Paucis Verbis: Serotonin syndrome

Michelle Lin, MD on 01/06/2012

What exactly IS serotonin syndrome? It's caused by the excess of serotonin and presents classically as: Altered mental status Autonomic instability Neuromuscular hyperactivity Fortunately, there's a nice algorithm (Hunter's decision rule) which helps you decide whether it is serotonin syndrome or not. I also include a table, which I adapted from the New England Journal of [+]

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Background

Serotonin syndrome is caused by the excess of serotonin and presents classically as:

Altered mental status
Autonomic instability
Neuromuscular hyperactivity

Fortunately, there’s a nice algorithm (Hunter’s decision rule) which helps you decide whether it is serotonin syndrome or not. I also include a table, which I adapted from a New England Journal of Medicine review article, which helps you to differentiate it from its mimickers, such as anticholinergic syndrome, neuroleptic malignant syndrome, and malignant hyperthermia.

PV Card: Serotonin Syndrome

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Adapted from [1, 2]
Go to ALiEM (PV) Cards for more resources.

A video to remind you what clonus looks like:

Thanks to Dr. Steve MacDade (Univ of Florida, Jacksonville EM resident) for the idea!

References

Boyer E, Shannon M. The serotonin syndrome. N Engl J Med. 2005;352(11):1112-1120. [PubMed]
Ables A, Nagubilli R. Prevention, recognition, and management of serotonin syndrome. Am Fam Physician. 2010;81(9):1139-1142. [PubMed]

Author information

Michelle Lin, MD

ALiEM Founder and CEO
Professor and Digital Innovation Lab Director
Department of Emergency Medicine
University of California, San Francisco