Dilekela maluvu makole, Delirium Tremens (DTs), ne Disungula dia maluvu¶

Kulekela mu tshimpitshimpi anyi kukepesha bikole dinua dia maluvu a bungi, dituku dionso ntshimue tshia ku bilumbu bia njiwu bia bungi bia luondapu mu malu a luondapu. Nansha mudi bantu batamba kuangata dilekela maluvu bu "tshintu tshia mashika" kumbelu bu bualu bupepele bua disua dia muntu nkayende, lungenyi lua Alcohol Withdrawal Syndrome (AWS) lukole ludi luenza mudimu bu tshipepele tshikole tshia nzembu tshidi katshiyi tshikanga munda mua tshitupa tshia mubidi tshidi tshienza mudimu ne lungenyi. Padi buongo budi buibidilangane ne ngondo anyi bidimu bia bungi bia dienza dia ethanol dituku dionso bujimija maluvu mu tshimpitshimpi, biamu bidi bipangisha gamma-aminobutyric acid (\(\text{GABA}_\text{A}\)) bidi binyanguka eku biamu bidi bienza mudimu wa glutamate (NMDA) bidi bienza mudimu bikole.

Mu mêba 6 too ne ku 48 a dinua dia ndekelu, divulangana dia adrenergic ne dia glutamatergic edi didi mua kujula tshimpitshimpi tshipupu tshia tonic-clonic ("rum fits"), nansha kudi babedi badi bianza biabu kabiyi bitekete. Mu mêba 48 too ne ku 96, pabuipi ne 5 pa lukama ya babedi badi kabayi bapeta luondapu badi bafika ku Delirium Tremens (DTs), disama dia tshimpitshimpi dia malu a luondapu didi dimanyibua kudi dipanga dia lungenyi dia pa buloba bujima, dimona ne dimona dia malu adi akuatshisha buôwa, kapia, disama dia mashi makole, ne disama dia mutshima didi difikisha ku lufu too ne ku 150 pa lukama bikalabu kabayi baondapibue kumbelu** (pa kumufuanyikija ne lufu lua muinshi mua 1 pa lukama mu tshibambalu tshia malu a mpukapuka tshia mu lupitadi lua matuku etu aa). Kumanya mua kupima bukole bua dilekela dia maluvu ku diambuluisha dia CIWA-Ar criteria, bua tshinyi mêku kaena ne bua kuenzeja muntu bua kujikija lutetuku lua tshimpitshimpi kakuyi dilombola dia baminganga, ne mushindu udi baminganga ba mu lupitadi benza mudimu ne benzodiazepine loading, phenobarbital, ne thiamine (Vitamine B1) bua kusungila mioyo ya buongo.

