Gerardi Diana M, Murphy Tanya K, Toufexis Megan, Hanks Camille
From the Rothman Center for Pediatric Neuropsychiatry-USF Health, St Petersburg, FL.
Pediatr Emerg Care. 2015 Dec;31(12):846-50. doi: 10.1097/PEC.0000000000000515.
The aim of this study was to report an acute onset of symptoms erroneously attributed to serotonin syndrome in a child who had been given both anticholinergic and serotonergic agents.
A 9-year-old girl with chronic anxiety and gastrointestinal problems was prescribed oral sertraline 6.25 mg daily, as well as hyoscyamine, ondansetron, montelukast, and a course of nitazoxanide. She was also routinely given diphenhydramine and omeprazole. Three days after increasing sertraline to 12.5 mg, she presented to the emergency department with altered mental status, hallucinations, mydriasis, tachycardia, and pyrexia. She was admitted to the pediatric intensive care unit and subsequently treated unsuccessfully for serotonin syndrome, with blurred vision and clonus persisting at discharge 4 days after admittance. Upon follow-up with her outpatient clinic, all anticholinergic agents were discontinued, and symptoms slowly resolved.
This case illustrates the importance of differential diagnosis between toxidromes and how clinical presentation can be altered by preexisting conditions as well as the use of medications that affect multiple neurotransmitter systems.
本研究旨在报告一名同时服用抗胆碱能药物和5-羟色胺能药物的儿童出现被错误归因于血清素综合征的急性症状发作情况。
一名患有慢性焦虑和胃肠道问题的9岁女孩，每天服用6.25毫克口服舍曲林，同时服用莨菪碱、昂丹司琼、孟鲁司特以及一个疗程的硝唑尼特。她还常规服用苯海拉明和奥美拉唑。将舍曲林剂量增至12.5毫克三天后，她因精神状态改变、幻觉、瞳孔散大、心动过速和发热前往急诊科就诊。她被收入儿科重症监护病房，随后因血清素综合征接受治疗但未成功，入院4天后出院时仍有视力模糊和阵挛。在门诊随访时，停用了所有抗胆碱能药物，症状逐渐缓解。
本病例说明了中毒综合征鉴别诊断的重要性，以及既往疾病和使用影响多个神经递质系统的药物如何改变临床表现。
