Serotonin syndrome is a condition that occurs when there is too much serotonin in the body. Serotonin is a chemical that acts as a neurotransmitter, and it is found in the brain, gut, and blood vessels. When serotonin levels become too high, it can cause a range of symptoms, including agitation, delirium, hallucinations, fever, sweating, and muscle spasms. In severe cases, serotonin syndrome can lead to coma and even death.
Introduction
The condition is most often seen in people who are taking multiple medications that affect serotonin levels, such as antidepressants, painkillers, and migraine medications. It can also occur in people who have recently started taking a new medication or have increased their dosage of an existing medication. Treatment for serotonin syndrome typically involves discontinuing the offending medication and providing supportive care to manage the symptoms. In severe cases, hospitalization may be necessary.
Pathophysiology of serotonin syndrome
Serotonin, a neuroendocrine chemical exerts its effects by acting on both central and peripheral 5HT receptors. Overstimulation of the ubiquitous 5HT-1A and 5HT-2A results in neuropsychiatric and additional multiorgan symptoms.
Mnemonic of the clinical features of serotonin syndrome
The serotonin syndrome mnemonic can help you remember the signs and symptoms of this potentially fatal condition. The mnemonic is:
- S – Sweating and Shivering
- E – Excitement
- R – Rigidity
- O – Oculogyric crisis (spasmodic deviation of the eyeball into a fixed position)
- T – Tremor (Twitching), Tachypnea and Tachycardia
- O – Oral mucosal dryness
- N – Neuromuscular Excitability (Hyperreflexia and Clonus)
- I – Irregular heart rhythm (arrhythmias)
- N – Nausea and vomiting
Reference
Volpi-Abadie J, Kaye AM, Kaye AD. Serotonin syndrome. Ochsner J. 2013 Winter;13(4):533-40.
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