔde gye wɔn ani kanyan ntini a ɛwɔ nipadua no mfinimfini a ɛguan a entumi nnyina, ntini a ɛyɛ den anaasɛ ɛtwetwe, ne nipadua no mu hyew a ɛkɔ soro a ɛyɛ hu sen digrii Celsius 40.0 (Ɛyɛ digrii Fahrenheit 104.0). Bere a serotonin yare no pae ntɛmntɛm wɔ nnɔnhwerew 2 kosi 24 akyi bere a wɔanom aduru foforo, wɔama dodow bi akɔ soro, anaasɛ wɔaka nnuru abien a ɛma serotonergic bom no, neuroleptic malignant syndrome taa ba nkakrankakra wɔ nnafua 1 kosi 14 akyi bere a wɔafi ase anaasɛ wɔama aduru a ekum adwenemhaw anaa akisikuru a esiw dopamine agyefo ano akyi.

Nneɛma a ɛho hia wo ntɛm ara bere a wosusuw sɛ nnuru no di nkitaho kɛse ne sɛ wobɛfrɛ ayarehwɛfo a wɔakɔ anim a wɔde bɛkɔ, agyae nnuru ne nnuru a wɔde ka ho biara a wɔde bɛma bio nyinaa, afi ase ayɛ abɔnten so nsu a ɛyɛ hyew ne nsukyenee a wɔde ahyɛ mu ma ayɛ nwini denneennen sɛ onipa no rehyew a, wobɛbɔ mframa kwan no ho ban bere a ɔreyɛ akisikuru anaasɛ ne ho ayɛ den kɛse, na woaboaboa nnuru toa ne nnurutɔnbea biara a wɔatintim ano sɛnea ɛbɛyɛ a nnuruyɛfo a wɔhwɛ ntɛmpɛ betumi ayɛ fa nnuru a wɔde kum ɔyare mmoawa a wɔde wɔn ani asi so ma ntɛm ara bere a wɔadu ayaresabea no.

Yɛ eyi mprempren¶

1. Frɛ ntɛmpɛ adwumayɛbea ntɛm ara: Frɛ wo mpɔtam hɔ ntɛmpɛ nɔma (911 wɔ United States ne Canada, 112 wɔ European Union nyinaa, 999 wɔ United Kingdom, 000 wɔ Australia) anaa hwɛ yɛn directory of nɔma ahorow a egye ntɛmpɛ. Wɔ United States no, wubetumi nso afrɛ Poison Control wɔ 1-800-222-1222 bere a ambulance akɔ kwan so no. Bɔ amanneɛ sɛ wosusuw sɛ serotonin yare anaa neuroleptic malignant syndrome a atiridiinini ne ntini a ɛyɛ den ka ho.
2. Gyae nnuru, nnuru a wɔde ka aduan ho, ne nnuru a wɔtɔn nyinaa ntɛm ara: Mma nnuru biara a wɔde kum adwenemhaw, ɛyaw, atiridiinini triptan, ɔfe aduru, aduru a ekum akisikuru, anaa nhabannuru a wɔde ma no dodow foforo. Mmɔ mmɔden da sɛ wode acetaminophen (paracetamol), ibuprofen, anaa aspirin a wɔtɔn wɔ aduruyɛdan mu bɛsa atiridiinini no.
3. Susuw ɔhyew na fi ase yɛ hyew a ano yɛ den wɔ abɔnten sɛ ɛyɛ hyew a: Sɛ onipa no te nka sɛ ne ho yɛ hyew bere a woka no, ne ho fifiri reyɛ kɛse, anaasɛ ne hyew boro digrii Celsius 38.5 (digrii Fahrenheit 101.3) a, yi ntade a emu yɛ duru, fa nsu a ɛyɛ nwini hyɛ wɔn honam ani a ɛda hɔ kwa bere a worebɔ no denneennen no, na fa nsukyenee a wɔde ntama abɔ mu gu abasa no mu, groin, ne kɔn no afã horow.
4. Fa si wɔn nkyɛn dwoodwoo na nsiw nsa a ɛtwetwe no ano da: Boa onipa a ne ho adwiriw no anaasɛ ɔyɛ katee no ma ɔnda n’afã wɔ tebea a ɛbɛma ne ho atɔ no mu wɔ fam anaa mpa a wɔde ntama ayɛ so a ɛne anoano a ɛyɛ den no ntam kwan ware. Mma nkura akwaa a ɛrewosow, ɛrewosow, anaasɛ ɛyɛ den no mu, ntena so, anaasɛ nhyɛ wo ho so da, efisɛ isometric apereperedi a ɛne nipadua mu ahosodi no ma ntini a ɛpaapae a edi awu no yɛ ntɛmntɛm ntɛmntɛm na ɛma nipadua no mu hyew yɛ kɛse.
5. Boaboa nnuru a wɔde gu mu, aduru a wɔde hyɛ mu, ne toa a wɔde ka ho ano: Boaboa nkotoku a wɔakyerɛw ama obi, akisikuru a wɔde ahyɛ mu, aduru a wɔde fa honam ani (hwɛ honam ani hwɛbea a ɛwɔ akyi, moma so, abasa, ne asen mu sɛ fentanyl, selegiline, anaa rivastigmine a wɔde ahyɛ mu), awɔw aduru a wɔtɔn, nhabannuru tii, ne nneɛma a mmara mma ho kwan nyinaa ano gu plastic bag biako mu ma nnuruyɛfo.
6. Hwɛ sɛnea wohome na siesie wo ho ma CPR anaasɛ akisikuru hwɛ: Tena onipa no nkyɛn bere nyinaa. Sɛ generalized seizure ba a, cushion wɔn ti na roll wɔn gu wɔn nkyɛn bere a jerking ano abrɛ ase. Sɛ wɔnyɛ nea wontumi nyɛ hwee na wogyae ahome sɛnea ɛsɛ a, fi ase koma ne ahurututu mu ahoɔden a wɔde ma (CPR) . ntɛm ara.