Enza nunku mpindieu¶

1. Bikila nimero ya lukasa ya muaba uudi musombele diakamue pikala muntu udi ulekela kunua maluvu ne disama dia tshimpitshimpi, mupampakane anyi mupangile tshia kuenza, mumone malu adi kaayi malelela, anyi mupete kapepe anyi disama dia mu tshiadi. Ela 911 mu États-Unis ne mu Canada, 112 mu Union européenne mujima, 999 mu Royaume-Uni, anyi tangila nomba ya tshimpitshimpi tshilaminu. Amba patoke ne: "Ndi ne muntu mukulumpe udi mu dilekela dia maluvu udi ne disama dia tshiadi / udi ne tshimvundu tshikole ne mutshima wenda unyema."
2. Lama njila wa lupepele ne uteke muntu udi usama anyi udi upela ku luseke luabu mu muaba wa diondopangana. Bikala disama dia tshimpumpu dia dipatuka dia tshimpitshimpi dienzeke, umbusha bintu bikole kule ne muntu au, umubuikile mutu wende ne jacket mubuikila, kuela minu, bipese anyi bintu mukana muende nansha kakese, ne ubikuate ku luseke luabu lua dia bakaji padi mate anyi ajika tshisuku tshidi tshipatuka bimpa mu njila wa luya. Tangila wetu diambuluisha dia kumpala dia tshimpumpu mulombodi.
3. Kuenzeji muntu udi unua maluvu a bungi dituku dionso bua kulekela "cold turkey" kumbelu padiye muindile bulalu bua diondopangana to. Wewe anyi muntu uudi munange unua maluvu a bungi dituku dionso (nangananga muntu yonso udi unua maluvu mu dinda bua kuimanyika "maluvu," uvua mupete tshipupu tshia dilekela maluvu anyi Delirium Tremens anyi unua maluvu mapite pa 28 ku dituku) kabena mua kubuela mu nzubu wa diondopangana too ne malaba to, ya buludiludi ku tshibambalu tshia malu a mpukapuka tshia mu lupitadi lelu pamutu pa kubasuika mu nzubu wa bulalu kuyi ne maluvu anyi bukubi bua GABA bua luondapu.
4. Tangila dikuma dia mutshima, tension, ne muaba udi muntu mu minite 30 yonso paudi muindile bua kuya nende. Dipuekesha dia mashi dipite pa 110 too ne ku 120 mu minite, tension wa pa mutu pa 160/100 mmHg, tuishi tua bungi, anyi dipanga dia kuleja dituku ne muaba bidi bileja ne: udi ne bua kuikala ne disama dia tshiadi didi dienda dikola anyi didi dikengela dijadika dia lukasa dia mu lupitadi mu mishipa.
5. Lama muaba udi butoke bukese, mupole, ne mupole. Divulangana dia glutamate didi dienza bua buongo budi bupatuka buikale ne lungenyi lua bungi ku miendu mikole, ku mutoyi wa televizion, ne ku bienzedi bia tshimpitshimpi bidi bikemesha, bidi bipuekesha buludiludi tshipiminu tshia disama dia tshiadi ne bivudija buôwa.
6. Ikala mushindike ne: lupitadi ludi lufila Thiamine (Vitamine B1) ya bungi KUMPALA anyi pamue ne glucose/sugar IV. Kunua maluvu makole kudi kujimija thiamine mu mubidi; kufila bintu bia bungi bia sukadi mu mishipa (D5W) anyi biakudia bidi ne nsukadi kudi mubedi udi kayi ne biakudia bia bungi mu dilekela dia maluvu kayi mumupeshe tshiamine mu mushipa anyi mu mifuba kumpala bidi mua kufikisha ku disama dia Wernicke's Encephalopathy didi kadiyi mua kupingana (dinyanguka dia buongo dia kashidi ne dijimija dia lungenyi).

Mutshi wa dipangadika: Kusungula njiwu ya kulekela maluvu ne ya kulekela maluvu¶

Ingidija tshimfuanyi etshi tshia disungula dia maluvu bua kumanya ni muntu udi ulekela kunua maluvu udi mua kuikala mu lupitadi lua pambelu anyi udi dijinga ne diambuluisha dia lukasa dia ku lupitadi lua tshibambalu tshia malu a mpukapuka.

flowchart TD
    A["Muntu udi ulekela anyi ukepesha lukasa dinua dia maluvu"] --> B{"Bimanyinu bia tshimpitshimpi bia dibendele dikunze bidiku mpindieu anyi?"}
    B -->|"Disama dia tshimpitshimpi, dipanga dia lungenyi, dipanga dia lungenyi, dipanga dia lungenyi, dikuma dia mashi >115 bpm, kapia >38.3C (101F), anyi dipuekesha dia kashidi"| C["MUSHINDU WA LUPILU (Udi wela meji ne: udi ne disama dia tshiadi / Delirium Tremens): Bikila 911 / 112 / 999 diakamue bua kuya ne ED mu lupitadi"]
    B -->|"Kakuena mabenda makunze diakamue to; mubedi udi mudimuke ne udi mumanye tshidiye wenza"| D{"Tangila malu a kale a lupitadi ne malu adi mua kufikisha ku didia dia dituku dionso"}
    D -->|"Muyuki wa disama dia tshiadi anyi DTs, NANSHA >10 maluvu/dituku, NANSHA maluvu a mu dinda adi abulula mêsu, NANSHA disama dia benzo/opioid/muoyo didi dienzeka pamue"| E["NYIKA MUNENE BIA KUTUA BIKOLE (ASAM Level 3.7/4.0): Ndaku ku lupitadi lua ED anyi 24/7 Inpatient Medical Tox KUMPALA kua bimanyinu kufika"]
    D -->|"Kunua maluvu makese anyi a pa tshibidilu, kakuyi disama dia tshimpitshimpi/DT, makanda a mubidi mimpe, muntu wa kueyemena udi ulama dîku kumbelu"| F["MUSHINDU MUKESE / MUKESE: Dikonkonona dia lukasa dia dituku dimue kudi munganga / Dilama dia lukasa bua CIWA-Ar scoring ne chlordiazepoxide/gabapentin taper wa babedi badi kabayi mu lupitadi"]
    C --> G["Mikenji ya lupitadi: IV Lorazepam/Diazepam anyi Phenobarbital + High-Dose IV Thiamine (Vitamine B1) + Magnesium/Potassium replacement"]
    E --> G

