Serotonin syndrome ss also referred to as serotonin toxicity is a potentially life threatening druginduced toxidrome associated with. Serotonin toxicity commonly referred to as serotonin syndrome is a potentially lifethreatening druginduced condition caused by too much serotonin in the synapses of the brain. Pdf demystifying serotonin syndrome or serotonin toxicity. Syndrome, misdiagnosis, and failure to understand serotonin syndromes potentially rapid rate of progression. Serotonin syndrome can be indistinguishable from sympathomimetic intoxication and these may be largely the same thing, because sympathomimetics increase serotonin levels alcohol or baclofen withdrawal. Serotonin syndrome is often characterized by a triad of symptoms, which include altered mental status, neuromuscular hyperactivity, and autonomic instability or hyperactiv. Some symptoms of serotonin syndrome overlap with features of other presentations in psychiatry and thus may be misattributed to mental illness diagnostic. Ssris, snris, tricyclic antidepressants, and maois are all classes of. Rhabdomyolysis develops acutely in untreated, severe serotonin toxicity due to prolonged tonicclonic muscle activity in association with hyperthermia. The diagnosis of serotonin syndrome depends on iden tifying autonomic instability, 1,3,8,14neuromuscular signs, and cognitivebehavioral changes in the presence of sero. Better described as a spectrum of toxicity, ranging from mild to severe, rather than a syndrome. Serotonin is a chemical found naturally in the body.
Serotonin syndrome also referred to as serotonin toxicity is associated with the use of some medicines. Unlike nms, serotonin syndrome is a dosedependent phenomenon and develops rapidly following administration of single doses of, or combinations of, drugs that enhance serotonergic transmission. The presentation of serotonin syndrome is extremely variable, ranging from mild symptoms to a lifethreatening syndrome. Prevention, diagnosis, and management of serotonin syndrome. Serotonin syndrome serotonin toxicity or serotonin toxidrome is a potentially serious and theoretically predictable reaction that appears to be rarely diagnosed in practice in the uk. Even if the diagnosis is unclear, the clinician should withhold serotonergic agent when serotonin syndrome is suspected. Serotonin syndrome ss or serotonin toxicity was first described in the 1950s. Information on serotonin syndrome for service users and.
Serotonin syndrome is a potentially fatal condition caused by drugs that affect serotonin metabolism or act as serotonin receptor agonists. Signs and symptoms of serotonin syndrome include euphoria, sustained rapid eye movements, overreaction. Risperidone is a much more potent serotonin antagonist i. Symptoms in mild cases include high blood pressure and a fast heart rate.
Learn more about the symptoms, causes, diagnosis, and treatment of serotonin syndrome at webmd. Beware of serotonin syndrome university of waterloo. Serotonin syndrome, more aptly named serotonin toxicity, is a potentially fatal druginduced condition caused by too much serotonin in synapses in the brain. It is associated with a wide diversity of clinical signs and symptoms, including cognitive, autonomic and somatic effects, as well as serious. Patients present with a combination of neuromuscular, autonomic, and mental status symptoms. Serotonin toxicity is a symptom complex that arises from an increase in the biological activity of the neurotransmitter serotonin also called 5hydroxytryptamine or 5ht. Symptoms include mental status changes, autonomic instability, and neuromuscular hyperactivity 1. Toxidromes consist of groups of signs and symptoms found. Triptans, serotonin agonists, and serotonin syndrome serotonin toxicity. Serotonin syndrome symptoms, diagnosis and treatment. Today, more serotoninaffecting serotonergic medications are. Most cases involve 2 drugs that increase serotonin in different ways or an overdose of 1 serotonin elevating drug. Serotonin syndrome is more likely if you take more than one medicine listed in table 1.
Introduction serotonin syndrome, also referred to as serotonin toxicity, is a potentially lifethreatening condition associated with increased serotonergic activity in the central nervous system cns. Serotonin syndrome is rarely seen but it is a very serious reaction which can be lifethreatening if it is not recognised and treated quickly. Her exam was notable for tachycardia, diaphoresis, agitation, mydriasis, rigidity, hyperreflexia, and inducible clonus, consistent with serotonin syndrome per hunter serotonin toxicity criteria. Monoamine oxidase inhibitors, opioid analgesics and serotonin. Serotonin syndrome is a potentially fatal condition triggered by too much nerve cell activity. Due to the severity of her symptoms she was sedated, intubated, transferred to the icu, and later administered a loading dose of cyproheptadine.