flowchart TD
    Start["Ɛhaw Mpofirim, Atiridiinini, Fifiri, ne Ntini a Ɛyɛ Den anaa Ɛtwetwe Bere a Wɔde Nnuru Di Dwuma Awie no"] --> Call["1. Frɛ Emergency Services (911 / 112 / 999) na Gyae Nnuru Nyinaa Ntɛm ara"]
    Call --> CheckTemp{"2. So Wora a Ɛhyew no Yɛ Ɔhyew Anaasɛ Core Temp Bɛboro 38.5 C (101.3 F)?"}
    CheckTemp -->|Yes| CoolNow["Yi Ntade, Mist Skin ne Nsu a Ɛyɛ Nwini, Fan Fan denneennen, Fa Ice Packs gu Groin ne Armpits"]
    CheckTemp -->|No| MonitorTemp["Ma Pia no nyɛ nwini wɔ 18 kosi 20 C (64 kosi 68 F), Yi Ntama, Hwɛ Temp Simma 5 Biara"]
    CoolNow --> NeuroSign{"3. Hwehwɛ Ntini Tone ne Reflex Pattern mu"}
    MonitorTemp --> NeuroSign
    NeuroSign -->|Rhythmic Ankle Jerks, Shivering, Wide Pupils, Fast Onset Under 24 Hours| SS["Suspect Serotonin Syndrome: Kwati Ahohyɛso, Bɔ Ho Ban fi Ahwease ho, Boaboa Serotonergic Meds ano"]
    NeuroSign -->|Lead Pipe Stiffness Everywhere, Slow Reflexes, Onset Over Days| NMS["Suspect Neuroleptic Malignant Syndrome: Hwɛ Nnuru a Ɛko Tia Adwene ne Nkate anaa Nnuru a Ɛko Tia Adwene, Nipadua a Ɛyɛ Nwini"]
    SS --> Airway{"4. So Onipa no Nim Na Ɔbɔ Wɔn Mframa Kwan Ho Ban?"}
    NMS --> Airway
    Airway -->|Conscious but Agitated| Calm["Kanea a Ɛnyɛ Den, Kasa Dwo, Mma Nnuru a Ɛtew Atiridii So anaa Nsu a Wɔde Ano Da sɛ Mene no Nsɛe a"]
    Airway -->|Unconscious or Seizing| Recovery["Bobɔw kɔ Side-Lying Recovery Position, Cushion Head, Fi ase CPR sɛ Ɔhome Gyae a"]

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Nsonsonoe a ɛda serotonin yare, neuroleptic malignant syndrome, ne ɔhyew a ɛboro so a awuduru wom afoforo¶

Sɛ ɔyarefo bi nya adwene mu naayɛ kɛse, atiridiinini, koma a ɛbɔ denneennen, ne ntini mu ahoɔden a ɛnteɛ bere a wanom nnuru akyi a, ɛsɛ sɛ nnuruyɛfo a wɔhwɛ ntɛmpɛ mu no hu nsonsonoe a ɛda awuduru anan a ɛde ne nkwa to asiane mu ntam ntɛmntɛm: serotonin syndrome, neuroleptic malignant syndrome (NMS), anticholinergic toxicity, ne sympathomimetic overdose. Bere a mmoa a edi kan a wɔde ma ansa na wɔakɔ ayaresabea ma anan no nyinaa gyina mframa kwan ho banbɔ, aduru a ɛhyɛ abufuw no a wobegyae, ne nipadua mu onwini a ɛba ntɛmntɛm so no, sɛnea wɔhwɛ sɛnea ntini ahorow no keka ne ho, honam ani nsu, aniwa no kɛse, ne dwensɔtwaa mu nnyigyei ho nhyehyɛe pɔtee no ma nnuruyɛfo a wɔboa nkurɔfo ne nnuruyɛfo a wɔhwɛ ntɛmpɛ so nya nsɛm a ɛho hia a wɔde hwehwɛ yare no mu.

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Hunter Serotonin Toxicity Criteria ne nnuru a wɔde afrafra a asiane kɛse wom no ntease¶

Serotonin (5-hydroxytryptamine, anaa 5-HT) yɛ ntini mu nkwaadɔm a ɛhwɛ sɛnea obi te nka, ɔhyew a ɛkɔ so, yafunu mu ntini a ɛkɔ nipadua no mu, ntini mu nne, ne nipadua no mu ntini a ɛma nipadua no yɛ adwuma no so. Serotonin syndrome (a wɔsan frɛ no serotonin awuduru) ntaa mfi aduru biako a wɔde sa adwenemhaw a wɔde sa yare no mu; mmom no, Wiase Nyinaa Akwahosan Ahyehyɛde (WHO), United States Aduan ne Nnuru Dwumadibea (FDA), ne United Kingdom Nnuru ne Akwahosan Ho Nneɛma Ho Mmarahyɛ Bagua (MHRA) si so dua sɛ awuduru a ɛho hia taa ba bere a wɔde nnuru abien anaa nea ɛboro saa a ɛma serotonin kɔ soro denam abɔde mu nnuru ahorow so bom, anaasɛ bere a ɔyarefo bi sesa nnuru a ekum adwenemhaw a ɔnhwɛ bere a ɛsɛ sɛ ɔhohoro no.