Tshitupa 1: Tshikondo tshia 4 tshia disama dia dilekela kunua maluvu (AWS)¶

Buteyi bua njiwu mu dilekela maluvu budi ne: malu adi mua kushipa bantu kaena enzeka mu mêba 6 a kumpala to: adi afika ku tshibungubungu matuku 2 anyi 4 kunyima kua dinua dia ndekelu, anu padi mêku wela meji ne: muntu au udi "pabuipi ne kupitshila mu malu mabi menemene." Bu mudi ethanol upatuka mu mashi lukasa (pabuipi ne 15 anyi 20 milligrams ku decilitre ku dîba), muntu udi ne bungi bua maluvu a bungi mu mashi (bu mudi 0,30% BAC) udi mua kutuadija kupeta bimanyinu bikole bia dilekela maluvu patshidiye ne maluvu adibu mua kupima ku tshiamu tshia kupima natshi mupuya.

Tablo wa dikola dia disama: mêba 6 too ne ku 120 kunyima kua dinua dia ndekelu¶

Tshitupa 2: Disungula dia muena mudimu wa ku nzubu ku diambuluisha dia tshipiminu tshia CIWA-Ar tshia mu lupitadi¶

Mu mpitadi ne mu nzubu ya dilengeja dia maluvu pa buloba bujima, baminganga ne baminganga batu benza mudimu ne tshipiminu tshia Clinical Institute Withdrawal Assessment for Alcohol, Revised (CIWA-Ar) kunyima kua mêba 1 anyi 4 bua kupima bukole bua dilekela dia maluvu ne kutuadija bungi bua manga a bukubi kumpala kua disama dia tshimpitshimpi kuenzeka.

Nansha mudi muena mudimu wa ku nzubu kayi mua kupingana pa muaba wa munganga, kumvua bimanyinu 10 bia disama bidibu bafunde pa tshipiminu tshia CIWA-Ar (tshipeta tshijima tshia 0 too ne ku 67) kudi kukuambila diakamue padi muntu uudi munange upita mu tshitupa tshia njiwu:

