Last reviewed: November 2017
Last updated: November  2017

Summary

Definition

History and exam

Key diagnostic factors

  • change in mental status
  • tachycardia
  • hypotension
  • mydriasis
  • warm, dry, flushed skin
  • change in mental status
  • decreased or absent bowel sounds
  • urinary retention
  • ophthalmic signs
  • neurological signs

Other diagnostic factors

  • features of serotonin syndrome

Risk factors

  • Hx depression
  • obsessive-compulsive disorder
  • chronic pain
  • attention deficit hyperactivity disorders

Diagnostic investigations

1st investigations to order

  • ECG
  • sodium bicarbonate therapeutic trial
  • ABG
Full details

Investigations to consider

  • serum TCA concentrations
  • serum acetaminophen concentrations
  • serum salicylate concentrations
  • urine drug screen
Full details

Treatment algorithm

Contributors

Authors VIEW ALL

Staff Specialist in Emergency Medicine

Emergency Department

The Prince Charles Hospital

Brisbane

Queensland

Australia

Disclosures

AN declares that he has no competing interests.

Dr Alastair Newton would like to gratefully acknowledge Dr Catherine Kelly and Dr Robert S. Hoffman, previous contributors to this monograph. CK and RSH declare that they have no competing interests.

Peer reviewers VIEW ALL

Lecturer Pediatrics

The Children's Hospital

Boston

MA

Disclosures

EB declares that he has no competing interests.

Consultant Physician and Clinical Toxicologist

National Poisons Information Service (Newcastle)

Newcastle-upon-Tyne

UK

Disclosures

RT declares that he has no competing interests.

Emeritus Professor of Clinical Pharmacology

University of Edinburgh and Western General Hospital

Edinburgh

UK

Disclosures

LP declares that he has no competing interests.

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