Serotonin syndrome: Difference between revisions

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

@@ Line 1: / Line 1: @@
-== Hunter criteria ==
+== 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%
-<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 Manifestations ==