Serotonin Syndrome: A Subtle Toxicity

Bartlett, Dana

doi:10.1016/j.jen.2006.03.004

Cited by 5 publications

(6 citation statements)

References 2 publications

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“…Immediate withdrawal of the offending agent followed by supportive care is the treatment of choice for most cases. Supportive care includes the infusion of intravenous fluids for hydration and treatment with benzodiazepines to manage irritation (Bartlett & Muller, 2006; Dvir & Smallwood, 2008).…”

Section: Minimizing the Impact Of Nms And Ssmentioning

confidence: 99%

Are Neuroleptic Malignant Syndrome and Serotonin Syndrome the Same Syndrome?

Steele

Keltner

McGuiness

2010

Perspectives in Psychiatric Care

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Section: Minimizing the Impact Of Nms And Ssmentioning

confidence: 99%

Are Neuroleptic Malignant Syndrome and Serotonin Syndrome the Same Syndrome?

Steele

Keltner

McGuiness

2010

Perspectives in Psychiatric Care

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“…[ 2 ] However, various case series and review articles suggest that a large number of mild symptoms may be present in patients with SS. [ 3 4 5 6 ] Recognition of even mild SS is important as “an inadvertent increase in the dose of the causative agent or the addition of a drug with proserotonergic effects may provoke a dramatic clinical deterioration”. [ 1 ] Herein, in this retrospective study, we collected patients who had tremors and hyperreflexia and were on some serotonergic agents (fulfilling one of the feature of Hunter's criteria).…”

Section: Introductionmentioning

confidence: 99%

Mild serotonin syndrome: A report of 12 cases

Prakash¹,

Patel²,

Kakked³

et al. 2015

Ann Indian Acad Neurol

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Serotonin syndrome (SS) is an under diagnosed and under reported condition. Mild SS is easily overlooked by physicians. Every patient with mild SS is a potential candidate for developing life-threatening severe SS because of inadvertent overdose or the addition of the second serotonergic drug. Herein, we describe 12 patients with mild SS observed over 12 months in neurology outpatient clinic. It is a retrospective chart review of 12 consecutive patients who had hyperreflexia with tremor (defined as mild SS Hunter's criteria) and had received serotonergic agents in the past 5 weeks. Only four patients (33%) reported tremor as a presenting or main feature. The presenting features in another eight patients were: Dizziness, generalized body pain, headache, and seizure. Five patients responded to the removal of the offending agents and got a complete response in 2-7 days. There were no or minimal responses in another seven patients to the removal of the serotonergic drugs. Cyproheptadine was started in these patients, at the dose of 8 mg three times daily. Response started within 1-3 days of initiation of the drug and the complete responses were noted in 5-14 days. There were no side effects from cyproheptadine in any patient. We suggest that any patient on serotonergic drug developing new symptoms should be examined for the presence of tremor, hypertonia, hyperreflexia, and clonus to look for mild SS. In addition, every patient on any serotonergic drug should be examined for the presence of mild SS before escalating the dose or before adding a new one.

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“…On the other hand, considering criminal investigation by the police including inspection and the confession of the cadaver's wife, significant findings which could lead to the cause of death might be "hyperthermia" and "diaphoresis", which were comprised in "autonomic hyperactivity". Therefore, neuroleptic malignant syndrome (NMS), malignant hyperthermia (MH), anticholinergic toxidrome and serotonin toxicity could emerge as differential diagnoses in this case [1][2][3]16]. Then, MH and anticholinergic toxidrome could be excluded by the substances detected in the blood, their concentrations and medical history, since MH and anticholinergic toxidrome are induced by inhalational anesthesia and administration of anticholinergic agents, respectively.…”

Section: Discussionmentioning

confidence: 99%

“…Potential mechanisms of serotonin toxicity are increased serotonin synthesis or release; reduced serotonin uptake or metabolism; and direct serotonin receptor activation. Indeed, most reported cases of serotonin toxicity have been in patients who take multiple serotonergic drugs or a great amount of a single serotonin-augmenting drug [3][4][5][6][7][8][9][10].…”

mentioning

confidence: 99%

An autopsy case of serotonin toxicity resulting from suicidal administrations of fluvoxamine and lithium

Mannou¹,

Ikemura²,

Nagakawa³

et al. 2014

RJLM

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Although a late 40s male attempted double suicide with his wife by overdosing on their medication in their bedroom in which artificial coal burned, only he died, and was found in a drenching sweat. Whereas forensic autopsy showed no significant findings except for congestion of multiple organs, several psychotropic drugs including fluvoxamine and lithium were detected in his blood, but their concentrations were of a therapeutic level. In addition, the saturation of blood hemoglobin by carbon monoxide measured 10.6%. However, since postmortem inspection by the police revealed hyperthermia immediately after discovery of the corpse, serotonin toxicity or neuroleptic malignant syndrome (NMS) was suggested as the cause of death. Differential diagnosis between serotonin toxicity and NMS is generally difficult; however, in this case, we diagnosed the cause of death as serotonin toxicity on the basis of "autonomic" symptoms and the duration from drug intake to symptoms as well as the substances detected in the blood. Meanwhile, all findings revealed by the autopsy were clinically compatible with serotonin toxicity.

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Serotonin Syndrome: A Subtle Toxicity

Cited by 5 publications

References 2 publications

Are Neuroleptic Malignant Syndrome and Serotonin Syndrome the Same Syndrome?

Are Neuroleptic Malignant Syndrome and Serotonin Syndrome the Same Syndrome?

Mild serotonin syndrome: A report of 12 cases

An autopsy case of serotonin toxicity resulting from suicidal administrations of fluvoxamine and lithium

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