The Hunter Serotonin Toxicity Criteria: simple and accurate diagnostic decision rules for serotonin toxicity

Dunkley, E.J.C.; Isbister, Geoffrey K.; Sibbritt, David; Dawson, Andrew; Whyte, Ian M

doi:10.1093/qjmed/hcg109

Cited by 866 publications

(720 citation statements)

References 25 publications

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“…This syndrome is commonly seen earlier after overdose and does not have the gradual onset or protracted duration of NMS. Neuromuscular features of serotonin syndrome are also different from those seen in NMS, with a preponderance of hyperreflexia, myoclonus, and inducible clonus being more prominent as neuromuscular manifestations of the syndrome [16]. It is also unlikely that our patient's clinical deterioration could be explained by a further overdose in hospital as she was constantly supervised by a nurse while in the ICU and on the general medical ward.…”

Section: Discussionmentioning

confidence: 85%

Neuroleptic malignant syndrome developing after acute overdose with olanzapine and chlorpromazine

2009

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Neuroleptic malignant syndrome (NMS) is a relatively uncommon side effect that may develop after a recent increase in the therapeutic dose of an antipsychotic medication or the addition of a new agent in therapeutic doses.Case Report: We report a case of NMS developing in a 36-year-old female patient 2 days following deliberate self-poisoning with 30 ϫ10-mg olanzapine tablets, 7 ϫ100-mg chlorpromazine tablets and an unknown amount of escitalopram. These were the patient's own medications. She had not been taking these for several weeks. The patient initially presented with sedation from her overdose which resolved over the next 24 hours. Following this, over the subsequent 24 hours, she became progressively confused, ataxic, hypertonic, ferbrile and tachycardic, with marked lead pipe rigidity of the limbs. Head CT, lumbar puncture and septic screen were all negative. She was treated with intravenous midazolam infusion, nasogastrically administered bromocriptine, external cooling and was mechanically ventilated. She gradually improved over a period of 10 days, with residual confusion lasting another week, and was discharged well with no deterioration from her premorbid neurologic state.Conclusion: To our knowledge, although there are numerous cases reported with therapeutic use, NMS has not been reported to develop following acute olanzapine overdose. Clinicians should be aware that this may be an uncommon side effect of antipsychotic medication.

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Section: Discussionmentioning

confidence: 85%

Neuroleptic malignant syndrome developing after acute overdose with olanzapine and chlorpromazine

2009

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“…The following are the patient's symptoms that are consistent with serotonin toxicity using the Hunter Serotonin Toxicity Criteria [7] in the presence of a serotonergic agent:…”

Section: Discussionmentioning

confidence: 99%

Serotonin Toxicity Associated with Garcinia cambogia Over-the-counter Supplement

2014

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“…On the other hand, our patient's signs are also consistent with serotonin syndrome, including fever >38°C and rigidity on exam. Given her presentation in extremis, she did not have spontaneous clonus and, while her status would have allowed examination for induced clonus [16], its presence or absence was not documented. The incidence of serotonin syndrome following an acute overdose of SSRI agents is unknown, but in one series, serotonin syndrome occurred in 14 % of SSRI overdoses [17].…”

Section: Discussionmentioning

confidence: 99%

Citalopram Overdose: a Fatal Case

Kraai

Seifert

2014

J. Med. Toxicol.

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Background Citalopram is a selective serotonin reuptake inhibitor (SSRI) with cardiac and neurologic toxicities as well as the potential for serotonin syndrome. In most instances, patients recover fully from toxic ingestions of SSRIs. We describe a fatal case of a citalopram overdose. Case Report A 35-year-old woman presented to the emergency department after having witnessed seizures at home. An empty citalopram prescription bottle was located, and an intentional overdose was suspected. At the scene, she was found to be in cardiac arrest with pulseless electrical activity and underwent cardiopulmonary resuscitation, including intravenous epinephrine and bicarbonate. In the emergency department, her physical exam was notable for cough and gag reflexes and movement in all extremities with increased muscle tone and tachycardia. Her initial postresuscitation ECG showed sinus rhythm with QRS 92 ms and QTc 502 ms. Her temperature was initially normal, but she rapidly became febrile to 41.8°C shortly after admission. She was treated symptomatically and with cyproheptadine for suspected serotonin syndrome (SS) but became increasingly hemodynamically unstable over the next 6 h and then developed torsades des pointes (TdP) progressing to pulseless, wide complex tachycardia. She underwent cardiopulmonary resuscitation (CPR) for approximately 50 min but ultimately expired. Postmortem serum analysis revealed a citalopram concentration of 7300 ng/mL (therapeutic range 9-200 ng/mL) and THC, but no other nonresuscitation drugs or substances. Case Discussion Citalopram overdoses often have only mild to moderate symptoms, particularly with ingestions under 600 mg in adults. However, with higher doses, severe manifestations have been described, including QTc prolongation, TdP, and seizures. Serotonin syndrome has also been described in SSRI overdose, and our patient exhibited signs consistent with SS, including increased muscle tone and autonomic dysregulation. Our patient's serum concentration suggests a massive overdose, with major clinical effects, possible SS, and death. Conclusions Although most patients recover from citalopram overdose, high-dose ingestions can produce severe effects and fatalities may occur. In this case, it is likely that the patient's delayed presentation also contributed significantly to her death. The clinician must be aware of the potential for large ingestions of citalopram to produce life-threatening effects and monitor closely for the neurologic, cardiovascular, and other manifestations that, in rare cases, can be fatal.

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The Hunter Serotonin Toxicity Criteria: simple and accurate diagnostic decision rules for serotonin toxicity

Abstract: These redefined criteria for serotonin toxicity should be more sensitive to serotonin toxicity and less likely to yield false positives.

Cited by 866 publications

References 25 publications

Neuroleptic malignant syndrome developing after acute overdose with olanzapine and chlorpromazine

Neuroleptic malignant syndrome developing after acute overdose with olanzapine and chlorpromazine

Serotonin Toxicity Associated with Garcinia cambogia Over-the-counter Supplement

Citalopram Overdose: a Fatal Case

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