Serotonergic akwan anum a ɛbɔ¶

1. Sɛrotonin a ɛsan kɔ nipadua no mu a wɔbara fi synaptic cleft no mu: Nnuru a wɔpaw a esiw serotonin a ɛsan fa mu ano (SSRIs te sɛ fluoxetine, sertraline, escitalopram, citalopram, paroxetine), serotonin-norepinephrine a ɛsan fa no ano (SNRIs te sɛ venlafaxine, duloxetine, desvenlafaxine), nnuru a wɔde kum adwenemhaw a wɔde di dwuma abiɛsa (TCAs te sɛ amitriptyline, clomipramine, imipramine), nnuru bi a wɔde opioid a wɔde kum ɛyaw a wɔayɛ (tramadol, meperidine/pethidine, fentanyl, methadone, tapentadol), aduru a wɔde siw ɔfe ano a wɔtɔn a wɔmfa nnuru nhyɛ mu dextromethorphan (DXM), nhabannuru a wɔde ma Ɔhotefo. John's wort (Hypericum perforatum), ne aduru a ɛma ntini no dwo cyclobenzaprine.
2. Monoamine oxidase (MAOIs) a wɔde siw serotonin a ɛpaapae ano: Adwene ne nneyɛe mu MAOIs (phenelzine, tranylcypromine, isocarboxazid, moclobemide), Parkinson yare MAO-B a esiw ano (selegiline, rasagiline), ayaresabea ne aduru a wɔde kum ɔyare mmoawa a wɔnom linezolid (a ɛyɛ MAOI a ɛyɛ den a wotumi dan), ne oprehyɛn aduru a wɔde fa ntini mu methylene blue.
3. Serotonin a wɔakora so a ɛkɔ soro wɔ presynaptic: Amphetamines, dextroamphetamine, methylphenidate, methamphetamine, cocaine, MDMA (ecstasy / Molly), ne nnuru a wɔde siw congestants a wɔde di dwuma kɛse.
4. Serotonin agyefoɔ a ɛwɔ akyi berɛmo mu a wɔkanyan no tẽẽ: Atiridiinini triptans (sumatriptan, rizatriptan, zolmitriptan), ergot alkaloids (dihydroergotamine), buspirone, lithium, ne hallucinogens (LSD).
5. Serotonin a ɛkɔ soro fi aduan a edi kan mu: L-tryptophan anaa 5-HTP (5-hydroxytryptophan) aduannuru a wɔde ma kɛse a wɔtɔn de boa nna anaa adwene.

Nnuru a wɔtaa de di dwuma wɔ fie a ɛkanyan serotonin yare no¶

• "Cold and Cough Syrup" afiri no: Obi a ɔnom SSRI anaa SNRI da biara da de hwehwɛ adwenemhaw anaa dadwen no nya awɔw bere mu atiridii na ɔnom aduru a wɔtɔn a wɔtɔn a ɛwɔ sɛnkyerɛnne ahorow pii a ɛkyerɛ ɔfe ne atiridiinini a dextromethorphan (DXM) wom. Esiane sɛ DXM siw serotonin a wɔsan gye no ano denneennen na ɛtaa fa mmerɛbo mu enzyme kwan (CYP2D6) koro no ara a ɛwɔ aduru a ekum adwenemhaw no so nti, serotonin dodow kɔ soro wɔ nnɔnhwerew kakraa bi mu.
• "Post-Injury Painkiller" afiri no: Ɔyarefoɔ a ɔnom sertraline anaa duloxetine kɔ ayaresabea a wɔhwɛ no ntɛm ara wɔ akyi yaw anaa abubuo ho na wɔkyerɛw no tramadol anaa cyclobenzaprine, anaasɛ ɔde opioid ɛyaw nnuru a aka di dwuma ka wɔn nnuru a wɔde kum adwenemhaw daa no ho.
• "Infection Antibiotic" afiri no: Wɔkyerɛw ɔyarefo a ɔnom aduru biara a ekum adwenemhaw anaa Parkinson aduru a ekum ɔyare mmoawa linezolid ma Staphylococcus aureus (MRSA) honam ani anaa ahurututu mu yare a ɛko tia methicillin. Esiane sɛ linezolid siw monoamine oxidase kwan sɛ ɛnsɛe serotonin nti, sɛ wɔde ka SSRI anaa SNRI ho a, ɛde serotonin yare a emu yɛ den a ɛtaa di awu ba.
• "Washout Period" afiri no: Ɔyarefo bi gyae fluoxetine (Prozac) nom na ofi ase de MAOI anaa serotonergic aduru foforo a ahoɔden wom kɛse di dwuma nna kakraa bi akyi. Esiane sɛ fluoxetine ne nea ɛyɛ adwuma (norfluoxetine) wɔ abɔde mu nkwa nna fã tenten soronko nti, ayaresabea adwumayɛfo hwehwɛ sɛ wɔde anyɛ yiye koraa no adapɛn 5 hohoro bere a wɔagyae fluoxetine akyi (ne anyɛ yiye koraa no adapɛn 2 bere a wɔagyae SSRI, SNRI, anaa MAOI afoforo akyi) ansa na wɔde aduru a ɛbɔ abira aba.

Sɛnea wobɛhwɛ Hunter Serotonin Toxicity Criteria no wɔ mpa ho¶

Awuduru ho animdefo a wɔhwɛ ntɛmpɛ so wɔ wiase nyinaa de Hunter Serotonin Toxicity Criteria (a ɛyɛ ɔha biara mu nkyem 84 a ɛyɛ mmerɛw na ɔha biara mu nkyem 97 yɛ pɔtee, a ɛyɛ adwuma sen nhwehwɛmu dedaw ahorow) di dwuma de hu serotonin syndrome wɔ obiara a wanom aduru bi a ɛma mogya tu wɔ adapɛn 5 a atwam no mu. Obi du gyinapɛn no ho sɛ ɔda biara adi wɔ ayaresabea sɛnkyerɛnne akuwakuw anum a edidi so yi mu a:

