Department of Psychiatry and Behavioral Sciences, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York, USA.
J Child Adolesc Psychopharmacol. 2021 Aug;31(6):394-403. doi: 10.1089/cap.2020.0176. Epub 2021 Apr 27.
Serotonin toxicity is a state of central nervous system (CNS) excitation classically featuring altered mental status, neuromuscular excitation, and autonomic instability. While retrospective studies and reviews have characterized serotonin toxicity in adults, there have been no systematic reviews of serotonin toxicity in pediatric populations. The goal of this review was to use published case reports to describe serotonin toxicity in pediatric patients and to consider the impact of age on clinical presentation. A search for case reports of serotonin toxicity in patients younger than 18 years was conducted. Cases were systematically screened for inclusion using serotonin toxicity diagnostic tools, and a meta-analysis of case characteristics was conducted. Sixty-six cases of serotonin toxicity in pediatric patients were reviewed. Only 56.1% met diagnostic criteria for serotonin toxicity on all three of the most commonly used diagnostic tools. Antidepressants were found to be the most common trigger of toxicity, implicated in 78.8% of cases. While onset of toxicity was rapid following overdose, toxicity was more likely to be delayed in the setting of medication titration (71.8% vs. 0%, < 0.0001). Signs of neuromuscular excitation were prevalent, occurring in 92.4% of cases with 81.8% showing the full triad of neuromuscular symptoms, altered mental status, and autonomic instability. The only age-related differences occurred in relation to activation symptoms (more likely to be reported in children than in adolescents) and seizures (less likely to be reported in children than in adolescents or toddlers). Treatment was primarily supportive in nature, although 25.8% of patients received cyproheptadine. In all but one reviewed case, the patient survived. The presentation of serotonin toxicity in the pediatric population is similar to that seen in adults. Treatment is supportive with most patients achieving full recovery. Further exploration of the age-related differences in serotonin activity within the CNS is needed.
血清素毒性是一种中枢神经系统（CNS）兴奋状态，其特征为精神状态改变、神经肌肉兴奋和自主神经不稳定。虽然回顾性研究和综述已经描述了成人的血清素毒性，但尚未有关于儿科人群中血清素毒性的系统评价。本综述的目的是使用已发表的病例报告来描述儿科患者的血清素毒性，并考虑年龄对临床表现的影响。我们对年龄小于 18 岁的患者的血清素毒性病例报告进行了搜索。使用血清素毒性诊断工具系统地筛选纳入病例，并对病例特征进行了荟萃分析。共回顾了 66 例儿科患者的血清素毒性病例。只有 56.1%的病例在最常用的三种诊断工具上均符合血清素毒性的诊断标准。发现抗抑郁药是毒性最常见的触发因素，占 78.8%的病例。虽然在过量用药后毒性迅速发生，但在药物滴定过程中更有可能延迟毒性（71.8%比 0%，<0.0001）。神经肌肉兴奋的迹象很常见，92.4%的病例出现，81.8%的病例出现完整的三联征，即神经肌肉症状、精神状态改变和自主神经不稳定。唯一与年龄相关的差异与激活症状有关（儿童比青少年更有可能报告）和癫痫发作（儿童比青少年或幼儿更不可能报告）。治疗主要是支持性的，尽管 25.8%的患者接受了赛庚啶。在所有回顾的病例中，除 1 例外，患者均存活。儿科人群中血清素毒性的表现与成人相似。治疗是支持性的，大多数患者完全康复。需要进一步探索中枢神经系统中与年龄相关的血清素活性差异。