1. Disama dia mutshima ne disama dia tshiadi (0 too ne ku 7): Ku disama dia mutshima dikole (1) ku dipanga dia bukole bua kulama mayi anyi manga a kunua panshi (7). (Dimanya: Muntu yense udi kayi mua kulama mâyi panshi kena mua kunua manga a diondopangana kumbelu to, ne udi ne bua kuya ku lupitadi bua kuenza luondapu lua IV.)
2. Tremor (0 to 7 points): Lomba muntu bua kuolola bianza bionso bibidi kumpala kuende ne minu mitangalake:
   • Dikankamika dia patupu didi diumvuika anu padibu batenga nsongo ya minu yabu (1 to 2).
   • Dikankamika dia pa tshibidilu didi dimueneka dikuata bianza biabu biolola (4).
   • Dikankamika dikole dia mubidi mujima anyi dia diboko nansha padi diboko diikisha ku nseke (7).
3. Mutoyi wa Paroxysmal (0 to 7 points): Maboko maume (1), bipese bia tuishi bidi bimueneka pa mpala (4), anyi kuela tuishi, kuela bilamba bia bulalu ne bilamba (7).
4. Tunyinganyinga (0 too ne ku 7): Buôwa bukese (1) too ne ku ntatu mikole idi mifuanangane ne buôwa bukole anyi kabutu kadi pabuipi (7).
5. Dibungama (0 too ne ku 7): Dienda dia lubilu, dipanga dia kusomba, dienda dienda diendakana ne dikudimuna anyi dikosa bilamba bia bulalu (7).
6. Tactile Disturbances (0 to 7 points): Disama, disama dia nsongo, dijima, anyi kumvua bishi bia mu lungenyi bienda muinshi anyi pa dikoba (difuka).
7. Dinyanguka dia matshi (0 too ne ku 7): Mitoyi ya mu nzubu idi imueneka mikole anyi mikole (1 to 3), too ne ku kumvua mêyi, mijiki, anyi mitoyi padi muntu kayi wakula (5 to 7).
8. Dinyanguka dia tshimuenekelu (0 too ne ku 7): Miendu ya mu nzubu idi imueneka mikole anyi mitoyi idi minyunguluke miendu (1 to 3), bindidimbi bidi bimueneka bu bidi bienda mu ditumba dia dîsu (4), too ne ku dimona dia nyama, bikunyibua anyi bantu (7).
9. Mutu usama / Mutu muwule (0 to 7 points): Diumvua dia tshilamba tshikole anyi dia dikuma dia mu mutu.
10. Dilombola ne dibuikila dia Sensorium (0 to 4 points): Lomba muntu bua kuamba udiye nganyi, nzubu kayi/tshimenga kayi tshidiye, dituku dia lelu, ne umulombe bua kubala kunyima kubangila ku 100 ku 7s (anyi kufunda "BULOBA" kunyima):
    • Dipanga dia kumanya muaba anyi dituku, anyi dipanga dia mushindu wa kulonda malu mapepele adibu basakidila/difunda dia miaku, bidi bifikisha diakamue ku Tshibambalu tshia malu a mpukapuka.

Mushindu udi baminganga bumvuija bungi buonso bua CIWA-Ar¶

• Tshipeta tshia 0 too ne ku 8 (Kakuyi too ne ku dilekela dia kakese): Dilonda dia diambuluisha, dinua dia mâyi, thiamine wa ku mishiku, ne dikonkonona dia dikuba dia gabapentin anyi dia dose mukese wa benzodiazepine taper pikalaku njiwu mikole.
• Tshipeta tshia 9 too ne ku 15 (Dilekela dia pa tshibidilu): Bidi bikengela luondapu lua tshilumbu anyi lua pa tshibidilu (bu mudi chlordiazepoxide, diazepam anyi lorazepam) bua kuepuka dikola dia tshimpumpu.
• Tshipeta tshia 16 too ne ku 20+ (Dilekela dia mudimu dikole / Disama dia Delirium didi dilua): Dibuela dia lukasa mu lupitadi / Tshibambalu tshia malu a mpukapuka didi dikengedibua. Bidi mua kuenzeka bikole bua kupeta disama dia tshimpitshimpi ne Delirium Tremens.

Tshitupa 3: Tshia kuenza pikala muntu uudi munange kayi mua kupeta bulalu bua kujikija lutetuku lelu (The Cold-Turkey Trap)¶

Umue wa ku malu a tshimpitshimpi adi enzeka misangu ya bungi udi wenzeka pa dîba 18:00 mu dilolo dia ditanu: muntu udi unua maluvu 12 too ne ku 20 anyi litre umue wa maluvu makole dituku dionso munkatshi mua ngondo ya bungi udi wangata dipangadika dia kulekela, udi ubikila nzubu isatu ya diondopangana, ne badi bamuambila ne: "Bulalu buetu budi bulonda bua babedi kabuenaku too ne mu dinda dia dimue."

