Abstract
Serotonin syndrome is a clinical diagnosis characterized by a constellation of autonomic and neurological physical examination findings due to the use of one or more serotonergic agents. Due to high morbidity and mortality associated with this condition, high index of suspicion is required in making this diagnosis. Treatment is aimed at discontinuation of the offending agent and supportive care. We present a case of a 28-year-old woman who presented with acetaminophen toxicity, however developed iatrogenic serotonin syndrome due to use of scheduled intravenous metoclopramide. Metoclopramide, by itself, very rarely causes serotonin syndrome and typically results in this condition when used in combination with other pro-serotonergic agents.
Highlights
Serotonin syndrome is a life-threatening condition resulting from serotonergic excess from therapeutic drug use, drug overdose or drug-drug interactions [1]
We present a case of a 28year-old woman who presented with acetaminophen toxicity, developed iatrogenic serotonin syndrome due to use of scheduled intravenous metoclopramide
Various drugs have been implicated in causation of serotonin syndrome such as selective serotonin reuptake inhibitors (SSRIs), tricyclic antidepressants, monoamine oxidase inhibitors (MAOIs), opiate analgesics, over the counter cough medicines, antibiotics, anti-emetics, anti-migraine agents, and herbal products [1]
Summary
Serotonin syndrome is a life-threatening condition resulting from serotonergic excess from therapeutic drug use, drug overdose or drug-drug interactions [1]. The common clinical presentation is altered mental status, restlessness, myoclonus, hyperreflexia, shivering, tremor, and diaphoresis [2] Diagnosing this entity can be difficult due to its dependence on taking a good medication history and physical examination findings alone, but has been made easier with the use of Hunter Serotonin Toxicity Criteria which have a high sensitivity and specificity [3]. Past medical history was significant for depression, anxiety, previous suicide attempts (with pill ingestions and wrist slitting), sexual abuse (rape), benzodiazepine addiction (underwent rehabilitation) and migraines Her home prescription medications included buspirone and paroxetine. The patient was diagnosed with high anion gap metabolic acidosis/lactic acidosis, acute kidney injury, elevated INR due to acetaminophen toxicity and was started on an intravenous N-acetylcysteine drip after initial volume resuscitation. The patient was seen in outpatient clinic two weeks later when her liver enzymes, creatinine, INR had normalized and the patient was back to her usual state of health
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
