Serotonin Syndrome: Pathogenesis and Clinical Findings Serotonin Syndrome: Variable combination of mental status changes, autonomic instability, and neuromuscular hyperactivity ranging from mild to life-threatening with an abrupt onset (within minutes to hours) after medication ingestion and most cases resolving within 24 hours of cessation of offending medication Serotonergic Agents: SSRls, SNRls, MOAls, TCAs, atypical antidepressants, antibiotics, mood stabilizers (valporate, lithium), opioids, antiemetic agents, triptans, weight loss agents, drugs of abuse (e.g. cocaine, amphetamines) • Altered Mental Status - Anxiety, confusion, agitation, hypervigilance, pressured speech, delirium, coma • Autonomic Instability - Shivering, diaphoresis, fever, diarrhea, tachycardia, mydriasis, hypertension • Neuromuscular Hyperactivity - Hyperreflexia, muscle rigidity (esp. lower extremities), myoclonus, tremor, incoordination, trismus , opisthotonus, ocular clonus, seizures The Hunter Serotonin Toxicity Criteria is used to make a clinical diagnosis - History of serotonergic agent taken within past 5 weeks + any of the following clinical features: - Spontaneous clonus - Inducible clonus and either agitation or diaphoresis - Ocular clonus and either agitation or diaphoresis - Tremor and hyperreflexia - Hypertonia, temperature > 38C, and either ocular clonus or inducible clonus #Serotonin #Syndrome #Pathophysiology #Psychiatry #Diagnosis #Signs #Symptoms
