Resumo
Definition
History and exam
Key diagnostic factors
- presença de fatores de risco
- clônus
- hiper-reflexia
Other diagnostic factors
- ansiedade
- agitação
- confusão
- tremores, espasmos musculares
- sudorese
- cefaleia
- taquicardia
- hipertonia/rigidez
- diaforese
- rubor
- pupilas dilatadas
- hipertermia
- mioclonia
- estimulação
Risk factors
- exposição a um medicamento serotoninérgico
- exposição a dois ou mais medicamentos serotoninérgicos
Diagnostic investigations
1st investigations to order
- diagnóstico clínico
Investigations to consider
- Hemograma completo
- creatina fosfoquinase
- eletrocardiograma (ECG)
- hemoculturas
- punção lombar
- tomografia computadorizada (TC) ou ressonância nuclear magnética (RNM) do crânio
Treatment algorithm
toxicidade serotoninérgica grave
toxicidade serotoninérgica moderada
toxicidade serotoninérgica leve
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
Laura Tormoehlen, MD, FAAN, FACMT
Neurologist and Medical Toxicologist
Associate Professor of Clinical Neurology and Emergency Medicine
Indiana University
Bloomington
IN
Disclosures
LT has been compensated as an expert witness for cases involving serotonergic drugs.
Daniel E Brooks, MD
Medical Director
Banner Poison and Drug Information Center
Phoenix
AZ
Disclosures
DEB declares that he has no competing interests.
Karl Marlowe, MbChB, MSc, PgC-Ed, PgD-CBT, MRCPsych
Consultant Psychiatrist
East London NHS Foundation Trust
London
UK
Declarações
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
Declarações
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
Declarações
PMG declares that he has no competing interests.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
Referências
Principais artigos
Buckley NA, Dawson AH, Isbister GK. Serotonin syndrome. BMJ. 2014;348:g1626 Resumo
Isbister GK, Buckley NA. The pathophysiology of serotonin toxicity in animals and humans: implications for diagnosis and treatment. Clin Neuropharmacol. 2005;28:205-214. Resumo
Dunkley EJ, Isbister GK, Sibbritt D, et al. The Hunter Serotonin Toxicity Criteria: simple and accurate diagnostic decision rules for serotonin toxicity. QJM. 2003;96:635-642.Texto completo Resumo
Chiew AL, Buckley NA. The serotonin toxidrome: shortfalls of current diagnostic criteria for related syndromes. Clin Toxicol (Phila). 2022 Feb;60(2):143-58. Resumo
Artigos de referência
Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.
Diagnósticos diferenciais
- Síndrome neuroléptica maligna (SNM)
- Toxicidade por simpatomiméticos
- Delirium anticolinérgico
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Síndrome serotoninérgica
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