Rubin Ashley N, Espiridion Eduardo D, Kattan Mohamad, Desmarais Elizabeth C
Family Medicine, West Virginia School of Osteopathic Medicine, Lewisburg, USA.
Psychiatry, Frederick Memorial Hospital, Clear Spring, USA.
Cureus. 2018 Nov 19;10(11):e3616. doi: 10.7759/cureus.3616.
The incidence of serotonin syndrome in the United States is rising yearly. Providers should be aware of the useful diagnostic criteria and have a low threshold for utilizing such criteria to prevent increased morbidity and mortality. In this case, a 64-year-old female with a complex past medical history presented to the emergency department with an altered mental status after being found poorly responsive by her husband. Many of her symptoms aligned with the commonly used criteria for serotonin syndrome; yet, her complex past medical history and uncommonly elevated sodium levels veered her providers from arriving at this diagnosis earlier. This unique case illustrates that despite having specific criteria for diagnosis, serotonin syndrome can be a complicated diagnosis to make, particularly in the setting of multiple co-morbidities and polypharmacy. In addition, it is important to keep medication toxicities high on a differential diagnosis list and be aware of the criteria used for diagnosis. One of the easiest and most cost-effective methods to diagnosis is to start with a thorough history, physical exam, and medication reconciliation to address easily preventable medication adverse effects.
在美国，血清素综合征的发病率逐年上升。医疗服务提供者应了解有用的诊断标准，并对使用这些标准保持较低门槛，以防止发病率和死亡率上升。在这个病例中，一名有复杂既往病史的64岁女性被丈夫发现反应迟钝后，被送往急诊科，其精神状态改变。她的许多症状与血清素综合征常用标准相符；然而，她复杂的既往病史和异常升高的钠水平使她的医疗服务提供者未能更早做出这一诊断。这个独特的病例表明，尽管有特定的诊断标准，但血清素综合征可能是一个复杂的诊断，尤其是在存在多种合并症和多种药物治疗的情况下。此外，在鉴别诊断清单上要高度重视药物毒性，并了解用于诊断的标准。最简单且最具成本效益的诊断方法之一是从全面的病史、体格检查和药物核对开始，以解决易于预防的药物不良反应。
