Serotonin syndrome - Revision history

Aidan at 15:24, 2 November 2021

2021-11-02T15:24:53Z

← Older revision		Revision as of 15:24, 2 November 2021
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⚫	== Hunter ~~criteria~~ ==
			== Diagnosis ==
		⚫	=== Hunter Criteria ===

	* Must have a serotonergic exposure		* Must have a serotonergic exposure
			*The diagnosis is made in any of the following situations:
			**Spontaneous clonus
			**Either ocular clonus or inducible clonus, plus either agitation or diaphoresis
			**Tremor plus hyperreflexia
			**Hypertonia, plus temperature over 38C, plus either ocular clonus or inducible clonus

			* Sensitivity 84% and specificity 97%
	<pre class="mermaid">graph TD;

			=== Sternbach Criteria ===
	spont["spontaneous clonus"] --Y--> ss["serotonin syndrome"]
	spont --N--> ind["inducible clonus &<br/>agitation or diaphoresis"]
	ind --Y--> ss
	ind --N--> oc["ocular clonus &<br/>agitation or diaphoresis"]
	oc --Y--> ss
	oc --N--> trem["tremor & hyperreflexia"]
	trem --Y--> ss
	trem --N--> hyper["hypertonic & temp >38C &<br/>ocular clonus or inducible clonus"]
	hyper --Y--> ss
	hyper --N--> nss["not serotonin syndrome"]

			* Recent addition or increase in a known serotonergic agent
	</pre>
			* Absence of other possible etiologies such as infection, substance abuse
	* 84% sensitive and 97% specific
			* No recent addition or increase of a neuroleptic agent
			* At least three of the following:
			** Mental status changes such as confusion or hypomania
			** Agitation
			** Myoclonus
			** Hyperreflexia
			** Diaphoresis
			** Shivering
			** Tremor
			** Diarrhea
			** Incoordination or ataxia
			** Fever
			* False positives are common

	== Clinical Manifestations ==		== Clinical Manifestations ==

Aidan: Text replacement - "== Clinical Presentation" to "== Clinical Manifestations"

2020-08-02T13:31:37Z

Text replacement - "== Clinical Presentation" to "== Clinical Manifestations"

← Older revision		Revision as of 13:31, 2 August 2020
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	* 84% sensitive and 97% specific		* 84% sensitive and 97% specific

	== Clinical ~~Presentation~~ ==		== Clinical Manifestations ==

	* Fever, rigidity, clonus, diaphoresis, tremor, and agitation		* Fever, rigidity, clonus, diaphoresis, tremor, and agitation

Maintenance script: Imported from text file

2020-07-04T01:17:55Z

Imported from text file

New page

== Hunter criteria ==

* Must have a serotonergic exposure

<pre class="mermaid">graph TD;

spont["spontaneous clonus"] --Y--> ss["serotonin syndrome"]
spont --N--> ind["inducible clonus &<br/>agitation or diaphoresis"]
ind --Y--> ss
ind --N--> oc["ocular clonus &<br/>agitation or diaphoresis"]
oc --Y--> ss
oc --N--> trem["tremor & hyperreflexia"]
trem --Y--> ss
trem --N--> hyper["hypertonic & temp >38C &<br/>ocular clonus or inducible clonus"]
hyper --Y--> ss
hyper --N--> nss["not serotonin syndrome"]

</pre>
* 84% sensitive and 97% specific

== Clinical Presentation ==

* Fever, rigidity, clonus, diaphoresis, tremor, and agitation
* Compared to [[NMS]], SS is more likely to have:
** Acute onset
** Sialorrhea, hyperactive bowel sounds
** Hyperreflexia and clonus
** Mydriasis

== Management ==

* Stop all serotonergic drugs
* Supportive therapy
** Aggressive cooling
* Sometimes can use
** Cyproheptadine but is PO and takes 24-48h
** Olanzapine 10mg IV BID

[[Category:Toxicology]]