Serotonin syndrome: Difference between revisions
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== Diagnosis == |
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* Must have a serotonergic exposure |
* Must have a serotonergic exposure |
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*The diagnosis is made in any of the following situations: |
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**Spontaneous clonus |
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**Either ocular clonus or inducible clonus, plus either agitation or diaphoresis |
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**Tremor plus hyperreflexia |
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**Hypertonia, plus temperature over 38C, plus either ocular clonus or inducible clonus |
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* Sensitivity 84% and specificity 97% |
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<pre class="mermaid">graph TD; |
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=== Sternbach Criteria === |
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spont["spontaneous clonus"] --Y--> ss["serotonin syndrome"] |
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spont --N--> ind["inducible clonus &<br/>agitation or diaphoresis"] |
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ind --Y--> ss |
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ind --N--> oc["ocular clonus &<br/>agitation or diaphoresis"] |
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oc --Y--> ss |
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oc --N--> trem["tremor & hyperreflexia"] |
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trem --Y--> ss |
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trem --N--> hyper["hypertonic & temp >38C &<br/>ocular clonus or inducible clonus"] |
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hyper --Y--> ss |
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hyper --N--> nss["not serotonin syndrome"] |
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* Recent addition or increase in a known serotonergic agent |
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</pre> |
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* Absence of other possible etiologies such as infection, substance abuse |
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* 84% sensitive and 97% specific |
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* No recent addition or increase of a neuroleptic agent |
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* At least three of the following: |
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** Mental status changes such as confusion or hypomania |
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** Agitation |
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** Myoclonus |
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** Hyperreflexia |
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** Diaphoresis |
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** Shivering |
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** Tremor |
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** Diarrhea |
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** Incoordination or ataxia |
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** Fever |
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* False positives are common |
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== Clinical Manifestations == |
== Clinical Manifestations == |
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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
