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Serotonin Syndrome

Dr Swapnil Pawar February 11, 2024 32


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    Serotonin Syndrome
    Dr Swapnil Pawar

 

Serotonin Syndrome

Written by Dr Andrew Lam

Hunter Criteria: 

The presence of a serotonergic agent in addition to one of the following:

  • Spontaneous clonus
  • Inducible clonus + agitation or diaphoresis
  • Ocular clonus + agitation or diaphoresis
  • Tremor + Hyperreflexia
  • Hyperthermia + Hypertonia + inducible or ocular clonus

Presence of Serotonergic agent defined as: 

  • Overdose of a serotonergic agent
  • Drug-Drug interaction of two serotonergic agents
  • Initiation or dose change of a serotonergic agent, or agent that decreases metabolism of serotonergic agent

 

Serotonin Syndrome vs. NMS

Serotonin Syndrome NMS
Onset Abrupt Gradual
Course Short Prolonged
Neuromuscular Effects Tremor and Myoclonus Lead Pipe Rigidity
Reflexes Hyper-reflexic Hyporeflexic
Pupils Dilated Normal

 

Management: 

Serotonin Antagonist: 

Cyproheptadine – H1 antagonist, but also non-specific 5-HT antagonistic activity

 

Supportive Therapy

Hypertension/Tachycardia: Short acting IV agents (i.e. esmolol, SNP)

Hyperthermia: Cooling + may require paralysis and intubation 

Sedation: Benzodiazepines (i.e. diazepam) preferred over anti-psychotics

 

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