Serotonin syndrome

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Serotonin syndrome

Psychological disorders

Bipolar and related disorders

Bipolar disorder

Feeding and eating disorders

Anorexia nervosa

Bulimia nervosa

Medication-induced movement disorders and other adverse effects of medication

Neuroleptic malignant syndrome

Serotonin syndrome

Somatic symptom and related disorders

Factitious disorder

Somatic symptom disorder

Trauma and stressor-related disorders; Abuse

Physical and sexual abuse

Post-traumatic stress disorder

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Serotonin syndrome

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Serotonin syndrome

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USMLE® Step 1 style questions USMLE

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A 55-year-old woman comes to the emergency department (ED) for evaluation of recurrent left flank pain and vomiting. She has a history of recurrent nephrolithiasis and recently noticed gross blood in her urine. Medical history is notable for obesity, hypertension, hyperlipidemia, depression, and type II diabetes mellitus. The patient has been taking ondansetron at home for nausea as well as losartan, metformin, rosuvastatin, and sertraline for her other medical conditions. On physical exam, the patient has left costovertebral angle tenderness. Blood is detected on urinalysis. The patient's symptoms are well controlled during the ED visit, and she is subsequently discharged with prescription analgesia, additional antiemetics, and urology follow-up. Three days later, the patient is brought back to the ED altered, diaphoretic, and agitated. Temperature is 39.4°C (103°F), pulse is 122/min, respirations are 20/min, and blood pressure is 184/95 mmHg. She has bilateral mydriasis and myoclonus. Which of the following medications was the most likely precipitant of this patient's clinical presentation?

External References

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Autonomic nervous system

in serotonin syndrome p. 592

Serotonin syndrome p. 409, 567, 573, 593

dextromethorphan p. 711

MAO inhibitors p. 599

MDMA p. 595

oxazolidinones p. 190

Summary

Serotonin syndrome is a potentially life-threatening condition that occurs when there is an excess of serotonin, a neurotransmitter in the brain, leading to a dangerous increase in nerve cell activity. Serotonin syndrome can occur as a result of taking certain medications, including selective serotonin reuptake inhibitors (SSRIs), monoamine oxidase inhibitors (MAOIs), and serotonin-norepinephrine reuptake inhibitors (SNRIs) or taking a combination of medications that increase serotonin levels. Symptoms include agitation, confusion, muscle rigidity and hyperreflexia, hypertension, dysrhythmias, diaphoresis, and tachypnea. Treatment may include discontinuing the culprit drug, supportive management, and providing cyproheptadine.

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