Abstract
Serotonin syndrome is a potentially life-threatening drug effect. It may be misdiagnosed because it has mostly been reported in adults. Case Report. An 8-year-old girl with behavioral problems and medicated with risperidone and sertraline was admitted in the emergency department after she had taken voluntarily 1500 mg of sertraline (50 mg/kg). At admission, she had marked agitation, visual hallucinations, diaphoresis, flushing, and tremor. She had fever and periods of hypertension. She also showed generalized rigidity and involuntary movements. She was treated with fluids and iv diazepam, midazolam, clemastine, and biperiden. As the patient presented a severe insomnia and a progressive rhabdomyolysis, she was transferred to pediatric intensive care unit (ICU), where she was under treatment with cyproheptadine, mechanical ventilation, and muscular paralysis for 11 days. She was discharged from hospital a few days later with no neurological sequelae. Conclusions. Serotonin syndrome is still not well recognized by physicians. In our patient, the diagnosis was made early due to the history of overdose with serotonin reuptake inhibitors and the triad of mental, neurological, and autonomic signs. Parents must be educated to prevent children from having free access to drugs, avoiding self-medication or overdose.
Highlights
In the past years, the use of psychiatric drugs like serotonin reuptake inhibitors (SSRIs) has increased among children and adolescents [1]
The authors report the case of Serotonin syndrome (SS) in an 8-year-old child resulting in pediatric intensive care unit (ICU) admission following an overdose of selective serotonin reuptake inhibitors (SSRIs)
The receptors located in the periphery are involved in the regulation of gastrointestinal mobility and vascular tone [2]
Summary
The use of psychiatric drugs like serotonin reuptake inhibitors (SSRIs) has increased among children and adolescents [1]. Serotonin syndrome (SS) is a potentially lifethreatening drug effect from the use of SSRIs as well as other drugs like monoamine oxidase inhibitors (MAOIs), tricycle antidepressants, over-the-counter cough medicines, antibiotics, antiemetics, drugs of abuse, and herbal products [2]. It is often described as a clinical triad of mental-status changes, neuromuscular abnormalities, and autonomic dysfunction, these symptoms may not be all present in the same patient and at the same time [2–4]. The incidence of this condition in children has increased and it is important to recognize the clinical manifestations [2]. The authors report the case of SS in an 8-year-old child resulting in pediatric intensive care unit (ICU) admission following an overdose of SSRIs
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