Serotonin Syndrome and Overdose Management
Diagnosis and Clinical Manifestations
- The American Academy of Child and Adolescent Psychiatry notes that key diagnostic features of serotonin syndrome include confusion/agitation, myoclonus/tremor/hyperreflexia/muscle rigidity, and fever/tachycardia/sweating, with symptoms typically emerging within 24-48 hours after ingestion or dose increases 1, 2
- Myoclonus occurs in 57% of cases and is the most common finding in serotonin syndrome 2
Management and Treatment
- The American Academy of Child and Adolescent Psychiatry recommends that if serotonin syndrome is suspected, sertraline and all other serotonergic agents should be immediately discontinued 2
- Administering benzodiazepines, such as lorazepam, is recommended for agitation, muscle rigidity, and seizures, with a strength of evidence based on clinical guidelines 2
- Providing IV fluids for supportive care and using external cooling measures for hyperthermia are also recommended 2
- It is crucial to never use physical restraints if serotonin syndrome is suspected, as they worsen muscle contractions and increase mortality risk 2