Toxidromes - serotonin syndrome
Description
- Excess serotonergic activity at central and peripheral 5-HT2A (and 5-HT1A) receptors
- A predictable dose-related drug effect, not an idiosyncratic reaction - it is toxicity, not allergy
- Triad:
- Neuromuscular excitation - clonus (the discriminator), hyperreflexia, tremor, rigidity
- Autonomic instability - hyperthermia, tachycardia, diaphoresis, mydriasis, diarrhoea, hypertension
- Altered mental state - agitation, anxiety, confusion
- Lower-limb-predominant: clonus and hyperreflexia are greater in the legs than the arms - highly characteristic
- Spectrum from mild tremor/diarrhoea to life-threatening hyperthermia with rhabdomyolysis and DIC
- Onset is fast - usually <6 h, almost always <24 h of the precipitating change
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