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Serotonin Syndrome: The ten minute version

Serotonin Syndrome: The ten minute version. Russell Berger, MD. Clinical Triad. Altered mental status Dysautonomia Hyperreflexia (lower extremity>upper extremity). Relevant History. New serotonergic agent(usually in addition to one old agent) Rapid onset of symptoms.

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Serotonin Syndrome: The ten minute version

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  1. Serotonin Syndrome: The ten minute version Russell Berger, MD

  2. Clinical Triad • Altered mental status • Dysautonomia • Hyperreflexia (lower extremity>upper extremity)

  3. Relevant History • New serotonergic agent(usually in addition to one old agent) • Rapid onset of symptoms

  4. What are some of the more common serotonergic agents • Tramadol • Demerol • TCA’s • SSRI’s • Lithium • MAOi’s • Linezolid(yes, the abx) • Trazodone • Valproic acid • Tryptophan • St John’s Wort • Ginseng

  5. Complications of Serotonin Syndrome Seizures Rhadbomyolysis Hyperthermia Metabolic Acidosis Renal Injury Death

  6. Treatment Options • Benzodiazepines • No risk • Cyproheptadine(5HT-2A antagonist) • Anticholinergic

  7. The diagnostic dilemma

  8. Questions

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