Serotonin syndrome presents with a triad of altered mental status, autonomic hyperactivity, and neuromuscular abnormalities.
Serotonin syndrome presents with a triad of altered mental status, autonomic hyperactivity, and neuromuscular abnormalities. Excessive serotonin in the central and periphery derives from several mechanisms. These include pathways that directly or indirectly increase pre- and postsynaptic serotonin. Monoamine oxidase inhibitors are commonly reported but serontonin syndrome can occur with any serontnergic agent, including illicit substances.
Several other diseases have similar presentations, making the patient history in relation to a serotonergic agent and physical exam crucial for ruling other etiologies out. The Hunter's criteria, listed above, has been used as a diagnostic tool but still has limitations.
Treatment is primarily supportive care. Watch for signs of high metabolic demand, specifically fevers, hypertension, and arrhythmia. Thats bad. Benzodiazepines for agitation. Lorazepam 2 to 4 mg as needed for symptom control. Cyproheptadine is a h1 blocker and nonspecific serotonin antagonist. The benefit is questionable and evidence is limited to retrospective and case reports.
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