1. Spontaneous clonus: Ntini kuw bi (titiriw nan, nansoaa, anaa anom) a ɛkɔ so, ɛyɛ nnyigyei a ɛyɛ dɛ, ɛwosow anaasɛ ɛbɔ a ɛnyɛ ne pɛ a ɛba a obiara nka ɔhonam akwaa no.
2. Inducible clonus PLUS agitation OR profuse sweating (diaphoresis): Sɛ wode brɛoo nanso wode ahoɔhare pia onipa no nan bɔɔl no kɔ soro kɔ ne shin (dorsiflexion) na wokura nhyɛsoɔ brɛoo a, nan ne nansoaa no bɔ akɔ anim ne akyi bɛboro mpɛn 3 anaa 4 (inducible ankle clonus), a emu biara ka ho adwene mu basabasayɛ anaa fifiri a ɛyɛ nwini.
3. Ocular clonus PLUS agitation OR profuse sweating: Sɛ woka kyerɛ onipa no sɛ ɔnhwɛ n’anim tẽẽ anaasɛ ɔnhwɛ wo nsateaa akyi nkɔ nkyɛn a, wɔn aniwa no da brɛoo, ɛkɔ so, roving side-to-side oscillations ("ping-pong gaze") anaasɛ ntɛmntɛm rhythmic jerks adi, a agitation anaa fifiri ka ho.
4. Tremor PLUS hyperreflexia: Nsa ne nan a ɛwosow a ɛyɛ nnyigyei a wotumi hu a ɛka bom ne bounding, hyperactive knee ne ankle reflexes.
5. Hypertonia (ntini a ɛyɛ den) PLUS atiridii a ɛboro digrii Celsius 38.0 (digrii Fahrenheit 100.4) PLUS either ocular clonus OR inducible clonus: Saa akuwakuw a ɛto so anum yi gyina hɔ ma serotonin awuduru a emu yɛ den a ɛde nkwa to asiane mu a ɛhwehwɛ sɛ wɔma ɛyɛ nwini ntɛm ara na wɔde ɔhwɛ a emu yɛ den ma.

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Neuroleptic malignant syndrome (NMS) ne Parkinson a wɔtwe wɔn ho fi ho ho haw a wobehu¶

Bere a serotonin yare no fi serotonin a ɛboro so a ɛkanyan ntini ahorow a ɛkanyan boro so no, neuroleptic malignant syndrome (NMS) fi mpofirim, asiane dopamine sɛnkyerɛnnede ho ɔkɔm wɔ amemene no mmeae atitiriw abien: nigrostriatal kwan (a ɛhwɛ nnompe mu ntini a ɛyɛ mmerɛw so, a ɛde kɔ extreme mu rigidity bere a wɔasiw ano) ne anterior hypothalamus (a ɛhwɛ nipadua no mu hyew titiriw ne autonomic mogya mmoroso so).

Akwan abien a ɛsono emu biara a ɛkɔ neuroleptic malignant syndrome mu¶

1. Dopamine receptor blockade (Classic NMS): Wɔnam nnuru a esiw D2 dopamine receptors ano a wofi ase, dodow a ɛkɔ soro, anaasɛ wɔde ka bom so na ɛkanyan. Bere a awo ntoatoaso a edi kan nnuru a ekum adwene mu yare a ahoɔden kɛse wom (haloperidol, fluphenazine, chlorpromazine) de asiane kɛse ba no, awo ntoatoaso a ɛto so abien nnuru a ɛko tia adwenemhaw a ɛnyɛ nea wɔtaa yɛ (risperidone, olanzapine, quetiapine, paliperidone, aripiprazole, clozapine) nso de NMS ba. Nea ɛho hia no, ayarefo pii a wɔnyɛ adwenemyarefo nya NMS fi nnuru a esiw dopamine ano a ɛko tia akisikuru ne yafunu mu ntini a wɔtaa de sie fie ma yafunu mu yare, atiridiinini, anaa yafunu mu yare, a metoclopramide, prochlorperazine, promethazine, ne droperidol ka ho.
2. Dopamine agonist a wɔtwe wɔn ho fi ho (Parkinsonism-Hyperpyrexia Syndrome): Ɛkanyan bere a ɔyarefo bi a ɔwɔ Parkinson yare anaasɛ nan a ɛnyɛ ahomegye gyae nnuru a wɔde si dopamine ananmu da biara da (levodopa/carbidopa, pramipexole, ropinirole, rotigotine patches, anaa amantadine), te sɛ bere a yafunu mu atiridii anaasɛ wɔde obi rekɔ ayaresabea. Bere a wɔamma ɔyarefo no amemene a efi akyi no wɔ nnɔnhwerew 18 kosi 72 mu no, ɛkɔ tebea koro no ara mu a ɛyɛ kɔbere-paipu a ɛyɛ den, atiridiinini kɛse, na ɛyɛ ne ho a ɛhwe ase.

Tetrad a wɔtaa de di dwuma wɔ neuroleptic malignant syndrome ho¶

NMS taa da adi nnidiso nnidiso a wotumi hu wɔ nnɔnhwerew 24 kosi 72 mu:

