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Serotonin Toxicity in the Critically Ill
- Serotonin toxicity (aka serotonin syndrome) can easily be overlooked and misdiagnosed in many of our critically ill patients.
- Several common ED medications are associated with serotonin toxicity and include tramadol, linezolid, ondansetron, and metoclopramide.
- Clues to the diagnosis include hyperthermia, increased muscle tone, hyperreflexia, dilated pupils and clonus. Of these, clonus is the most sensitive and specific sign.
- A few important treatment pearls:
- Avoid physical restraints
- Consider cyproheptadine: only available in PO form; initial dose is 12 mg
- Avoid dopamine for those that need vasopressors
- Avoid bromocriptine and dantrolene
References
Bienvenu OJ, Neufeld KJ, Needham DM. Treatment of four psychiatric emergencies in the intensive care unit. Crit Care Med 2012; 40:2662-2670.