Serotonin Syndrome Definition A potentially life-threatening condition caused by serotonergic overactivity in patients with exposure to serotonergic drugs. Aetiology Anti-depressants Anxiolytics e.g. buspirone Anti-convulsants e.g. valproate Opioids e.g. tramadol, meperidine NMDA-R antagonist e.g. dextromethorphan 5HT$_2$-R antagonist e.g. ondansetron Serotonin - R agonists e.g. triptans & ritonavir Antibiotics e.g. linezolid Herbal supplements e.g. St John's wort, ginseng, tryptophan Recreational stimulants e.g. MDMA, cocaine RF concurrent use of > 2 or more serotonergic drugs e.g. MAOIs with an SSRI 1 or more serotonergic drug with certain CYP450 e.g. ciprofloxacin leads to serotonin accumulation accidental or intentional overdose patient specific pharmacokinetic &/or pharmacodynamic factors Clinical Features Onset = acute typically within 24hrs of administration Resolution = rapid typically within 24hrs of Treatment initiation Presentation = classic triad autonomic dysregulation diaphoresis, tachycardia, HTN, Mydriasis neuromuscular excitability can lead to hyperthermia hyperreflexia -> horizontal ocular clonus myoclonus -> hyperkinesia clonus -> rigidity especially in lower limbs Altered mental states delirium autonomic dysfle) →psychomoter agilahan HAHAI altered mental status Coma J other Peatures. nausea, diarrhea, vomit Neuromuscular excitability anxiety HOTN Coue to HADI poisoning) Ciagnosis * mainly clinical * may une diagoniste crileras such as the tunde serotonin torcity crilena *lab studies ceomay be used to assess for complications related tom rigidity hyperthermia NMS *Infechous meningihs, encephalits Grdocrine ey Mayroid sturm Anti-cholinergis quadrame provide supportive que no angen bedryfeed long abala auova colio