• 1.1. Adwene mu tebea a ɛsakra (mpɛn pii no ɛyɛ sɛnkyerɛnne a edi kan): Ansa na atiridiinini bɛda adi no, ɔyarefo no yɛ komm wɔ ɔkwan soronko so, ɔyɛ mum (akinetic mutism), n’adwene tu fra, n’adwene tu fra, anaasɛ n’adwene mu yɛ no naa, ɔhwɛ no denneennen na ontumi mmua nsɛmmisa, anaasɛ ɔsesa ne ho a ɛyɛ hu ne adwenemhaw.
• 2.1. Generalized "lead-pipe" muscular rigidity: Sɛ wobɔ mmɔden brɛoo sɛ wobɛkotow anaasɛ wobɛteɛteɛ onipa no nsateaa, ne nsateaa, anaa ne kotodwe a, ɔhonam akwaa no siw kankyee a emu yɛ duru, ɛyɛ pɛ, a entumi nnyae wɔ kankyee no nyinaa mu, te sɛ nea wobɛbɔ kɔbere paipu a ɛyɛ den no pɛpɛɛpɛ. Sɛ superimposed tremor wɔ hɔ a, ɛte sɛ nea ratcheting a stiff gear (cogwheel rigidity). Menewa ne anom ntini a ɛyɛ den (dysphagia ne dysarthria) ma kasa yɛ mmerɛw na ɛma nnompe a ɛyɛ den no boaboa ano na ɛtɔ nsu fi anom.
• 3.1. Hyperthermia: Nipadua mu hyew titiriw kɔ soro boro 38.5 degrees Celsius (101.3 degrees Fahrenheit) na ɛtaa boro 40.0 kosi 41.5 degrees Celsius (104.0 kosi 106.7 degrees Fahrenheit) bere a nnompe mu ntini a wɔatoto mu no hyew adenosine triphosphate (ATP) bere nyinaa.
• 4.1. Autonomic nervous system instability: Nipadua no mu autopilot no ntumi nni so: koma bɔ mmirika boro 110 kosi 140 simma biara, mogya mmoroso dannan denneennen fi soro a ɛyɛ hu kɔ fam a ɛyɛ ahodwiriw wɔ simma kakraa bi mu, ɔhome yɛ ntɛmntɛm na ɛnyɛ den (tachypnea), honam ani fifiri a srade wom (diaphoresis), na onipa no betumi anya bi mpofirim a obi ntumi nkɔ nsu mu.

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Mmoa a edi kan a wɔde ma anammɔn anammɔn bere a wɔretwɛn nnuruyɛfo a wɔboa nkurɔfo no¶

Esiane sɛ serotonin syndrome ne neuroleptic malignant syndrome nyinaa nam cascades abiɛsa koro no ara a ɛba awiei so kum nnipa (amemene no mu ɔhyew a ɛsɛe esiane ɔhyew a ɛboro digrii Celsius 41 / digrii Fahrenheit 105.8, amemene a ɛyɛ den a efi koko fasu mu ntini a ɛyɛ den anaasɛ aspiration mu ba, ne koma a ɛtwetwe fi potassium a efi ntini mu ntini a ɛrepaapae mu gyae mu) nti, ɛsɛ sɛ wo afuw mu hwɛ yɛ nea ɛyɛ nhyehyɛe na ɛyɛ ntɛm.

Anamɔn 1: Ntɛm ara ɔhyew nkwagye (Active evaporative ne conductive onwini) .¶

Sɛ onipa no honam ani te nka sɛ ɛyɛ hyew, ɛyɛ kɔkɔɔ, anaasɛ fifiri ayɛ no, anaasɛ sɛ ano, tympanic (aso), anaa ne moma so thermometer kenkan boro 38.5 degrees Celsius (101.3 degrees Fahrenheit) a, simma biara a wɔde kyɛ no ma core temperature kɔ soro.

1. Yi insulation: Yi ntama, awerɛkyekye, jacket, sweaters, sɔks, ne pants a emu yɛ duru fi hɔ ntɛm ara kosi ntade ase. Fa onipa no fi mfɛnsere anaa radiator ahorow a owia bɔ kɛse mu kɔ ɔdan a ɛyɛ nwini sen biara a ɛwɔ hɔ mu, na fa mframa a wɔde yɛ adwuma no si hɔ kɛse.
2. Fa onwini a ɛkɔ so yɛ hyew (mist ne fan): Nwini a ɛma nsuo yɛ hyew ne ɔkwan a ahobammɔ wom a ɛyɛ ntɛm sen biara wɔ fie mu bere a nsukyenee aguaree nni hɔ anaasɛ ahobammɔ nni mu esiane asiane a ɛwɔ hɔ sɛ ɛbɛhaw anaasɛ ɛbɛkyere obi nti. Fa afifide a ɛho tew petepete toa anaa ntama a wɔde horo nneɛma a ɛyɛ nsu fa nsu a ɛyɛ nwini anaasɛ ɛyɛ hyew (digrii Celsius 15 kosi 20 / digrii Fahrenheit 59 kosi 68) hyɛ onipa no koko a ɛda hɔ kwa, ne yafunu, ne nsa, ne n’asen mu bere a wode anyinam ahoɔden adaka mu fan anaasɛ fan a ɛwosow no reto wɔn honam ani a ɛyɛ nsu no so tẽẽ (anaasɛ wode a krataa anaa krataa a wɔde to paanoo a ɛyɛ den). Mframa a ɛretu no ma nsu no sini no yɛ nwini, na ɛtwe ɔhyew a ahintaw pii fi honam ani mogya ntini mu a ɛmma ne ho popo kɛse.
3. Fa nsukyenee a wɔde asie a ɛma nsuo fa mu a wɔde asi wɔn ani so gu so: Fa nsukyenee a wɔde ahyɛ mu, nkotokuo a nhabannuru a wɔahyɛ no nwini wom, anaa plastic nkotokuo a wɔtumi san to mu a nsukyenee ne nsuo kuruwa ahyɛ mu ma wɔ nkukuo mpopaho a ɛyɛ tratraa a ɛyɛ nsuo mu. Fa gu ntini akɛse a ɛwɔ soro no so yiye:
4. kɔn no afã abien no nyinaa (carotid ntini ahorow, hwɛ yiye na woanmia mframa afiri no so da).
5. Nnipa baanu no nyinaa abasa (axillary arteries).
6. groin (femoral arteries) no afã abien no nyinaa.
7. Target stopping temperature: San hwɛ ɔhyew simma 5 biara sɛ ɛbɛyɛ yiye a. Sɛ core temperature kɔ fam kodu 38.0 degrees Celsius (100.4 degrees Fahrenheit) wie a, yi nsukyenee a ɛwɔ mu no na gyae nsuyiri no sɛnea ɛbɛyɛ a worenkɔ soro nsen nkɔ hypothermia mu.