Most cases involve 2 drugs that increase serotonin in different ways. Diagnosis is clinical and should be based on the hunter serotonin toxicity criteria hstc, of which clonus is a key diagnostic feature. The condition happens when people experience symptoms from having too much serotonin in the body. Many reports prefer to call this serotonin toxicity rather than syndrome due to its wide range of symptoms and toxicity. Demystifying serotonin syndrome or serotonin toxicity canadian. Serotonin syndrome results from a druginduced excess of serotonin in the central nervous system. A few drug interactions are clearly linked to apparently clas sic cases of serotonin toxicity where the mechanism remains unclear. Linezolid is a weak, reversible inhibitor of monoamine oxidase mao. Although classically described as the triad of mental status changes. Serotonin syndrome results from druginduced overstimulation of serotonin receptors in the cns and is characterized by a triad of cns dysfunction, autonomic disturbance and neuromuscular effects. Unfortunately, many of the symptoms of serotonin syndrome are nonspecific, and the severity varies among patients. It is a spectrum of clinical findings ranging from benign to lethal.
Serotonin syndrome is a potentially serious negative drug reaction. Serotonin syndrome also called serotonin toxicity or serotonin toxidrome is not an idiosyncratic drug reaction. The severity of the toxicity is dependent on the degree of increase in serotonin. Symptoms in moderate cases include high body temperature, agitation, increased reflexes, tremor, sweating, dilated pupils. This condition can be caused by the use of medicines that increase levels of serotonin in the brain, which include several types of. It is seen with therapeutic medication use, inadvertent interactions between drugs, and intentional selfpoisoning. The first and most commonly used are sternbachs criteria. Serotonin syndrome ss also referred to as serotonin toxicity is a potentially lifethreatening druginduced toxidrome associated with. Demystifying serotonin syndrome or serotonin toxicity. Pdf excess serotonin in the central nervous system leads to a condition commonly referred to as the serotonin syndrome, but better described as a. Serotonin syndrome, or serotonin toxicity, is a rare and potentially lifethreatening condition caused by dangerously high levels of serotonin in the brain. It sounds like anticholinergic toxicity to me and for one thing they never use chlorpromazine aka throrazine to treat serotonin syndrome.
Introduction serotonin toxicity or serotonin syndrome is a potentially life threatening adverse reaction to the use of one or more serotonergic drugs. Its believed to occur when too much serotonin builds up in your body. Serotonin syndrome an overview sciencedirect topics. Monoamine oxidase inhibitors, opioid analgesics and serotonin toxicity. The scoop on serotonin syndrome pubmed central pmc. The serotonin syndrome is a potentially lifethreatening drug reaction that may result from therapeutic medication use, selfpoisoning, or interactions between drugs. Druginduced serotonin syndrome critical care nurse. Serotonin syndrome is a potentially lifethreatening state caused by an excess of serotonergic activity in the nervous system. Introduction assessment management introduction serotonin excess is best thought of as a spectrum of toxicity, rather than a defined clinical entity syndrome with clear prognostic importance gillman, 1998. Serotonin syndrome is a rare, but potentially severe condition caused by an increase in serotonin, a chemical found naturally in all of our bodies.
Given the widespread use of seroton ergic agents in psychiatry, other fields of medicine. These would also be commonly observed in many other conditions such as anticholinergic delirium, and alcohol and drug. Characterised by a rising creatine phosphokinase level. Although commonly called serotonin syndrome, serotonin toxicity is a more accurate term, since toxicity presents on a spectrum rather than as a defined set of symptoms i. Syndrome, misdiagnosis, and failure to understand serotonin syndrome s potentially rapid rate of progression. To meet these criteria, a patient must have received a serotonergic agent, and at least one of the following must be present 4. Can be prevented with early treatment of severe serotonin toxicity plus muscle paralysis and cooling.
Serotonin syndrome ss is a group of symptoms that may occur with the use of certain serotonergic medications or drugs. A complex case of suspected serotonin syndrome anna kim, m. Serotonin syndrome results from excessive stimulation of central and peripheral serotonin receptors, particularly 5ht 2a receptors. Its generally caused by mixing two or more medications that affect serotonin levels in the central nervous system. Monoamine oxidase inhibitors, selective serotonin reuptake inhibitors, and serotoninnorepinephrine reuptake inhibitors are the medications most commonly associated with serotonin syndrome. Consultation with any of the following is necessary once serotonin syndrome. Serotonin syndrome is a drug induced syndrome characterised by a cluster of dose related adverse effects that are due to increased serotonin concentrations in the central nervous system. Most cases involve 2 drugs that increase serotonin in different ways or an overdose of 1 serotoninelevating drug. The degree of symptoms can range from mild to severe. Overstimulation may be the result of an overdose of serotonergic medication, but can also be caused by a combination of two or more serotonergic drugs.
80 1158 459 1302 786 307 674 1067 1283 252 1015 459 835 1312 869 586 962 110 1307 325 804 363 977 695 1034 963 1151 778 1326 1055 686 511 364 824 364 305 1477 1403 1279 1055 153 1346 613 956 459 778