Serotonin syndrome in the intensive care unit: Clinical presentations and precipitating medications

Swetha Pedavally, Jennifer E. Fugate, Alejandro Rabinstein

Research output: Contribution to journalArticle

29 Citations (Scopus)

Abstract

Background: Serotonin syndrome (SS) is becoming a more frequent diagnosis in the intensive care unit (ICU). We sought to determine the clinical presentation, drug exposures, and outcomes of SS in critically ill patients. Methods: A retrospective study of 33 consecutive ICU patients with SS between March 2007 and March 2012 in ICUs in a large teaching hospital. SS was defined using the Hunter Serotonin Toxicity Criteria. Results: Seventeen patients (52 %) were admitted for mental status changes, including seven patients (21 %) with drug overdose and four cases (12 %) in which SS was considered the primary admission diagnosis. In 13 patients (39 %) the features of SS developed only after a mean of 6.8 ± 9 days of hospitalization. Most received multiple serotonergic drugs upon diagnosis (median three drugs, range 1-5). Antidepressants were the serotonergic medications most often used before admission, and opioids (principally fentanyl) and antiemetics were the most frequently prescribed new serotonin-enhancing medications. Altered mental status was present in all patients and myoclonus, rigidity, and hyperreflexia were the most prevalent examination signs. All but one patient had documented recovery. The mean time to neurological improvement was 56 ± 5 h, but ranged from 8 to 288 h. There were no cases of renal failure related to rhabdomyolysis, or death or persistent disability caused by SS. Conclusion: SS in the ICU occurs most often because of exposure to multiple serotonergic agents. Continuation of antidepressants plus the addition of opioids and antiemetics during hospitalization are most commonly responsible for this complication.

Original languageEnglish (US)
Pages (from-to)108-113
Number of pages6
JournalNeurocritical Care
Volume21
Issue number1
DOIs
StatePublished - Jan 1 2014

Fingerprint

Serotonin Syndrome
Intensive Care Units
Serotonin Agents
Antiemetics
Opioid Analgesics
Antidepressive Agents
Serotonin
Hospitalization
Drug Overdose
Abnormal Reflexes
Myoclonus
Rhabdomyolysis
Fentanyl
Critical Illness
Teaching Hospitals
Pharmaceutical Preparations
Renal Insufficiency
Retrospective Studies

Keywords

  • Antidepressants
  • Intensive care unit
  • Neurotoxicity
  • Opioids
  • Serotonin syndrome

ASJC Scopus subject areas

  • Clinical Neurology
  • Critical Care and Intensive Care Medicine

Cite this

Serotonin syndrome in the intensive care unit : Clinical presentations and precipitating medications. / Pedavally, Swetha; Fugate, Jennifer E.; Rabinstein, Alejandro.

In: Neurocritical Care, Vol. 21, No. 1, 01.01.2014, p. 108-113.

Research output: Contribution to journalArticle

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