Dietary Supplement-Drug Interaction-Induced Serotonin Syndrome Progressing to Acute Compartment Syndrome

Abstract

Patient: Male, 28Final Diagnosis: Serotonin syndrome/acute compartment syndromeSymptoms: Muscle painMedication: SertralineClinical Procedure: FasciotomySpecialty: Critical Care MedicineObjective:Rare co-existance of disease or pathologyBackground:Dietary supplements have been associated with an increase in emergency intervention as a result of unexpected adverse events. Limited resources and information on significant drug-drug interactions with dietary supplements and prescription medications have contributed to associated complications and unexpected events. We present the case of a patient who consumed multiple prescription medications and dietary supplements which resulted in significant complications.Case Report:A 28-year-old man presented to the Emergency Department complaining of severe calf pain after exercising. In addition to his prescription medications, which included sertraline, he also consumed dietary supplements prior to his workout. He developed serotonin syndrome with rhabdomyolysis, which rapidly progressed to acute compartment syndrome. An emergency bilateral four-compartment double-incision lower extremity and forearm fasciotomy was performed, with complete recovery.Conclusions:Drug-drug interactions involving dietary supplements are frequently overlooked in most healthcare settings, especially in the Emergency Department. Health care providers should be cognizant of the potential drug- drug interactions resulting in serotonin syndrome to prevent the progression to acute compartment syndrome and associated complications. Pharmacists play a key role in recognizing drug-dietary supplement interactions and adverse effects.

Substance-Related Found-Down Compartment Syndrome: A Systematic Review

“…Sixty-one articles were included, dating from 1972 to 2019. 1,6–66 There were 7 retrospective cohort studies and 54 case reports or case series. Forty-eight studies were assessed to have a good quality and 13 were of fair quality, assessed with “NIH Quality Assessment Tool for Case Series Studies” (see Table , Supplemental Digital Content 2 , http://links.lww.com/JOT/B280) We found 166 cases of substance-related FDECS with 87% (n = 145) being men and an average age of 35 ± 12 years.…”

Sports nutrition supplements and adverse events – a meta-epidemiological study of case reports specifically addressing causality assessment

“…In 8 (13%) cases with clinical reasoning, a systematic causality assessment method was applied. The Naranjo Adverse Drug Reaction Probability scale [18] was used in 3 cases [19][20][21], the CIOMS/RUCAM (Council for International Organizations of Medical Sciences/Roussel Uclaf Causality Assessment Method) [22,23] in 2 cases [24,25], the WHO/UMC (World Health Organization-Uppsala Monitoring Center) causality assessment system [26] in 1 case [4], and the Teschke scale [27] in 1 case [28]. In 1 case [29], both the WHO/UMC causality assessment system and CIOMS/RUCAM were used.…”

Biological Role of Nutrients, Food and Dietary Patterns in the Prevention and Clinical Management of Major Depressive Disorder

“…These effects can be due to therapeutic medication use, interactions between medications or recreational drugs, or intentional overdose [ 195 ]. Indeed, there are some case reports in which the interaction between drugs and dietary supplements was associated with the co-occurrence of serotonin and acute compartment syndrome, demonstrating the remarkable issue of studying these interactions [ 196 ]. In addition, some deleterious interactions between nutraceuticals/dietary supplements with drugs in the field of MDD have been previously defined [ 197 ].…”