Ntshinyi tshiudi ne bua kuenza mu tshitupa tshia mêba 24 too ne ku 72 etshi wewe kuyi mua kubuela mu nzubu wa diondopangana udi nkayende mpindieu?

1. Mushindu A (Gold Standard): Ndaku buludiludi ku tshibambalu tshia malu a mpukapuka tshia mu lupitadi¶

Kuindidi too ne mu dinda bua kupeta bulalu bua nzubu wa tshilala benyi bikalabi ne: udi unua maluvu a bungi dituku dionso to. Enda mu Tshibambalu tshia lupitadi lua lukasa lukasa tshidi pabuipi (ki ntshibambalu tshia luondapu lua lukasa tshia mu kartshie to). - Mukanda mulelela wa kuamba ku tshibambalu tshia disungula dia lupitadi: > "Ndi nnua [amba bungi bulelela bua dituku dionso, e.g., 1 litre wa vodka / 18 bia bia kunua] dituku dionso. Tshintu tshianyi tshia ndekelu tshia kunua tshivua [X] mêba mapite. Ndi ntuadija kumvua dikankamika dia dilekela dia maluvu, dipatuka dia tuishi, ne muoyo udi unyunguluka, ne ndi mu njiwu mikole ya disama dia dilekela dia maluvu. Ndi dijinga ne dilekela dia maluvu dia luondapu." - Baminganga ba mu lupitadi badi mua kutuadija diakamue kukuela benzodiazepines (diazepam, lorazepam, anyi chlordiazepoxide) anyi phenobarbital udibu bafila kumpala, kukupesha IV thiamine ne magnesium, ne kukubueja mu lupitadi bua matuku 3 too ne ku 5 bua kukuambuluisha bua kuikala ne disama dia tshimpitshimpi anyi . mukanda wa luondapu too ne padi bulalu buebe bua diondopangana bubuluka.

2. Bua tshinyi kuikala nkayebe kumbelu kudi mua kushipa muntu¶

Kukanga muntu udi unua maluvu a bungi mu nzubu, kuela maluvu ende mu tshina tshia mâyi, ne kumuenzeja bua kuenza mêba 48 kayi ne maluvu ne benzodiazépines ya luondapu padiye muindile rendez-vous wa mu Dimue. - Mikenji ya dipuekesha dia njiwu ne ya dikuatshika dia maluvu idi ifumina ku Bulongolodi bua makanda a mubidi pa buloba bujima (OMS), Tshilongelu tshia ditunga tshia malu a bukola bua mubidi ne dilama dia malu mimpe (NICE, Royaume-Uni), ne Health Canada idi idimuija patoke mêku ne babedi ne: bikala muntu udi ne dikuatshika dia maluvu dikole kayi ne mushindu wa kupeta luondapu lua lukasa lua lukasa anyi dia diadia dipuekesha dia tshimpitshimpi dia kunua maluvu too ne ku zero musangu umue didi mua kufikisha ku disama dia tshimpitshimpi ne dia Delirium Tremens mu mêba 24 too ne ku 48. - Shi udi mupangile muaba wa kule anyi muindile mêba a bungi bua kukuambula ne dikankamika dikole, difuka, ne tshiji tshituadije, kuya ku Tshibambalu tshia malu a mpukapuka bua kupeta manga mimpe a GABA-agonist ke mushindu mutambe buimpe wa buanga; kueyemenyi nansha kakese bukole bua nzubu budi kabuyi bulonda padi ditekemena dia mubidi dikole.

3. Malu makole a buanga adi amueneka bu (anyi adi akolesha) dilekela dia maluvu¶

Padi muntu udi unua maluvu makole ulua mubungame, mutekete mu mikolo, ne luya, anyi utuadija kuela nsukadi, bena mu dîku batu misangu ya bungi bela meji ne: "tshidi anu tshitupa tshia diondopangana." Mu malu a luondapu lua lukasa, baminganga batu babenga malu atanu adi mua kunyanga muoyo adi amueneka bu a dilekela maluvu:

