Serotonin Toxicity (A better name for Serotonin Syndrome)

Serotonin syndrome was first described in the 1950s in patients taking tryptophan and a MAOi. Somehow 70 years later we still can't agree on how to diagnose it, manage it or write it up in a case report.

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I'll try and boil this topic down for you to a neat little toxicology pill:
1) You can only get severe serotonin toxicity if you are on a combination of serotonergic agents
2) Features of this include hyperthermia, neuromuscular excitability and increased tone
3) Manage hyperthermia aggressively with active cooling
4) Treat with benzodiazepines and/or specific serotonin antagonists like cyproheptadine or chlorpromazine

Obviously this video is not medical advice.

References:

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Chiew AL, Buckley NA. The serotonin toxidrome: shortfalls of current diagnostic criteria for related syndromes. Clin Toxicol (Phila). 2021 Nov 22:1-16. doi: 10.1080/15563650.2021.1993242. Epub ahead of print. PMID: 34806513.

Dunkley EJ, Isbister GK, Sibbritt D, Dawson AH, Whyte IM. The Hunter Serotonin Toxicity Criteria: simple and accurate diagnostic decision rules for serotonin toxicity. QJM 2003;96(9):635–42

Isbister GK, Bowe SJ, Dawson A, Whyte IM. Relative toxicity of selective serotonin reuptake inhibitors (SSRIs) in overdose. J Toxicol Clin Toxicol. 2004;42(3):277-85. doi: 10.1081/clt-120037428. PMID: 15362595.

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Sternbach H. The serotonin syndrome. Am J Psychiatry. 1991 Jun;148(6):705-13. doi: 10.1176/ajp.148.6.705. PMID: 2035713.

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