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Serotonin toxicity — RCPSC EM MCQ

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ModerateToxicologySerotonin toxicityRCPSC EM

A 32-year-old woman presents with palpitations, tremor and sweating after taking a friend's tablet at a party. Temperature is 39.4°C, heart rate is 154/min and blood pressure is 176/96 mmHg. She has inducible clonus, hyperreflexia and diarrhoea. What is the most appropriate initial management?

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Correct answer: A — Give benzodiazepines, active cooling and stop serotonergic agents while escalating supportive care

Serotonin toxicity is suggested by hyperthermia, autonomic instability, diarrhoea, clonus and hyperreflexia. Treatment is stopping serotonergic drugs, benzodiazepines, cooling and supportive care; cyproheptadine may be considered.

Reference: Canadian poison centre guidance; Goldfrank's Toxicologic Emergencies