1. Occult Subdural Hematoma (Brain Bleeding from an Unwitnessed Fall): Dinua dia maluvu makole didi difikisha ku dinyanguka dia buongo (dilengeja dia mijilu idi munda mua tshifu) eku dipanga dia mudimu wa tshifu didi dikepesha dikola dia mashi. Dikuluka dia patupu anyi dibutuka ku mutu mêba 24 too ne ku 72 kumpala didi mua kufikisha ku subdural hematoma. Misangu yonso ambila munganga wa ED pikala mubedi ne mputa, mputa, anyi mputa ku mutu anyi ku mpala bua yeye kuenza CT scan wa mutu udi kauyi ne dishilangana.
2. Dipatuka dia mashi mu tshifu tshia kuulu (disama dia mu tshifu, ditshibuka dia Mallory-Weiss, anyi disama dia tshifu didi difumina ku mashi): Dipatuka dia mashi mu tshifu tshia kuinshi didi mua kutshibula tshifu tshia kuinshi, anyi disama dia tshiadi didi mua kutshibula tshifu tshia kuinshi. Shi muntu muele mashi makunzubile, bintu bya "kafe" bya mfiondo, nansha upita mashi mafike, a goudron, a mupuya mubi (melena), ubikile 911/112/999 diakamue (tangila diambuluisha dia kumpala dia mashi adi apatuka mu tshifu mulombodi).
3. Disama dia pancréatite dikola ne disama dia tshiadi tshia maluvu: Disama dikole dia mu difu didi difika too ne munkatshi mua mukolo dilondangana ne disama dia nsukadi didi dileja pancréatite wa tshimpitshimpi, didi difikisha ku dijimija dia mayi a bungi a munda ne ku ditshioka padibu kabayi baondapa ne mayi a mu lupitadi.
4. Meningitis bactérienne ou Aspiration Pneumonie: Bu mudi dilekela maluvu kumpala kua dîba kadiyi dikole kadiyi difila kapia kakole mu mêba 24 a kumpala, luya lukole lua pa mutu pa 38,5 degrés Celsius (101,3 degrés Fahrenheit) pamue ne nshingu mikole, tshifu tshidi tshipatula bipeta, anyi oxygène mukese bidi bikengela kuenza mudimu diakamue mu lupitadi disama dia tshiadi anyi dia meningitis pamue ne luondapu lua Delirium Tremens.
5. Dilekela dia manga a benzodiazepine anyi a opioid: Shi mubedi uvua kabidi unua manga a benzodiazepines (Xanax, clonazepam) adibu bamufundile anyi a mu njila pamue ne maluvu, njiwu ya disama dia tshiadi idi ivula misangu ibidi ne tshikondo tshia dilekela tshidi tshibanga matuku 5 too ne ku mbingu 2 too ne ku 4.

Tshitupa 4: Mikenji ya diondopangana dia mu lupitadi (Tshiudi mua kutekemena ku ED)¶

Kujingulula manga menemene adi baminganga bangata mu lupitadi kudi kumbusha buôwa bua kukeba diambuluisha dia lukasa. Dilengeja dia buanga kadiena dilomba kuela babedi panshi bua kukenga to; GABA-stabilizing protocols ya lelu idi ipuekesha tshitupa tshia mijilu mu minite 30 too ne ku 60 bua mubedi apuwe bimpa ne mu bukubi.

1. Mulongo wa kumpala wa GABA-Agonist Cross-Tolerance Medicaments¶

Bualu bua benzodiazepines ne phenobarbital bidi bilamakaja ku \(\text{GABA}_\text{A}\) chloride-channel receptor complex mu buongo bu mudi maluvu (cross-tolerance), difila dia benzodiazepine anyi barbiturate udi wenza mudimu mutantshi mule didi dipingana diakamue pa muaba wa mayi adi kaayi makane mu buongo, dipangisha dia buongo dikankamika, dipuekesha dia dikuma dia muoyo ne dia mashi, ne dipangisha dia tshimpumpu padi buongo buenda bulongolola bitekete bitekete bintu biabu bia ku tshilelelu mu matuku 4 too ne ku 7:

