Sunday, April 1, 2018

Hunter's Algorithm - Serotonin Toxicity

Q: All of the following are parts of Serotonin Syndrome (SS) except?

A) Hyperthermia 

B) Ocular clonus
C) Deep tendon hyperreflexia 
D) Inducible muscle clonus 
E) Neuromuscular findings more pronounced in the upper extremities

Answer: E

SS is a clinical diagnosis. A wide range of clinical signs can be seen in SS including fluctuations in vital signs, hyperthermia, agitation, ocular clonus, muscle rigidity,  mydriasis, tremors, deep tendon hyperreflexia, inducible or spontaneous muscle clonus, dry mucous membranes, and diaphoresis. Neuromuscular findings are usually more pronounced in the lower extremities including bilateral Babinski signs.

Related: Hunter's Decision Rules (algorithm) for Diagnosis of Serotonin Toxicity at


Boyer EW, Shannon M. The serotonin syndrome. N Engl J Med 2005; 352:1112.

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