Serotonin Syndrome: The ten minute version Russell Berger, MD
Clinical Triad Altered mental status Dysautonomia Hyperreflexia (lower extremity>upper extremity)
Relevant History New serotonergic agent(usually in addition to one old agent) Rapid onset of symptoms
What are some of the more common serotonergic agents Tramadol Demerol TCA’s SSRI’s Lithium MAOi’s Linezolid(yes, the abx) Trazodone Valproic acid Tryptophan St John’s Wort Ginseng
Complications of Serotonin Syndrome Seizures Rhadbomyolysis Hyperthermia Metabolic Acidosis Renal Injury Death
Treatment Options Benzodiazepines – No risk Cyproheptadine(5HT-2A antagonist) – Anticholinergic
The diagnostic dilemma
Questions