Last reviewed: 23 Apr 2022
Last updated: 31 Dec 2019
Summary
Definition
History and exam
Key diagnostic factors
- exposure to a serotonergic drug
- clonus
- hyperreflexia
More key diagnostic factors
Other diagnostic factors
- anxiety
- agitation
- confusion
- tremor, shivering, muscle jerking
- sweating
- headache
- tachycardia
- hypertonia/rigidity
- diaphoresis
- flushing
- dilated pupils
- hyperthermia
- myoclonus
- startling
Other diagnostic factors
Risk factors
- exposure to a serotonergic drug
- genetic predisposition
More risk factors
Diagnostic investigations
1st investigations to order
- clinical diagnosis
More 1st investigations to order
Investigations to consider
- CBC
- creatine phosphokinase
- urine toxicology screen
- ECG
More investigations to consider
Treatment algorithm
ACUTE
severe serotonin toxicity
moderate serotonin toxicity
mild serotonin toxicity
Contributors
Authors
Geoffrey Isbister, BSc, MBBS, FACEM, MD
Clinical Toxicologist
Calvary Mater Newcastle
Associate Professor
University of Newcastle
Newcastle
Australia
Disclosures
GI is an author of several references cited in this monograph.
Peer reviewers
Karl Marlowe, MbChB, MSc, PgC-Ed, PgD-CBT, MRCPsych
Consultant Psychiatrist
East London NHS Foundation Trust
London
UK
Disclosures
KM declares that he has no competing interests.
Theodore A. Stern, MD
Chief
Psychiatric Consultation Service
Massachusetts General Hospital
Professor of Psychiatry
Harvard Medical School
Boston
MA
Disclosures
TAS declares that he has no competing interests.
Paul M. Gahlinger, MD
Adjunct Professor
Department of Family and Preventive Medicine
University of Utah
Salt Lake City
UT
Disclosures
PMG declares that he has no competing interests.
Differentials
- Neuroleptic malignant syndrome (NMS)
- Sympathomimetic toxicity
- Anticholinergic delirium
More DifferentialsPatient leaflets
Meningitis and septicemia
More Patient leafletsLog in or subscribe to access all of BMJ Best Practice
Use of this content is subject to our disclaimer