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Morarasu BC, Coman AE, Bologa C, Lionte C, Petris OR, Ceasovschih A, Sorodoc V, Haliga RE, Puha G, Stoica A, Sirbu O, Constantin M, Sorodoc L. Recognition and Management of Serotonin Toxidrome in the Emergency Department-Case Based Review. J Pers Med 2022; 12:2069. [PMID: 36556289 PMCID: PMC9782506 DOI: 10.3390/jpm12122069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 12/11/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022] Open
Abstract
Serotonin syndrome (SS) is a clinical toxidrome with high variability in clinical practice. It develops due to increased serotonin levels in the central nervous system. With an underestimated frequency, SS can develop following an overdose, a therapeutic dose increase, or drug to drug interaction of at least one serotonergic agent. It can present with autonomic signs, neuromuscular changes and an altered mental status. However, history and clinical examination are key features to formulate the diagnosis. Treatment options consist of supportive measures, discontinuation of the offending agent and certain therapeutic agents previously reported to improve outcomes. Physicians have limited experience with SS, partially due to the lack of its identification in clinical practice. Therefore, we have integrated, in a narrative review, the case of a young male with SS following an atypical antipsychotic overdose superimposed on chronic treatment with agents previously known to produce SS.
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Affiliation(s)
- Bianca Codrina Morarasu
- 2nd Internal Medicine Clinic, ‘‘Sfântul Spiridon’’ Emergency Clinical County Hospital, 700111 Iasi, Romania
| | - Adorata Elena Coman
- 2nd Internal Medicine Clinic, ‘‘Sfântul Spiridon’’ Emergency Clinical County Hospital, 700111 Iasi, Romania
- Preventive Medicine and Interdisciplinary Team Department, “Grigore T. Popa” University of Medicine and Pharmacy, 700150 Iasi, Romania
| | - Cristina Bologa
- 2nd Internal Medicine Clinic, ‘‘Sfântul Spiridon’’ Emergency Clinical County Hospital, 700111 Iasi, Romania
- Internal Medicine Department, “Grigore T. Popa” University of Medicine and Pharmacy, 700111 Iasi, Romania
| | - Catalina Lionte
- 2nd Internal Medicine Clinic, ‘‘Sfântul Spiridon’’ Emergency Clinical County Hospital, 700111 Iasi, Romania
- Internal Medicine Department, “Grigore T. Popa” University of Medicine and Pharmacy, 700111 Iasi, Romania
| | - Ovidiu Rusalim Petris
- 2nd Internal Medicine Clinic, ‘‘Sfântul Spiridon’’ Emergency Clinical County Hospital, 700111 Iasi, Romania
- Nursing Department, “Grigore T. Popa” University of Medicine and Pharmacy, 700111 Iasi, Romania
| | - Alexandr Ceasovschih
- 2nd Internal Medicine Clinic, ‘‘Sfântul Spiridon’’ Emergency Clinical County Hospital, 700111 Iasi, Romania
- Internal Medicine Department, “Grigore T. Popa” University of Medicine and Pharmacy, 700111 Iasi, Romania
| | - Victorita Sorodoc
- 2nd Internal Medicine Clinic, ‘‘Sfântul Spiridon’’ Emergency Clinical County Hospital, 700111 Iasi, Romania
- Internal Medicine Department, “Grigore T. Popa” University of Medicine and Pharmacy, 700111 Iasi, Romania
| | - Raluca Ecaterina Haliga
- 2nd Internal Medicine Clinic, ‘‘Sfântul Spiridon’’ Emergency Clinical County Hospital, 700111 Iasi, Romania
- Internal Medicine Department, “Grigore T. Popa” University of Medicine and Pharmacy, 700111 Iasi, Romania
| | - Gabriela Puha
- 2nd Internal Medicine Clinic, ‘‘Sfântul Spiridon’’ Emergency Clinical County Hospital, 700111 Iasi, Romania
- Internal Medicine Department, “Grigore T. Popa” University of Medicine and Pharmacy, 700111 Iasi, Romania
| | - Alexandra Stoica
- 2nd Internal Medicine Clinic, ‘‘Sfântul Spiridon’’ Emergency Clinical County Hospital, 700111 Iasi, Romania
- Internal Medicine Department, “Grigore T. Popa” University of Medicine and Pharmacy, 700111 Iasi, Romania
| | - Oana Sirbu
- 2nd Internal Medicine Clinic, ‘‘Sfântul Spiridon’’ Emergency Clinical County Hospital, 700111 Iasi, Romania
- Internal Medicine Department, “Grigore T. Popa” University of Medicine and Pharmacy, 700111 Iasi, Romania
| | - Mihai Constantin
- 2nd Internal Medicine Clinic, ‘‘Sfântul Spiridon’’ Emergency Clinical County Hospital, 700111 Iasi, Romania
- Internal Medicine Department, “Grigore T. Popa” University of Medicine and Pharmacy, 700111 Iasi, Romania
| | - Laurentiu Sorodoc
- 2nd Internal Medicine Clinic, ‘‘Sfântul Spiridon’’ Emergency Clinical County Hospital, 700111 Iasi, Romania
- Internal Medicine Department, “Grigore T. Popa” University of Medicine and Pharmacy, 700111 Iasi, Romania
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