Serotonin syndrome

Question 1

What is the pathophysiology of serotonin syndrome?

Answer 1

Too much serotonin due to increased release (alcohol, cocaine), increased receptor stimulation (TCAs) or decreased reuptake (SSRI)

Question 2

What are the symptoms of serotonin syndrome?

Answer 2

1) altered GCS
2) autonomic instability - labile BP & HR, high temp
3) tremor, hyperreflexia, muscle rigidity

Question 3

How is serotonin syndrome diagnosed?

Answer 3

History and presentation with a drug hx of at least 1 sertonergic agent

Question 4

Differentials for serotonin syndrome

Answer 4

NMS
MH
CNS infection
Thyroid storm

Question 5

How would you manage serotonin syndrome?

Answer 5

I&V - sedation, +/- paralysis if severe temp, agitation or seizures
Fluids - high insensible losses
Coolling
Stop causative drug
Intralipid if cocaine or SSRIs
Can give serotonin antagonist eg olanzapine if sedation not improving symptoms