Anamɔn 2: Gyinabea a ahobammɔ wom ne bara a wɔbara katee wɔ nipadua mu ahosodi ho¶

Ayarefo a wɔwɔ serotonin awuduru a emu yɛ den anaa NMS no taa yɛ basaa, ehu ka wɔn, wɔbɔ wɔn akuturuku, anaasɛ wonya ntini a ɛyɛ hyew a ɛyɛ basabasa (myoclonus).

• Popa nneɛma a atwa yɛn ho ahyia no sen sɛ wobɛsiw nipadua no ano: Fa kɔfe pon, nkongua, akanea, ne nneɛma a ano yɛ nnam fi onipa no ho. Fa mpa so ntama, apɔw-mu-teɛteɛ, anaa ntama a wɔabobɔw twa wɔn ho hyia wɔ fam sɛnea ɛbɛyɛ a sɛ wɔn nan wosow anaasɛ ɛbobɔw a, ɛbɛbɔ nneɛma a ɛyɛ mmerɛw a wɔde kata so sen sɛ wɔbɛbɔ dan mu nneɛma a ɛyɛ den.
• Tew nkate mu nkanyan so: Kanea a ɛhyerɛn a ɛwɔ soro, nne a ano yɛ den, television dede, ne nipadua mu dede a wɔde ka obi mpofirim kanyan ahodwiriw a ɛma clonus ne ntini a ɛyɛ mmerɛw no yɛ kɛse. Dum dan no mu akanea, dum television ne radio, na ma obiako a ne ho dwo no nkasa brɛoo, komm, na ɛma awerɛhyem.
• Fa gyinabea a ɛda nkyɛn a ɛma wo ho tɔ no di dwuma: Sɛ onipa no da, ɔyɛ mum, nsu retu, anaasɛ ɔyɛ katee a, bobɔ no brɛoo wɔ n’afã. Wɔ neuroleptic malignant syndrome mu no, menewa a ɛyɛ den no mma obi ntumi mene sɛnea ɛsɛ; sɛ obi da fam a, ɛma nnompe anaa ɔfe a aboaboa ano no kɔ ahurututu no mu tẽẽ, na ɛde ahurututu mu ahurututu mu yare a edi awu anaasɛ ɔhome a ɛyɛ hu ba. Fa ntama a ɛho tew a wɔde abɔ wo nsateaa ho popa nsu a ɛwɔ wɔn ano ase no.

Anamɔn 3: Nsu ho mmara ne mframa kwan a wɔhwɛ so yiye¶

• Mma nsu, aduan, anaa nnuru a wɔde di dwuma wɔ ano da: Sɛ ɛte sɛ nea onipa no ani da hɔ mpo a, wosow kɛse, anom clonus, anaa pharyngeal lead-pipe rigidity ma ɛyɛ mmerɛw kɛse sɛ ɔbɛmene. Mmɔ mmɔden sɛ wobɛma wɔanom nsu anaa agumadi mu anonne de asa nsu a ɛho ayɛ fĩ; nnuruyɛfo a wɔboa nkurɔfo bɛhyehyɛ nhama a wɔde fa ntini mu (IV) na wɔde isotonic crystalloid nsu a ayɛ nwini ahyɛ mu dwoodwoo.
• Exception for Parkinson withdrawal only (wɔ aduruyɛ akwankyerɛ ase): Sɛ ɔyarefo bi a wonim sɛ ɔwɔ Parkinson yare no nyaa NMS esiane sɛ ɔpaa wɔn levodopa dodow a wɔahyɛ da ayɛ no nkutoo nti na ɔda so ara ma n’ani da hɔ koraa na otumi mene no dwoodwoo a, bisa nea ɔde kɔma ntɛm anaa ntini ho ɔyaresafo a ɔfrɛ no sɛ ebia ɛsɛ sɛ wɔma wɔn dodow a wɔhwere no anaasɛ wɔbubu no ma wɔde ma ayaresabea nasogastric. Mfa nnuru nhyɛ ɔyarefo a ɔda anaasɛ ɔretu nsu anom da.
• Hwɛ chest wall excursion: Rigidity a emu yɛ den wɔ NMS anaa late-stage serotonin syndrome mu no betumi ato intercostal muscles a ɛda mpampam ne diaphragm ntam (chest wall rigidity), na asiw koko no ntrɛwmu. Hwɛ koko a ɛda hɔ kwa no yiye; sɛ ahome no mu nnɔ, ɛyɛ mmerɛw, anaasɛ ɛyɛ brɛoo (wɔn home 10 simma biara), anaasɛ sɛ anofafa no dan bruu-fitaa a, bɔ nea ɔde rekɔma no kɔkɔ ntɛm ara na siesie wo ho sɛ wobɛyɛ nkwagye ahome na CPR a wɔde yɛ adwuma.

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Nnuru ho akontaabu a edi mũ: nea ɛsɛ sɛ wɔboaboa ano ma nnuruyɛfo a wɔboa nkurɔfo¶

Nnuruyɛfo a wɔhwɛ ntɛmpɛ so ntumi npaw cyproheptadine (ma serotonin syndrome), dantrolene ne bromocriptine (ma neuroleptic malignant syndrome), anaa physostigmine (ma anticholinergic awuduru) a wonnim biribiara a ɛkɔɔ ɔyarefo no nipadua mu wɔ nnafua 14 kosi 35 a atwam no mu. Bere a onipa biako te ɔyarefo no nkyɛn ma onwini na ɔbɔ ne mframa kwan ho ban no, fa onipa a ɔto so abien ma sɛ onwie akontaabu a wɔyɛ no ntɛmntɛm yi:

