Lopez Braden M, Shin Won, Lopez Mark D
Medical Education, Creighton University School of Medicine, Phoenix, USA.
Emergency Medicine, Yavapai Regional Medical Center, Dignity Health, Prescott, USA.
Cureus. 2025 Feb 19;17(2):e79314. doi: 10.7759/cureus.79314. eCollection 2025 Feb.
Serotonin syndrome (SS) is a life-threatening condition caused by excessive serotonin, typically due to drugs such as selective serotonin reuptake inhibitors (SSRIs), monoamine oxidase inhibitors (MAOIs), and certain opioids. It often results from combining two serotonin-affecting drugs or excessive use of one. SS is diagnosed clinically, presenting with neuromuscular hyperactivity, autonomic instability, and altered mental status, with clonus as a key distinguishing feature. The Hunter Criteria aids diagnosis but should not be used to rule out SS. Treatment starts with discontinuing the offending agent, followed by supportive care, including airway management and stabilization of vital signs. Benzodiazepines can help control seizures and agitation, while cyproheptadine may be used in moderate to severe cases. Benzodiazepines have many side effects and cyproheptadine is only available in oral formulations, which adds complexity to effective treatment. In rare instances, SS can be refractory and may require intubation and neuromuscular paralytics. In this case, we present a case of a 42-year-old female who developed confusion, tachycardia, muscle rigidity, and hypertension after outpatient ankle surgery, where she received midazolam, fentanyl, propofol, toradol, ondansetron, meperidine, and dexamethasone perioperatively. Her daily medication also included fluoxetine, dextroamphetamine-amphetamine, and trazodone. The patient required intubation for continued diazepam administration and was admitted to the ICU. Despite improving vital signs, she remained altered with diffuse muscle rigidity. After three days of refractory SS, dexmedetomidine, an alpha-2 antagonist, was administered. The patient showed clinical improvement over the next four days and was stable enough for extubation and discontinuation of dexmedetomidine. The patient made significant clinical progress and was discharged to follow up with her primary care provider. This case highlights the importance of early detection through clinical context and not relying solely on the Hunter criteria and the potential use of dexmedetomidine as an adjuvant to benzodiazepine therapy.
血清素综合征（SS）是一种由血清素过量引起的危及生命的病症，通常是由选择性血清素再摄取抑制剂（SSRI）、单胺氧化酶抑制剂（MAOI）和某些阿片类药物等药物所致。它常因联用两种影响血清素的药物或过量使用一种药物而引发。血清素综合征通过临床诊断，表现为神经肌肉活动亢进、自主神经功能不稳定以及精神状态改变，其中阵挛是关键的鉴别特征。亨特标准有助于诊断，但不应被用于排除血清素综合征。治疗首先要停用致病药物，随后进行支持性护理，包括气道管理和生命体征稳定。苯二氮䓬类药物可帮助控制癫痫发作和躁动，而赛庚啶可用于中重度病例。苯二氮䓬类药物有许多副作用，且赛庚啶仅有口服剂型，这给有效治疗增添了复杂性。在罕见情况下，血清素综合征可能难以治疗，可能需要插管和使用神经肌肉阻滞剂。在此，我们报告一例42岁女性病例，该患者在门诊踝关节手术后出现意识模糊、心动过速、肌肉强直和高血压，术中接受了咪达唑仑、芬太尼、丙泊酚、托拉朵尔、昂丹司琼、哌替啶和地塞米松。她的日常用药还包括氟西汀、右旋苯丙胺 - 苯丙胺和曲唑酮。患者因持续使用地西泮而需要插管，并被收入重症监护病房。尽管生命体征有所改善，但她仍意识改变且伴有全身肌肉强直。在难治性血清素综合征持续三天后，给予α-2拮抗剂右美托咪定。患者在接下来的四天里临床症状改善，稳定到足以拔管并停用右美托咪定。患者取得了显著的临床进展，并出院以便由其初级保健提供者进行随访。该病例强调了通过临床背景进行早期检测的重要性，并不能仅依赖亨特标准，以及右美托咪定作为苯二氮䓬类药物治疗辅助药物的潜在用途。
