scholarly journals Serotonin Toxicity Precipitated by Tramadol in the Setting of Polypharmacy: A Case of Serotonin Syndrome

Cureus ◽  
2021 ◽  
Author(s):  
Ariel Ruiz de Villa ◽  
Tyler Jones ◽  
Amina Lleshi ◽  
Monica Macahuachi ◽  
Katie Lamar ◽  
...  
Keyword(s):  
Serotonin Syndrome ◽  
Serotonin Toxicity

Serotonin Syndrome

2019 ◽  
pp. 467-471
Author(s):  
Kevin T. Gobeske ◽  
Eelco F. M. Wijdicks
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Autonomic Nervous System ◽  
Serotonin Syndrome ◽  
Neuromuscular System ◽  
Autonomic Nervous ◽  
Life Threatening ◽  
The Central Nervous System ◽  
Serotonin Toxicity

Serotonin syndrome affects the central nervous system, the autonomic nervous system, and the neuromuscular system and can have acute and potentially life-threatening manifestations. By definition, serotonin syndrome is associated with changes in serotonin exposure and thus might be described more accurately as serotonergic excess or serotonin toxicity. The central nervous system effects of serotonin involve regulation of attention, arousal, mood, learning, appetite, and temperature.

scholarly journals Delayed Recovery from General Anaesthesia: A Post-operative Diagnostic Dilemma and Implications of ICU Management of Serotonin Toxicity. Case report

2015 ◽  
Vol 1 (4) ◽  
pp. 174-178
Author(s):  
Asha Naik ◽  
Cristobal Rincon-Aznar
Keyword(s):  
Methylene Blue ◽  
Differential Diagnosis ◽  
Case Report ◽  
Serotonin Syndrome ◽  
Unknown Etiology ◽  
Diagnostic Dilemma ◽  
Neurological Signs ◽  
Delayed Recovery ◽  
Icu Management ◽  
Serotonin Toxicity

Abstract We report a case of delayed recovery from general anesthesia following a routine parathyroidectomy. Our objectives are to describe the process of establishing a differential diagnosis and subsequent management of a patient presenting with atypical neurological signs from an unknown etiology and to increase awareness about the potential for serotonin syndrome and neurotoxicity due to known interactions between methylene blue and selective serotoninnoradrenaline re-uptake inhibitors. ICU management of Serotonin Toxicity is briefly described.

scholarly journals Unprovoked serotonin syndrome-like presentation of SARS-CoV-2 infection: A small case series

2021 ◽  
Vol 9 ◽  
pp. 2050313X2110320
Author(s):  
Philip Keith ◽  
Marc Saint-Jour ◽  
Frank Pusey ◽  
Jeremy Hodges ◽  
Farid Jalali ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Multiple Sclerosis ◽  
Intensive Care Unit ◽  
Serotonin Syndrome ◽  
Case Series ◽  
Altered Mental Status ◽  
Whole Body ◽  
External Cooling ◽  
High Index Of Suspicion ◽  
Serotonin Toxicity

Clinicians and researchers have reported an array of neurological abnormalities in coronavirus disease 2019 (COVID-19), and while serotonin excess has been observed we are unaware of reports of central nervous system serotonin toxicity in COVID-19. We present two cases that resemble serotonin syndrome in COVID-19, but without identifiable inciting medications. A 54-year-old with multiple sclerosis and diabetes mellitus presented with altered mental status. His altered sensorium was attributed to diabetic ketoacidosis, but his condition quickly deteriorated with fever to 105 degrees Fahrenheit, rigidity in all extremities, inducible clonus, and hyperreflexia. He was intubated and was treated for possible meningitis and seizure. Neurologic workup was negative for acute pathology. Despite acetaminophen, his core temperature remained elevated to 105 degrees Fahrenheit. He was treated with external cooling and cyproheptadine and within 48 h, his fever, rigidity, hyperreflexia, and clonus resolved. He was extubated and discharged home on day 14. A 72-year-old with hyperlipidemia was admitted with tremors, 4 days after testing positive for COVID-19. His symptoms rapidly worsened, and he was transferred to the Intensive Care Unit on day 3 in extremis, febrile to 104.4 degrees Fahrenheit, heart rate of 180 beats per minute, and apparent whole body myoclonus. He was intubated and developed fever refractory to acetaminophen requiring external cooling. Extensive neurologic workup was negative. He received cyproheptadine and slowly improved. He was extubated and discharged to rehab on day 11. These cases represent a unique presentation in COVID-19 that must be considered and requires a high index of suspicion.

scholarly journals An audit on prescribing practice and risk of serotonin syndrome among patients with chronic pain

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S152-S152
Author(s):  
Salakan Rai ◽  
Aizad Yusof
Keyword(s):  
At Risk ◽  
Chronic Pain ◽  
Pain Management ◽  
Drug Interactions ◽  
Serotonin Syndrome ◽  
Pain Clinic ◽  
Antidepressant Agents ◽  
Concurrent Use ◽  
Prescribing Practice ◽  
Serotonin Toxicity

