Serotonin syndrome: Difference between revisions

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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[&quot;spontaneous clonus&quot;] --Y--&gt; ss[&quot;serotonin syndrome&quot;]
spont --N--&gt; ind[&quot;inducible clonus &amp;&lt;br/&gt;agitation or diaphoresis&quot;]
ind --Y--&gt; ss
ind --N--&gt; oc[&quot;ocular clonus &amp;&lt;br/&gt;agitation or diaphoresis&quot;]
oc --Y--&gt; ss
oc --N--&gt; trem[&quot;tremor &amp; hyperreflexia&quot;]
trem --Y--&gt; ss
trem --N--&gt; hyper[&quot;hypertonic &amp; temp &gt;38C &amp;&lt;br/&gt;ocular clonus or inducible clonus&quot;]
hyper --Y--&gt; ss
hyper --N--&gt; nss[&quot;not serotonin syndrome&quot;]


* 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 Presentation ==
== Clinical Manifestations ==


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

Latest revision as of 15:24, 2 November 2021

Diagnosis

Hunter Criteria

  • 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%

Sternbach Criteria

  • Recent addition or increase in a known serotonergic agent
  • Absence of other possible etiologies such as infection, substance abuse
  • 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

  • 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