Serotonin Syndrome Case Debrief

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					Serotonin Syndrome Case
         Debrief
           Case Debriefing
• How do you think that the case went
  overall?
• What was done well by the team leader?
  by the participants?
• How did you come to a concrete
  diagnosis?
• What factors played a role in the patient’s
  disposition?
• What could have been done better?
       Serotonin Syndrome
• First described in 1959 in TB patients.
• Named in 1982 to describe the symptoms
  that occur when >2 drugs that increase
  serotonin concentrations are given.
        Serotonin Syndrome
• Pathophysiology
  – Hyperserotonergic state caused by excessive
    stimulation of the serotonin 5HT1A receptors
  – Different types of serotonin receptors are
    found throughout the organ systems in the
    body.
        Serotonin Syndrome
• Drugs that increase serotonin
  – Precursor – L-tryptophan
  – Inhibit serotonin metabolism – MAOIs
  – Increase serotonin release – amphetamines,
    lithium, MDMA
  – Inhibit serotonin reuptake – cocaine,
    dextromephoraphan, meperidine, SSRIs,
    TCAs, trazadone, venlafaxine
  – Serotonin receptor agonists – buspirone, LSD
  – Dopamine agonists – l-dopa
        Serotonin Syndrome
• Signs and symptoms vary by patient (1-2
  in each category)
  – Cognitive-Behavioral
  – Neuromuscular
  – Autonomic
           Serotonin Syndrome
• Cognitive-Behavioral Signs and Symptoms
  –   Confusion/disorientation
  –   Agitation/irritability
  –   Unresponsiveness
  –   Anxiety
  –   Insomnia
  –   Lethargy
  –   Seizures
  –   Hypomania
  –   Hallucinations
  –   dizziness
        Serotonin Syndrome
• Neuromuscular signs and symptoms
  – Myoclonus
  – Hyperreflexia
  – Muscle rigidity
  – Tremor
  – Ataxia
  – Shivering/chills
  – Nystagmus
  – Babinski’s sign bilaterally
            Serotonin Syndrome
• Autonomic signs and symptoms
  –   Hyperthermia
  –   Diaphoresis
  –   Sinus tachycardia
  –   Hypertension
  –   Tachypnea
  –   Dilated pupils
  –   Non-reactive pupils
  –   Flushed skin
  –   Hypotension
  –   Diarrhea
  –   Abdominal cramps
  –   salivation
          Serotonin syndrome
• Clinically
   – Vital signs abnormally high – Temperature, Pulse,
     Respiratory Rate, Blood Pressure
   – Symptoms as previously discussed
• Treatment
   – Supportive with aggressive cooling measures
   – Benzodiazepines for seizures, rigidity, agitation
   – Cyproheptadine for severe cases (PO form only)
• Precautions
   – Cardiovascular collapse
   – Seizures
        Serotonin Syndrome
• Differential diagnosis
  – Serotonin syndrome
  – Neuroleptic malignant syndrome
  – Sepsis
  – Heat stroke
  – Anticholinergic toxidrome
  – Thyroid storm
              References
• Tintinelli, et al. Emergency Medicine: A
  Comprehensive Guide. 6th Edition.
• http://uuhsc.utah.edu/poison/healthpros/ut
  ox/vol4_no4.pdf
• Emedicine.com

				
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