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Serotonin syndrome — RCPSC EM MCQ

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HardPsychiatric emergenciesSerotonin syndromeRCPSC EM

A patient taking sertraline develops agitation, temperature 39.4 °C, hypertension, inducible clonus and hyperreflexia soon after starting linezolid. What is the most appropriate immediate management?

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Correct answer: C — Stop serotonergic drugs and provide supportive toxicology management

The best answer is “Stop serotonergic drugs and provide supportive toxicology management”. This is severe serotonin toxicity. Stop the precipitating serotonergic medicines, support airway and circulation, rehydrate, actively cool and treat agitation, with poison-centre or toxicology support and escalation for complications. Acetaminophen does not correct toxic hyperthermia, and dopamine agonists, antipsychotic-first therapy or dantrolene-only management target other syndromes or omit core treatment.

Reference: Emergency Care BC: Serotonin Toxicity: https://emergencycarebc.ca/sim_cases/serotonin-toxicity/