Serotonin syndrome Flashcards
1
Q
What are the potential causes of serotonin syndrome?
A
- Increased release of serotonin: amphetamines, MDMA, cocaine
- Impaired serotonin reuptake: SSRIs, SNRIs, MDMA, TCAs, serotonin modulators
- Inhibit serotonin metabolism: MOAs
- Serotonin receptor agonists: buspirone, triptans
- Increased sensitivity of serotonin receptors: lithium
2
Q
What are the symptoms of serotonin syndrome?
A
- Altered mental status - anxiety, restlessness, disorientation, agitation
- Sweating
- Fever
- Vomiting
- Diarrhoea
3
Q
What are the signs of serotonin syndrome?
A
- Dilated pupils
- Flushed skin, diaphoresis
- Tachycardia, hypertension
- Temp >38 degrees C
- Hyperreflexia
- Clonus
- Myoclonus
- Rigidity
- +ve Babinski sign
4
Q
What criteria is used to diagnose serotonin syndrome?
A
Hunter criteria
5
Q
What clinical features does Hunter criteria use to diagnose serotonin syndrome?
A
- Spontaneous clonus
- Inducible/ocular clonus and agitation or diaphoresis
- Tremor and hyperreflexia
- Hyperthermia, hypertonia, and ocular/inducible clonus
6
Q
What abnormalities may be seen on the following blood tests:
- FBC
- U&Es
- Creatine kinase
A
- FBC: neutrophilia
- U&Es: AKI (urea raised, creatinine raised)
- Creatine kinase: raised (rhabdomyolysis)
7
Q
What is the management of serotonin syndrome?
A
If mild, then stop offending agent, observe for 4-6h, and discharge
More severe cases:
- Supportive care: cardiac monitoring, IV fluids, anti-pyretics
- some may require ITU admission and organ support
8
Q
What are the potential complications of serotonin syndrome?
A
- Cardiac arrest
- Cardiac arrhythmia
- AKI
- Rhabdomyolysis
- DIC
- Seizures
- Respiratory failure
- VTE
