Serotonin Syndrome on a Low Dose SSRI and an Atypical Antipsychotic Agent in a Patient with Cirrhosis of Liver

Abstract

We present a case of 50-year-old male patient with a known history of cirrhosis of liver, hepatic encephalopathy, hepatitis C, stimulant use disorder, methamphetamine type and major depressive disorder, with psychotic features who presented to the emergency department for altered mental status.Patient was previously admitted 5 days ago for acute encephalopathy to medicine service and after stabilization, transferred to a psychiatry inpatient service for worsening depression. He was started on Lexapro 5 mg and Zyprexa 5 mg for major depressive disorder with psychotic features and at the time of presentation he had already been taking these medications for the past 10 days.When the patient was seen at the ER, he was lying in