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

SeizuresRhadbomyolysisHyperthermiaMetabolic AcidosisRenal InjuryDeath

Treatment Options

• Benzodiazepines– No risk

• Cyproheptadine(5HT-2A antagonist)– Anticholinergic

The diagnostic dilemma

Questions