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Serotonin syndrome — SCE Acute Medicine MCQ

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HardToxicology and OverdoseSerotonin syndromeSCE Acute Medicine

A 42-year-old man taking sertraline receives linezolid for resistant pneumonia. Twelve hours later he is agitated and diaphoretic, temperature 39.1°C, pulse 128/min, with inducible clonus, hyperreflexia and diarrhoea. Which initial management package is best?

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Reveal the answer and explanation

Correct answer: E — Withdraw linezolid and sertraline; give benzodiazepines and supportive care

Explanation lettering: E = shown as A · D = shown as B · B = shown as D · A = shown as E

A is correct. The exposure, rapid onset, autonomic disturbance and clonus indicate serotonin syndrome. Stop linezolid and other serotonergic agents, provide ABC support, intravenous fluid, oxygen and active cooling, and control agitation and muscle activity with benzodiazepines; discuss severe disease and possible cyproheptadine with toxicology. Dantrolene is used for malignant hyperthermia and bromocriptine for neuroleptic malignant syndrome. Propranolol can cause hypotension and does not reverse toxicity, while continuing either causal medicine prolongs serotonergic excess.

Reference: https://cpd.mhra.gov.uk/ssri/CON146583_21/