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Serotonin syndrome — SCE Acute Medicine MCQ

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HardClinical pharmacology and poisoningSerotonin syndromeSCE Acute Medicine

A patient taking sertraline receives linezolid and develops agitation, inducible clonus, hyperreflexia, diarrhoea and a temperature of 41.2°C. Benzodiazepines and external cooling have not controlled rigidity or temperature. Which escalation most directly addresses the lethal heat-generating mechanism?

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Reveal the answer and explanation

Correct answer: B — Intubation with non-depolarising neuromuscular paralysis plus continued active cooling

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

C is correct. Severe serotonin toxicity generates heat through extreme skeletal-muscle activity, so refractory hyperthermia requires deep sedation, non-depolarising paralysis, ventilation and aggressive cooling. Antipyretics do not correct this non-pyrogenic mechanism. Dantrolene is not mandatory first-line therapy and cannot substitute for stopping serotonergic drugs and supportive control. Haloperidol can impair heat loss; bromocriptine targets the different pathophysiology of neuroleptic malignant syndrome.

Reference: Management of serotonin toxicity: https://pmc.ncbi.nlm.nih.gov/articles/PMC11862804/