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The serotonin syndrome is a medication-induced condition resulting from serotonergic hyperactivity, usually involving antidepressant medications. As the number of patients experiencing medically-treated major depressive disorder increases, so does the population at risk for experiencing serotonin syndrome. Excessive synaptic stimulation of 5-HT2A receptors results in autonomic and neuromuscular aberrations with potentially life-threatening consequences.
Sternbach Criteria | Radomski Criteria | Hunter Criteria | |
---|---|---|---|
Inclusion Criteria | Presence of serotonergic medication | Presence of serotonergic medication | Presence of serotonergic medication |
Exclusion Criteria | Presence of other possible disease etiologies (e.g., infection, substance abuse, and withdrawal) and/or recent addition (or increase in dose) of neuroleptic medication. |
None | None |
Signs and Symptoms | At least three of the following signs/symptoms: | Either four major, or three major plus two minor signs/symptoms: | Any of the following combinations of primary (1°) ± secondary (2°) signs/symptoms: |
Major: | |||
Mental status changes (confusion, hypomania) | Impaired consciousness | ||
Elevated mood | |||
Agitation | Semicoma/coma | 1°: Spontaneous clonus alone | |
Myoclonus | |||
Myoclonus | Tremor | 1°: Inducible clonus AND | |
Shivering | |||
Hyperreflexia | Rigidity | 2°: Agitation or diaphoresis | |
Hyperreflexia | |||
Diaphoresis | Fever | 1°: Ocular clonus AND | |
Sweating | |||
Shivering | Minor: | 2°: Agitation or diaphoresis | |
Restlessness | |||
Tremor | Insomnia | 1°: Tremor AND | |
Incoordination | |||
Diarrhea | Dilated pupils | 2°: Hyperreflexia | |
Akathisia | |||
Incoordination | Tachycardia | 1°: Hypertonicity AND fever (temperature >38 °C) AND | |
Tachypnea/Dyspnea | |||
Fever | Diarrhea | 2°: Ocular clonus or inducible clonus | |
Hypertension/hypotension |
Disease | Medication Exposure | Shared Clinical Features | Distinguishing Clinical Features |
---|---|---|---|
Serotonin Syndrome | Serotonergic medications | Hypertension | Clonus, hyperreflexia Hyperactive bowel sounds |
Neuroleptic Malignant Syndrome | Dopamine antagonists | Tachycardia | No clonus or hyperreflexia Bradykinesia |
Anticholinergic Toxicity | Acetylcholine antagonist | Hyperthermia | No clonus or hyperreflexia Dry skin Absent bowel sounds |
Malignant Hyperthermia | Halogenated anesthetics Succinylcholine |
Altered mental Status | No clonus or hyperreflexia Extreme muscular rigidity |