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Serotonin Syndrome

Michael T. Partin, MD, Karl T. Clebak, MD, MHA, FAAFP and Munima Nasir, MD Reviewed 05/2023
 


BASICS

DESCRIPTION

  • A potentially life-threatening drug-induced syndrome that results from synaptic increase in serotonin (5-hydroxytryptamine [5-HT]) concentrations and stimulation of peripheral and CN...

DIAGNOSIS

  • Serotonin syndrome is a clinical diagnosis.

  • Hunter Toxicity Criteria Decision Rules (3) aid in the diagnosis of clinically significant serotonin toxicity (sensitivity, 84%; specificity, 97%)....

TREATMENT

  • Supportive care is the mainstay of therapy: administrating oxygen and aggressive IV fluids, continuous cardiac monitoring, monitoring urine output, and stabilizing vital signs.

    • Benzodiazepine...

ONGOING CARE

FOLLOW-UP RECOMMENDATIONS

  • In mild cases address risks and benefits of restarting offending agents. Serotonergic medications need to be titrated slowly, and patients must have close outpati...

REFERENCES

1
Bronstein  AC, Spyker  DA, Cantilena  LRJr, et al. 2008 Annual report of the American Association of Poison Control Centers’ National Poison Data System (NPDS): 26t...

ADDITIONAL READING

Mas Serrano M, Pérez-Sánchez JR, Portela Sánchez S, et al. Serotonin syndrome in two COVID-19 patients treated with lopinavir/ritonavir.  J Neurol Sci. 2020;415:116944. ...

CODES

ICD10

G25.79 Other drug induced movement disorders 

SNOMED

371089000 Serotonin syndrome (disorder) 

CLINICAL PEARLS

Consider serotonin syndrome in patients with recent use of a serotonergic agent (particularly if multiple proserotonergic agents are involved) presenting with unexplained tachycardia, ...

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