Friday Facts

Serotonin Syndrome
Typically caused by the use of multiple serotonergic medications or overdose. These medications include SSRIs, SNRIs, MAOIs, TCAs, amphetamines, MDMA (ecstasy), cocaine, and zofran. Other conditions with similar symptoms that can cause misdiagnosis include malignant hyperthermia, heat stroke, and meningitis.

Symptoms
Symptoms typically occur within a day of the extra serotonin. Once serotonin levels are elevated, onset is rapid. Symptoms can range from mild to severe.

•Mild: tachycardia, shivering, sweating, dilated pupils, and hyperreflexia

•Moderate: hyperactive bowel sounds, hypertension, hyperthermia, insomnia, agitation

•Severe: shock, severe hyperthermia (can reach above 106°F), rhabdomyolysis, seizures, renal failure, acidosis, DIC

Treatment
•Serotonin agonists (cyproheptadine)
•Supportive care-benzodiazepines for control of agitation and myoclonus
•Temperature control
•Activated charcoal within 1 hour (if known overdose)
•Severe cases also require sedation and paralytic medications to control myoclonus and hyperthermia