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1. Clin Med III > 4- Serotonin Syndrome > Flashcards

4- Serotonin Syndrome Flashcards

1
Q

What is the serotonin syndrome triad?

A
  1. AMS
  2. Neuromuscular abns
  3. Autonomic hyperactivity
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2
Q

What is the typical onset for serotonin syndrome?

A

Rapid- minutes to hrs after initiation of causative agent

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3
Q

How is serotonin syndrome diagnosed?

A

Clinically- no lab to confirm dx, serotonin/ drug levels not predictive

Labs/ imaging helpful to r/o other causes

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4
Q

What nonspecific lab findings might be noted with serotonin syndrome?

A

Elevated CPK and myoglobin

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5
Q

What are the Hunter toxicity criteria?

A

Serotonergic agent AND 1+ of:

  • spontaneous clonus
  • inducible clonus PLUS agitation/ diaphoresis
  • ocular clonus PLUS agitation/ diaphoresis
  • tremor PLUS hyperreflexia
  • hypertonia PLUS temp > 38C PLUS ocular/ inducible clonus
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6
Q

What is defined as a life threatening neurologic emergency a/w neuroleptic drugs and antiemetics?

A

Neuroleptic malignant syndrome

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7
Q

What is the classic tetrad a/w neuroleptic malignant syndrome?

A

FARM

Fever

Autonomic instability

Rigidity (“lead pipe rigidity”)

Mental status changes

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8
Q

What is defined as a potentially life threatening genetic disorder that occurs in susceptible individuals with exposure to anesthesia and succinylcholine?

A

Malignant hyperthermia

(occurs during/ immediately following anesthesia)

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9
Q

What is the most reliable initial sign of malignant hyperthermia (MH)?

A

Rapid rise in CO2 resistant to increased ventilation

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10
Q

Early detection/ tx of MH can lead to complete recovery. What is included in the tx?

A

D/c triggering agent

Dantrolene

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11
Q

How can you differentiate between serotonin syndrome and anticholinergic toxicity?

A

Anticholinergic toxicity does NOT affect muscle tone or reflexes

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12
Q

How will pupils appear for SS, ACT, NMS, and MH?

A

SS- mydriasis

ACT- mydriasis

NMS- normal

MH- normal

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13
Q

How will skin appear for SS, ACT, NMS, and MH?

A

SS- diaphoretic

ACT- red, hot, dry

NMS- diaphoretic

MH- diaphoretic

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14
Q

How will neuromuscular tone appear for SS, ACT, NMS, and MH?

A

SS- increased (esp LEs)

ACT- normal

NMS- “lead pipe” rigidity

MH- rigidity

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15
Q

How will reflexes appear for SS, ACT, NMS, and MH?

A

SS- hyperreflexia, clonus

ACT- normal

NMS- hyporeflexia, bradyreflexia (slower onset, slower resolution)

MH- variable

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16
Q

How will mental staus appear for SS, ACT, NMS, and MH?

A

SS- agitation

ACT- agitation

NMS- agitation, mutism, coma

MH- +/- agitation

17
Q

What specific drugs have the potential to lead to NMS?

A

Haldol, Risperdal, Reglan, Phenergan

18
Q

Pt presents with mydriasis, diaphoresis, increased NM tone especially in LEs, hyperreflexia, clonus, and agitation. What are you concerned for?

A

Serotonin syndrome

Hx of serotonin drug

19
Q

Pt presents with mydriasis, red/ hot/ dry skin, normal NM tone, normal reflexes, and agitation. What are you concerned for?

A

ACT

Hx of anticholingergic drug

20
Q

Pt presents with normal pupils, diaphoresis, “lead pipe” rigidity, hyporeflexia/ bradyreflexia, agitation, mutism, and coma. What are you concerned for?

A

NMS

Hx of dopamine antagonists (neuroleptics, anti-emetics)

21
Q

Pt presents with normal pupils, diaphoresis, rigidity, variable reflexes, +/- agitation. What are you concerned for?

A

MH

Hx of anesthesia

22
Q

What is included in the general management of serotonin syndrome?

A

D/c all serotonin agents

  • *Supportive care/ normalize VS**
  • no antipyretics agents
  • no physical restraints

Sedation w/ benzos

23
Q

What is the specific management for mild cases of serotonin syndrome?

A

Close obs x 4-6 hrs

IF mental status/ VS normal, no clonus/ increase in DTR- consider d/c and f/u in 24 hrs with edu for warning signs

24
Q

What is the specific management for mod-severe serotonin syndrome?

A

Hospitalization +/- ICU w/ intubation

If temp > 105.9/ critically ill → immediate sedation, paralysis, intubation

25
Q

What is the antidote for serotonin syndrome and how is it used?

A

Cyproheptadine (serotonin antagonist/ histamine-1 receptor antagonist)

Use if refractory to combo of supportive care/ benzos (considered adjunct)

1. Clin Med III (29 decks)

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