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Serotonin syndrome — RACP Adult Medicine MCQ

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HardClinical pharmacology and toxicologySerotonin syndromeRACP Adult Medicine

A patient taking sertraline develops agitation and diaphoresis six hours after tramadol is added. Temperature is 38.2°C, tone is normal, and examination shows inducible ankle clonus. Which finding combination satisfies the Hunter serotonin-toxicity criteria?

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Correct answer: A — Inducible clonus with agitation or diaphoresis

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

B is correct because inducible clonus plus agitation or diaphoresis fulfils the Hunter rule after serotonergic exposure. C contains autonomic features that are insufficient alone. D is more consistent with neuroleptic malignant syndrome. E is an anticholinergic pattern. A requires hyperreflexia when tremor is the qualifying neuromuscular feature. Tramadol and the serotonergic medicine should be stopped and severity-directed supportive care started.

Reference: Australian Prescriber, The hot patient: acute drug-induced hyperthermia: https://australianprescriber.tg.org.au/articles/the-hot-patient-acute-drug-induced-hyperthermia.html