• Hwɛ ɔyarefo no honam ani a ɛda hɔ kwa no mu sɛ ɛwɔ transdermal patches: Hwɛ n’akyi atifi, ne mmati, ne koko, ne nsa atifi, n’asen, ne n’asen. Hwehwɛ ntama a ɛda adi pefee anaasɛ ɛyɛ tan a ɛde fentanyl (ɛyaw), selegiline (adwenemhaw), rotigotine (Parkinson yare), rivastigmine (adwene mu yare), anaa scopolamine (akisikuru) ma. Sɛ ɔyarefo no rehyew denneennen a awuduru a wosusuw sɛ efi fentanyl, selegiline, anaa scopolamine aduru bi mu ba a, fa nsa anaa mpopaho a wɔde nsateaa ahyɛ mu yiyi no (bobɔ afã horow a ɛyɛ nnam no bom na fa gu kotoku mu ma nnuruyɛfo a wɔboa no), efisɛ honam ani hyew ma nnuru a wɔde fa honam ani no yɛ kɛse bɛyɛ ɔha biara mu nkyem 300. Mfa rotigotine Parkinson aduru bi mfi hɔ da, efisɛ sɛ woyi dopamine a wɔde si ananmu a, ɛma NMS yɛ kɛse.
• Pora mpa, aguaree, kotokuo, ne bag mu ma nkotokuo nyinaa: Boaboa toa biara a wɔkyerɛw ma, dapɛn dapɛn nnuruyɛ nhyehyɛeɛ, ne nnurutɔnbea krataa, a nnuru a wɔagyae wɔ adapɛn 5 a atwam no mu ka ho.
• Boaboa nneɛma a wɔtɔn wɔ aduruyɛdan mu (OTC) nyinaa ano: Hwehwɛ nsu a wɔde fa ɔfe, gelcaps a wɔakyerɛw so sɛ "DM" (dextromethorphan), nnuru a wɔde boa ma ɔda anadwo, nnuru a ekum histamine, nnuru a wɔde sa kankyee, ne atiridiinini aduru pɔtee.
• Boaboa nhabannuru, aduan, ne nipadua a wɔde hyɛ nipadua mu den ano: Hwehwɛ St. John's wort, 5-HTP, L-tryptophan, SAM-e (S-adenosyl-L-methionine), ginseng, synephrine / borɔdɔma a ɛyɛ nwononwono, yohimbine, nnuru a ɛma obi mu duru so tew, ne nnuru a wɔde yɛ apɔw-mu-teɛteɛ.
• Kyerɛw bere nhyehyɛe pɔtee ne nsakrae a ɛba wɔ dodow a wɔde ma mu: Kyerɛw gu krataa so:
• So oduruyɛfo biara fii ase kyerɛw nnuru foforo anaasɛ ɔmaa miligram dodow kɔɔ soro wɔ nnafua 14 a atwam no mu?
• So ɔyarefo no sae anaasɛ ogyaee adwenemyare anaa Parkinson nnuru biara wɔ nnafua 7 a atwam no mu?
• Bere bɛn na wɔnom nnuru a etwa to nnɛ, na so anka dodow a wɔde dii dwuma mmɔho abien anaasɛ wɔhyɛɛ da nom boro so wɔ akwanhyia mu?

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Nsɛnnennen: rhabdomyolysis, asaabo a entumi nyɛ adwuma yiye, ne ntini mu mogya a ɛtrɛw¶

Sɛ wɔte nea enti a ayaresabea ahorow di nnuru a ɛne wɔn ho wɔn ho di nkitaho a emu yɛ den ho hyew kɛse ho dwuma sɛ ade a ɛho hia sen biara a wɔde ma wɔn nkwa mu a, ɛboa mmusua ma wohu nea enti a sɛnkyerɛnne ahorow a emu nyɛ den anaa nea ɛkɔ fam mpo hwehwɛ sɛ wɔyɛ dwumadibea a wɔhwɛ ntɛmpɛ mu nhwehwɛmu:

1. Rhabdomyolysis ne acute hyperkalemic cardiac arrest: Sɛ wɔhyɛ nnompe mu ntini nhama ma ɛtwetwe anaasɛ ɛwosow bere nyinaa nnɔnhwerew pii wɔ ɔhyew a ɛboro digrii Celsius 39.5 (digrii Fahrenheit 103.1) mu a, ntini nkwammoaa no mu ntini no mu paapae na ɛpopae (mmɔdenbɔ ne nnuru a wɔde yɛ rhabdomyolysis). Ntini mu nkwammoaa a apaapae no tow potassium (a ɛde koma no mu yare a edi awu ba wɔ simma kakraa bi mu), creatine kinase (CK), ne myoglobin (protein a ɛyɛ kɔkɔɔ tuntum a ɛto asaabo no mu ntini nketenkete a ɛtwetwe nsu mu, na ɛma asaabo no di huammɔ kɛse na ɛyɛ bruu tuntum "cola-colored" pii gu. nsuo).
2. Metabolic acidosis: Ntini a abrɛ no dan kɔ anaerobic metabolism so, na ɛde lactic acid hyɛ mogya no mu kosi sɛ mogya no pH bɛkɔ fam asen dodow a ɛne koma no a ɛtwetwe sɛnea ɛte daa no hyia.
3. Disseminated intravascular coagulation (DIC): Core temperatures a ɛboro digrii Celsius 40.5 kosi 41.0 (104.9 kosi 105.8 degrees Fahrenheit) no sɛe endothelial proteins a ɛkata mogya ntini mu, na ɛkanyan mogya ntini nketenkete mpempem pii wɔ nipadua no nyinaa mu bere a bere koro no ara mu no, ɛma mogya a ɛtwetwe no nyinaa brɛ, na ɛde... mogya a ɛba ara kwa fi anom, aduan a wɔyam, ne mmeae a wɔde IV gu mu.