AimsTo determine the incidence of prescribing practice with associated risk of serotonin toxicity among patients with chronic pain conditions.BackgroundSerotonin syndrome is a potentially life-threatening condition caused by excessive serotonergic activity, usually from drug interactions. Concurrent use of antidepressants is strongly linked to serotonin syndrome, with recent data revealing record numbers of NHS prescribed antidepressants in 2019. Antidepressant medications are also used in chronic pain management for their anti-neuropathic pain properties. However, it is well-recognised that a significant number of chronic pain patients suffer from anxiety and depression. This cohort of patients is therefore vulnerable to being exposed to multiple concurrent antidepressant agents, and thus at relatively higher risk of serotonin syndrome compared to other patient groups. Additionally, these patients are likely to be exposed to the concurrent use of antidepressants and certain analgesic agents particularly phenylpiperidine derivatives which increases serotonin toxicity risk.MethodMedications of patients presenting to a secondary care pain clinic within the last year were looked into. Patients were selected at random by pain management secretaries. Concurrent use of multiple antidepressant agents including Selective Serotonin Reuptake Inhibitors (SSRIs), Serotonin Noradrenaline Reuptake Inhibitors (SNRIs), Tricyclic Antidepressants (TCAs) or Tetracyclic Antidepressant (TeCA) was noted. Additionally, concurrent use of any of these antidepressant agents and phenylpiperidine derivatives such as Fentanyl and Tramadol was noted.ResultData on medications of 97 patients were collected. A total of 28 patients (28.8%) were observed to have at-risk medication combinations. Out of these, five patients were on both SSRI and TCA. Two patients were on both TCA and TeCA. Four other patients were on either a combination of SSRI and SNRI, SNRI and TCA, SSRI and TeCA, or TCA and TCA. Three patients were on both Fentanyl patches and an antidepressant. Fourteen patients were on both an antidepressant and Tramadol. None of these patients were diagnosed with serotonin syndrome; however, it is unclear as to whether these patients experienced milder symptoms of the syndrome.ConclusionA considerable number of patients in this group were on medication combinations putting them at risk of serotonin syndrome. Despite no documented patient harm, there is an urgent need for an increased awareness among prescribers on drug interactions which may lead to this syndrome and a subsequent change in prescribing practice.

scholarly journals Serotonin Toxicity: Implications for Clinical Practice

2016 ◽  
Vol 13 (3) ◽  
Author(s):  
Auston Rotheram ◽  
Wayne Harris ◽  
Colin Curtain ◽  
David Nihill
Keyword(s):  
Adverse Reaction ◽  
Prescription Drugs ◽  
Serotonin Syndrome ◽  
Management Strategies ◽  
Clinical Information ◽  
Over The Counter ◽  
Life Threatening ◽  
Serotonergic Drugs ◽  
High Index Of Suspicion ◽  
Serotonin Toxicity

Serotonin toxicity, or serotonin syndrome, is a potentially life threatening adverse reaction to the use of one or more serotonergic drugs. Patients presenting with low level obscure symptoms may have pathophysiology rooted in adverse dopamine and serotonergic poly-pharmacy reactions involving illegal, over-the-counter and/or prescription drugs. In this clinical information paper an overview of serotonin toxicity, diagnostic criteria, and management strategies will be offered. Cultivating a high index of suspicion for serotonin toxicity across a broad patient demographic is recommended

scholarly journals Transient Serotonin Toxicity Evoked by Combination of Electroconvulsive Therapy and Fluoxetine

2014 ◽  
Vol 2014 ◽  
pp. 1-2 ◽  
Author(s):  
René Klysner ◽  
Birgitte Bjerg Bendsen ◽  
Maja Soon Hansen
Keyword(s):  
Electroconvulsive Therapy ◽  
Serotonin Syndrome ◽  
Antidepressant Medication ◽  
Serotonin Toxicity

The serotonin syndrome has been described only in rare instances for electroconvulsive therapy combined with an antidepressant medication. We describe a case of serotonin toxicity induced by electroconvulsive therapy in combination with fluoxetine.

scholarly journals Incidence of Serotonin Syndrome in Patients Treated with Fentanyl on Serotonergic Agents

2015 ◽  
Vol 18;1 (1;1) ◽  
pp. E27-E30
Author(s):  
Padma Gulur
Keyword(s):  
Chart Review ◽  
Serotonin Syndrome ◽  
Tertiary Care ◽  
Inherent Limitation ◽  
Institutional Review ◽  
Academic Center ◽  
Key Words Fentanyl ◽  
Serotonergic Drugs ◽  
Serotonin Toxicity ◽  
Toxicity Criteria

Background: There has been a recent surge in the literature highlighting the association of fentanyl as precipitating serotonin syndrome in patients on a serotonergic agent. Objective: The purpose of our study was to understand the incidence of serotonin syndrome in patients who receive fentanyl while on serotonergic agents. Study Design: This retrospective analysis was conducted from 2012 to 2013 after approval from the Institutional Review Board. We searched for all patients that had received a serotonergic agent and were admitted to the hospital during the study period. Next, we split these patients into 2 groups by placing all patients who had received fentanyl and a serotonergic agent into one group. We then searched for any of the Hunter Serotonin Toxicity Criteria in the records of patients that had received both fentanyl and a serotonergic agent. Further, we searched for all patients with serotonin syndrome mentioned in their records. Setting: This study was conducted at a 900 bed tertiary care academic center. Results: Over the 2 year study period, 112,045 patients were on a serotonergic agent, and 4,538 of these patients were treated with both fentanyl and a serotonergic agent. A search for Hunter’s Criteria through the records of the patients receiving both fentanyl and a serotonergic agent revealed 23 patients had been documented with some of these symptoms. On detailed chart review, only 4 [95% CI 1 – 10] of these patients truly met Hunter’s Criteria for serotonin syndrome. We then searched all admissions for a diagnosis code of serotonin syndrome during the study period. Five additional cases of serotonin syndrome were found, but none of these patients were treated with fentanyl. Limitations: Some of the limitations of our study include that it represents a single institution, although it is a large academic center. An inherent limitation may be the under diagnosis of serotonin syndrome. Conclusion: The incidence of serotonin syndrome in patients who receive both fentanyl and a serotonergic agent is low. Key words: Fentanyl, serotonin syndrome, serotonergic drugs, opioids, SSRI, antidepressant

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