Little Kimberly, Lin Christine M, Reynolds Paul M
Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO, USA.
Department of Medicine, Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado, Aurora, CO, USA.
Am J Case Rep. 2018 May 25;19:604-607. doi: 10.12659/AJCR.909063.
BACKGROUND Serotonin syndrome is a condition characterized predominantly by neuromuscular symptoms and altered thermoregulation in response to serotonergic overtone. Treatment is focused on withdrawal of serotonergic agents, which leads to resolution in the majority of cases. In the setting of serotonergic overdose, the onset of serotonin syndrome is usually within 4 to 13 h. Here, we report a case of delayed-onset serotonin syndrome in a patient who ingested a mixture of longer-acting serotonin agonists with serotonin antagonists. CASE REPORT A 24-year-old male was transferred to our medical intensive care unit with hypotension and altered mental status after an overdose of fluoxetine, cyproheptadine, trazodone, olanzapine, risperidone, and bupropion. After approximately 72 h, the patient developed symptoms of fever, lower leg clonus, hyperreflexia, and agitation. He was diagnosed with delayed-onset serotonin syndrome, which responded well to re-administration of cyproheptadine, leading to resolution of symptoms by day 5 of his stay. CONCLUSIONS In this present case, our patient presented with the longest reported delay in the onset of serotonin syndrome after intentional ingestion. This was likely secondary to co-ingestion of long-acting serotonin agonists with protective shorter-acting serotonin antagonists (cyproheptadine and olanzapine). Clinicians should consider delayed-onset serotonin syndrome when patients ingest longer-acting serotonergic agents with serotonin antagonists.
血清素综合征是一种主要以神经肌肉症状和体温调节改变为特征的病症，其由血清素过量引起。治疗重点在于停用血清素能药物，大多数情况下症状会随之缓解。在血清素过量的情况下，血清素综合征通常在4至13小时内发作。在此，我们报告一例延迟发作的血清素综合征病例，该患者摄入了长效血清素激动剂与血清素拮抗剂的混合物。病例报告：一名24岁男性在过量服用氟西汀、赛庚啶、曲唑酮、奥氮平、利培酮和安非他酮后，因低血压和精神状态改变被转入我们的医学重症监护病房。大约72小时后，患者出现发热、小腿阵挛、反射亢进和烦躁不安等症状。他被诊断为延迟发作的血清素综合征，再次给予赛庚啶治疗后反应良好，住院第5天时症状得以缓解。结论：在本病例中，我们的患者出现了故意摄入药物后血清素综合征发作延迟时间最长的情况。这可能是由于同时摄入了长效血清素激动剂和具有保护作用的短效血清素拮抗剂（赛庚啶和奥氮平）所致。临床医生在患者摄入长效血清素能药物与血清素拮抗剂时，应考虑延迟发作的血清素综合征。