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Nhwehwɛmu a wɔde siw ano ma ayarefo ne wɔn a wɔhwɛ wɔn¶

Sɛ obi ho tɔ no fi serotonin syndrome anaa neuroleptic malignant syndrome mu pɛ, anaasɛ sɛ ɔnom nnuru a wɔde sa adwenemyare, ntini mu yare, anaa ɛyaw a enni sabea da biara a, sɛ wodi nnuruyɛ mu ahobammɔ a emu yɛ den akyi a, ɛmma ɛnsan mma bio:

• Fa nnurutɔnbea biako di dwuma ma nnuru biara a wɔkyerɛw ma: Sɛ wohyɛ nnuru a wɔkyerɛw ma wɔ nnurutɔnbea nkɔnsɔnkɔnsɔn biako mu a, ɛma nnuruyɛfo no automated drug-interaction software no tumi de frankaa kyerɛ serotonergic anaa dopamine-blocking combinations a ɛyɛ hu wɔ nnuru ahorow a wɔkyerɛw ma no mu (te sɛ adwenemyare ho oduruyɛfo, ɛyaw ayaresabea oduruyɛfo, ne ntini ho oduruyɛfo).
• Bisa "Serotonin Asɛmmisa" ansa na woatɔ atiridii anaa ɛyaw aduru biara: Ansa na wobɛtɔ ɔfe aduru biara a wɔtɔn wɔ aduruyɛdan mu, aduru a ɛma obi ho yɛ no yaw, anaa nhabannuru a wɔde ma no, kyerɛ wo nnuru a wɔahyehyɛ no kyerɛ nnuruyɛfo no na bisa pefee sɛ: *"So dextromethorphan anaa biribiara a ɛne me nnuru a ekum adwenemhaw no di nkitaho wɔ saa aduru yi mu?"*Paw guaifenesin a ɛnyɛ den, saline aduru a wɔde petepete anom, anaa ɛwo a wɔde gu mu sen sɛ wɔde "DM" nnuru a wɔde siw ɔfe ano bedi dwuma.
• Nnyae Parkinson anaa nnuru a ekum adwene mu yare mpofirim da: Bere nyinaa san hyɛ nnuru a wɔakyerɛw ama wo no ma anyɛ yiye koraa no nnafua 7 ansa na asa, na fa nnafua 5 a wɔde asie ntɛm ara gu wo go-bag a wɔde yi nkurɔfo fi hɔ na ntɛmpɛ nkitahodi krataa.
• Hwɛ nhwehwɛmu ntɛm sɛ ebia "prodromal" kɔkɔbɔ nsɛnkyerɛnne a ɛnyɛ den: Serotonin a ɛboro so a ɛnyɛ den taa fi ase denam nsa foforo a ɛwosow, fifiri a wontumi nkyerɛkyerɛ mu bere a woregye w'ahome, akisikuru, ahomegye a enni hɔ, ne nan a ɛtwetwe ansa na atiridii aba da so. Sɛ wofrɛ oduruyɛfo a ɔkyerɛw nnuru ma no anaasɛ wobɛkɔ ayaresabea a egye ntɛmpɛ wɔ bere a wo ho popo no mu a, ɛma wotumi yɛ nsakrae wɔ dodow a wɔde ma no mu a ahobammɔ wom ansa na ɔhaw a edi mũ asɔre.

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Nsɛm a wɔtaa bisa¶

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Sources a wɔhwɛɛ mu¶

• Boyer EW, Shannon M (New England Nsɛmma Nhoma a Ɛfa Aduruyɛ Ho Ayaresabea Nneyɛe Nhwehwɛmu): Serotonin Syndrome ne Hunter Serotonin Toxicity Criteria (Dunkley EJC ne afoforo, QJM).
• United States Aduan ne Nnuru Dwumadibea (FDA, United States): FDA Nnuru Ahobammɔ Nkitahodi a ɛfa Serotonin Syndrome a wɔde SSRIs, SNRIs, Triptans, Opioids (Fentanyl, Tramadol), ne Methylene Blue / Linezolid di dwuma ho.
• United Kingdom Nnuru ne Akwahosan ho nneɛma ho Mmarahyɛ Bagua (MHRA) ne Ɔman Asoɛe a Ɛhwɛ Akwahosan ne Ɔhwɛ a Ɛyɛ Paara So (NICE, United Kingdom): Nnuru Ahobammɔ Ho Nsɛm Foforo a Ɛfa Serotonin Syndrome ne Neuroleptic Malignant Syndrome a Wohu ne Nea Wɔhwɛ So.
• Amerika Adwene ne Nkate Ho Ayaresa Fekuw (APA) ne Neuroleptic Malignant Syndrome Amanneɛbɔ Dwumadibea (NMSIS, United States): Amanaman Ntam Nkitahodi a Wɔde Hu Nhwehwɛmu ne Ayaresa Akwankyerɛ a Wɔde Ma Neuroleptic Malignant Syndrome.
• Amerika Sukuu a Ɛhwɛ Aduruyɛ mu Awduru Ho Adesua So (ACMT) ne Awuduru Ho Asoɛe (United States): Toxicologic Hyperthermia, Cyproheptadine a Wɔde Ma, ne Preyare Hospital Evaporative Cooling Protocols.
• Wiase Akwahosan Ahyehyɛde (WHO) ne Amanaman Ntam Mmeamudua Kɔkɔɔ ne Ɔsram Kɔkɔɔ Fekuw (IFRC, Amanaman Ntam): Awuduru a Ɛyɛ Hu, Nnuru a Wɔde Di Dwuma boro So, ne Mmoa a Edi Kan a Wɔde Ma Wɔn a Wɔyare Ho Ntɛmntɛm Nhwehwɛmu.

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Akwankyerɛ ahorow a ɛfa ho¶

• Awuduru ne nnuru a wɔde di dwuma boro so mmoa a edi kan
• Rhabdomyolysis a wɔde mmɔdenbɔ yɛ, asaabo mu opira a emu yɛ den, ne ntini a ɛpaapae
• Akisikuru ne akisikuru mmoa a edi kan
• Ɔhyew stroke versus ɔhyew ɔbrɛ onwini protocols
• Nnɔmba a egye ntɛmpɛ sɛnea ɔman biara te