Serotonin syndrome

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Summary of Serotonin syndrome

Serotonin syndrome is any of a group of symptoms which may be an indication of any number of potentially life-threatening drug interactions that may occur following therapeutic drug use, combination, an overdose of particular drugs, or the recreational use of certain drugs. Serotonin syndrome is not an idiopathic drug reaction; it is a predictable consequence of excess serotonin on the CNS and/or peripheral nervous system. For this reason, some experts strongly prefer the terms serotonin toxicity or serotonin toxidrome which more accurately reflect that it is a form of poisoning. Other names include serotonin sickness, serotonin storm, serotonin poisoning, hyperserotonemia, or serotonergic syndrome.

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Serotonin syndrome

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Serotonin syndrome

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A 40-year-old female presents to the emergency room with anxiety and nervousness after watching television. She states that her heart was “beating out of her chest” and that this bout of anxiety was worse than she has ever experienced. She has a history of major depressive disorder and generalized anxiety disorder which has been controlled with citalopram. When asked about any medication changes, she does report being prescribed fentanyl and diphenhydramine by her family doctor for lower back pain and insomnia respectively. Her temperature is 38.5°C (101.3°F), pulse is 120/min, respirations are 20/min, and blood pressure is 140/95 mm Hg. On neurologic examination, her pupils are dilated but reactive to light. Muscle rigidity is present in both extremities bilaterally. Triceps, biceps, brachioradialis, patellar, and achilles reflexes are 4+ throughout. Bilateral babinski signs bilaterally with positive ankle clonus. What is the most likely cause of her presentation?