Serotonin Syndrome Following an Uncomplicated Orthopedic Surgery in a Patient With Post-Traumatic Stress Disorder

Abstract

Serotonin syndrome (SS) is a potentially life-threatening adverse drug reaction that may occur in patients treated with serotonin agonist medications. Medications responsible for serotonin syndrome include commonly prescribed antidepressants, anxiolytics, analgesics, and antiemetics. Veterans with post-traumatic stress disorder (PTSD) are at risk for polypharmacy with serotoninergic medications, given their psychological comorbidities and service-related musculoskeletal injuries. The perioperative period is a particularly vulnerable time owing to the use of high-dose anxiolytics and antiemetics frequently administered in this period, and places PTSD patients at higher risk of SS. Herein, we present the first case of SS in a young veteran with combat-related PTSD following an uncomplicated L5-S1 revision discectomy that highlights the unique set of clinical challenges and dilemmas faced when treating SS in a patient with severe postsurgical pain. As we are likely to encounter increasing numbers of veterans treated for PTSD who require multiple surgical procedures to treat their service-related injuries, health care providers need to be familiar with prevention, recognition, and the clinical challenges in the management of SS in the postoperative period.

Serotonin Syndrome in ICU—A Road Less Traveled

“…5 Although SS is well recognized entity in perioperative setting, there are very few reports of patients presenting with SS in ICU setting. 6,7 To conclude, the present case highlights the importance of detailed history taking with respect to drug intake in patients presenting with severe agitation.…”

Serotonin syndrome in asymptomatic Huntington's disease

“…There have been case reports of the development of serotonin syndrome in patients with a previous psychiatric history who were given ondansetron, linked to the concomitant use of pro-serotonergic medications, but again highlighting the role of ondansetron in patients who are predisposed to neurotransmitter deficit. 8 We feel our case highlights the combination of several predisposing factors making this patient more vulnerable to the use of multiple serotonergic agents. These include:…”