2. Kuepuka disama dia Wernicke-Korsakoff ("Buongo butoke") ne dikanga dia electrolyte¶

Mubedi yense udibu bondopa bua dilekela dia maluvu udi dijinga ne malu asatu a mushinga adi atangila biakudia ne dishintulula dia mubidi pamue ne diondopangana:

1. High-Dose Parenteral Thiamine (Vitamine B1, 100 mg to 500 mg IV or IM dayly for 3 to 5 days):
   • Maluvu adi apangisha dikuata dia Vitamine B1 mu mala, kadi buongo budi dijinga ne Vitamine B1 bu co-enzyme udi ne tshia kuenza bua kushintulula glucose (sukadi).
   • Padi muntu kayi ne dose munene wa IV anyi IM thiamine (ma tablette a thiamine a ku mishiku kaena afika bimpe mu tshifu tshidi ne disama dia maluvu), mubedi udi ulekela udi mua kupeta Wernicke’s Encephalopathy, udi umueneka ku mishindu isatu ya kale ya dipanga dia lungenyi, ataxia (dipanga dia lungenyi/dipanga dia kuenda), ne dipanga dia lungenyi/dipanga dia mêsu anyi dienda dia mêsu misangu ibidi tshimuenenu). Bikalabu kabayi babaondape, bantu 80 pa lukama badi ne disama dia Wernicke badi baya ku disama dia Korsakoff’s Psychosis (dipanga dia kuvuluka malu mapiamapia, didi dilomba dilama dia matuku onso a muoyo wabu).
2. Intravenous Magnesium Sulfate (\(\text{MgSO}_4\)) and Potassium (\(\text{K}^+\)) Replacement:
   • Kunua maluvu matuku a bungi kudi kuenza bua mifuba ijimije bungi bua bungi bua magnesium, potassium, ne phosphate mu mashi.
   • Disama dikole dia hypomagnesemia (magnésium mukese mu mashi) ne hypokalemia (potassium mukesa mu mashi) bidi bipuekesha buludiludi tshipiminu tshia tshipupu tshia buongo ne bidi bijula ​​disama dia mutshima dia lufu (Torsades de Pointes). Kupingana pa muaba wa magnésium ne potassium kudi ne tshia kuenzeka bua kuimanyika disama dia tshimpitshimpi ne disama dia mutshima.
3. Dilonda dia disama dia ketoacidose dia maluvu (AKA) ne dipueka dia mashi mu mashi:
   • Padi muntu udi unua maluvu makole ulekela kudia matuku abidi ne utuadija kuela nsukadi bua dilekela anyi disama dia tshifu, glycogène wa mu tshifu udi mujimine kawena mua kulama sukadi mu mashi to, ne bidi bifikisha ku hypoglycémie (sukadi mukese mu mashi, udi uleja tshipupu anyi koma) ne **Ketoacidosis alcoolique (acide métabolique severe) mu mashi.

Tshitupa 5: Dishintuluka dia dilekela dia maluvu too ne ku dijikija dia maluvu mutantshi mule (MAUD)¶

Kujikija diondopangana dia matuku 5 kudi kujikija dilekela dia mubidi, kadi kakuena kuondopa majinga a mu lungenyi adi afumina ku disama dia dikuatshika dia maluvu to. Kumpala kua kupatuka mu lupitadi anyi mu nzubu wa dilengeja dia maluvu, lomba munganga bua kutuadija umue wa ku mishindu inayi idi mimanyine pa bijadiki Maluvu a disama dia dikuatshika dia maluvu (MAUD):

