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.
