Hot flushes and a mental Fog 1# Serotonin syndrome Presentation • • • • • Classical triad: - Autonomic dysfunction: ➔ Diaphoresis ➔ Tachycardia ➔ HTN ➔ Mydriasis Neuromuscular excitability -> can lead to hyperthermia - Hyperreflexia - Myoclonus - Clinic - Hypertonicity - Rigidity esp. in lower limbs Altered mental status Anxiety Seizures Management • • • • • Discontinue drug Supportive care -> oxygen, IV fluids, For agitation and excessive muscle activity -> benzos For hyperthermia -> cooling measures Autonomic instability -> antihypertensive medications Neuroleptic Malignant Syndrome History • • • • • • • • • • Hyperthermia Fever Muscle rigidity Fluctuating blood pressure Tachycardia Tachypnoea Diaphoresis Agitation confusion delirium Progression to unresponsiveness or coma in severe cases Bradykinesia • Tremors Lab findings • • • • • CK Leucocytosis AST, ALT Electrolyte imbalance Myoglobinuria Anticholinergic toxicity • • • • • • • • • • • AMS Seizures Myoclonus or tremors Mydriasis – dilated pupils and non-reactive to light Dry skin and mucus membrane Flushed skin Hyperthermia Urinary retention Decreased bowel sounds or ileus Tachycardia Hypertension or hypotension Lab • • • Electrolytes Urinary retention tests – confirm impaired bladder emptying ECG changes -> tachycardia, QRS prolongation Management • • • • • • Supportive care Decontamination Antidote -> physostigmine Benzos for agitation Cooling measures for hyperthermia Catheterization -> for urinary retention Malignant Hyperthermia • • • • Fever -> more than 40 Muscle rigidity Tachycardia Hypercapnia • • Respiratory acidosis Metabolic acidosis Lab • • CK elevated Myoglobinuria -> dark coloured urine -> acute kidney injury Management • • • • • • • • Discontinued causing agents e.g. drugs, ecstasy and other recreational drugs Give dantrolene -> antidote -> reduce ca+ release from SR -> decrease hypermetabolic state Cooling -> ice packs, cold IV fluids, cooling blankets Hyperventilation Fluids and diuresis Electrolyte correction Continuous ECG monitoring Frequent ABGs Other DDx • • Thyroid storm Infections