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 |
+ | == Clinical Manifestations == |
* Fever, rigidity, clonus, diaphoresis, tremor, and agitation |
* Fever, rigidity, clonus, diaphoresis, tremor, and agitation |
Latest revision as of 11:24, 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