Carolinas Core Concepts Core Concepts in EM; a repository for Carolinas lecture summaries.


Drug-Associated Neuromuscular Syndromes

Michael Beuhler, MD

  • Triptans used for migraines do not cause serotonin toxicity
  • Diagnosis of serotonin toxicity is made by the presence of a serotonergic agent along with spontaneous clonus; the presence of agitation, diaphorsis, tremor and hyperreflexia (lower > upper) may also indicate serotonin toxicity.
  • Thorazine can be used in the treatment of serotonin syndrome, however it is contraindicated in the treatement of neuroleptic malignant syndrome. Therefore, if you use thorazine make sure you are confident in the diagnosis
  • Ideas for cooling patients with hyperthermia:
    • Cool ice packs in groin and axilla
    • Cool blanket underneath the patient
    • Cold IV fluid
    • Mist
    • Fan
    • It is very important to monitor the patient’s temperature closely (temperature sensing foley for example), so you don’t over correct and make the patient hypothermic

MedGenMed. 2007; 9(3): 48. The FDA Alert on Serotonin Syndrome with Combined Use of SSRIs or SNRIs and Triptans: An Analysis of the 29 Case Reports. Evans RW.

Q J Med. 2003; 96:635-642. The Hunter Serotonin Toxicity Criteria: simple and accurate diagnostic decision rules for serotonin toxicity. Dunkley EJC et al.



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