• Naltrexone (50 mg ya tshiamu tshia ku mishiku ku dituku, anyi musangu umua ku ngondu Vivitrol 380 mg ya tshiamu tshia nzembu): Udi ukandika bintu bidi bipeta difutu dia endorphine mu buongo, udi ukepesha dipingana dia maluvu makole ne dijinga dia kunua maluvu bikole. Bidi mua kutuadija anu mu lupitadi anyi mu tshibambalu tshia malu a mpukapuka (bikala mubedi kayi unua manga a opioïde ne kayi ne disama dia tshiadi tshikole).
• Acamprosate (Campral, 666 mg misangu isatu ku dituku): Udi ulengeja buludiludi tshitupa tshia glutamate tshidi tshienda tshikola mu ngondo 6 too ne ku 12 ya kumpala ya dipanga dia maluvu, udi ujikija dipanga tulu dia panyima pa dipanga dia tulu, tunyinganyinga, ne dipanga dia dikisha (didi dijikija ku diambuluisha dia mifuba, dienza bua ikale muimpe menemene kudi babedi badi ne masama a muoyo).
• Gabapentin anyi Topiramate: Maluvu adi kaayi malelela adibu bafila kudi tshisumbu tshia baminganga ba mu lungenyi tshia mu Amerike ne ASAM adi apuekesha matuku a kunua maluvu a bungi, alengeja tulu, ne apuekesha tunyinganyinga tua panyima pa dilekela dia maluvu.
• Disulfiram (Antabuse): Udi ufila tshinyangu tshia lukasa tshia mubidi padi muntu unua maluvu; udi mua kuenza mudimu bimpa muinshi mua ditangila dia dituku dionso dia muena dibaka anyi dia lupitadi.

Bua kupeta mishindu ya luondapu ya matuku a bungi, bipimu bia dilama dia ASAM, ne bisumbu bia diondopangana dia balunda (AA, SMART Recovery, Recovery Dharma), bala mukanda wetu mujima dikuatshika dia maluvu ne dikuatshika dia manga ne kukuatshisha muena mu dîku udi ne tshilele tshia dikuatshika dia maluvu balombodi.

Nkonko itubu bela misangu ya bungi¶

Miaba mifumina¶

• Société américaine de l'addiction médecine (ASAM, États-Unis): The ASAM Clinical Practice Guideline on Alcohol Withdrawal Management (Risk stratification, CIWA-Ar symptom-triggered therapy, benzodiazepine vs. phenobarbital loading, and inpatient vs. outpatient placement criteria).
• Bulongolodi bua malu a bukola bua mubidi pa buloba bujima (OMS, International): Mibelu ya luondapu idi itangila dilekela dia maluvu ne diondapa dia dikuatshika dia manga mu miaba mikanga ne Mibelu ya diambuluisha dia mhGAP bua dilekela dia maluvu, disama dia tshiadi, ne disama dia Delirium Tremens.
• National Institute for Health and Care Excellence (NICE) and National Health Service (NHS, United Kingdom): Alcool-Use Disorders: Diagnostic and Management of Physical Complications (Clinical Guideline CG100), within parenteral Pabrinex / high-dose intravenous thiamine protocols to preventing Wer-Ksakkeffe syndrome.
• Tshibambalu tshia malu a dikuatshika dia maluvu ne a lungenyi (SAMHSA, mu États-Unis): MUBELU 45: Diumusha dia bintu bibi ne diondapa dia dikuatshika dia maluvu makole ne Manga a diondapa dia disama dia dikuatshika dia maluvu: Mukanda muipi.
• New England Journal of Medicine (NEJM) & American College of Medical Toxicology (ACMT): Mikenji ya dikonkonona dia malu a luondapu idi itangila Dimanya ne dilama dia disama dia tshiadi (Delirium Tremens), dikolesha dia mubidi (hypomagnesemia/hypokalemia), ne dikolesha dia mitu.

Malu adi apetangana¶

• Dikuatshika dia maluvu ne dikuatshika dia manga: bulombodi bua diambuluisha dia lukasa
• Dilekela dia tshimpitshimpi dia benzodiazepine ne njiwu ya tshipupu
• Kuambuluisha muena mu dîku udi ne tshilele tshia dikuatshika dia maluvu
• Dikuatshika dia maluvu, dikuatshika dia maluvu, ne diendesha dimpe
• Diambuluisha dia kumpala dia disama dia tshiadi
• Dipatuka dia mashi mu tshifu: disama dia mashi ne melena
• Tshilumbu tshia bukola bua mubidi
• Nomba ya tshimpitshimpi