P-MD006. Serotonin syndrome - case series

Abstract

Introduction. Serotonin syndrome (SS) is a life threatening condition caused by serotonin toxicity, and usually involves a combination of drugs that increase serotonergic transmission. Methods. All patients admitted with a clinical diagnosis of serotonin syndrome in KIMS hospital between april 2019 and September 2019 were studied. A total of 3 patients were diagnosed with Serotonin syndrome over a period of 6 months. Results. Case 1: 58-year-old male patient, diabetic and hypertensive, on Amantadine and Rasagiline for complaints of tremors, slowness of gait and activities since 3 months. Escitalopram and clonazepam with amitriptyline was advised by the treating doctor. Olanzapine was given for psychosis. Patient’s tremors increased further. CPK was 839 U/L. Considering possibility of Serotonin syndrome, patient was treated with cyproheptadine and clonazepam. Patient improved symptomatically and was discharged. Case 2: 70-year-old male patient presented with complaint of involuntary movements of both upper limbs of 5 days duration. Patient was on multiple antipsychotic drugs for psychiatric disorder. On examination, patient had rigidity of both upper limbs with rest and postural tremor both upper limbs with restless behaviour, agitation, decreased sleep and hallucinations. On evaluation CPK was 2413 U/L. Considering possibility of serotonin syndrome, all offending medications were stopped and patient was treated with cyproheptadine, clonazepam, and levodopa. Case 3: 69- year-old male patient with psychiatric disorder on multiple antipsychotics presented with complaint of tremors all over body, irrelevant talk, and auditory hallucinations since 2 days. He had history of right thalamic infarct in 2015. Considering possibility of serotonin sundrome, antipsychotics were stopped and treated with cyproheptadine, clonazepam and levodopa. Conclusion. The incidence of serotonin syndrome is rising, reflecting the growing number of serotonergic drugs available and the increased use of these agents in clinical practice.