Wednesday, December 9, 2020

criteria for serotonin syndrome

 Q: Which of the following is more reliable for Serotonin Syndrome? (select one)

A) Hunter Criteria

B) Sternbach Criteria

Answer: A

Hunter Criteria is easy to perform at the bedside and has a specificity of 97 percent. The sensitivity is 84 percent. It is reliable even in milder or subacute situations. Beside history of serotonergic agent ingestion, it requires only one of the following

  • Spontaneous clonus 
  • Inducible clonus PLUS agitation or diaphoresis 
  • Ocular clonus PLUS agitation or diaphoresis 
  •  Tremor PLUS hyperreflexia 
  •  Hypertonia PLUS temperature above 38ºC PLUS ocular clonus or inducible clonus

The Sternbach criteria is unspecific. Beside history of ingestion of serotonergic agent, it requires 3 out of the following 10 
  1.  agitation
  2. diaphoresis
  3. ataxia
  4. diarrhea
  5. mental status change
  6. hyperreflexia
  7. myoclonus
  8. tremor
  9. shivering
  10. hyperthermia



1. Dunkley EJ, Isbister GK, Sibbritt D, et al. The Hunter Serotonin Toxicity Criteria: simple and accurate diagnostic decision rules for serotonin toxicity. QJM 2003; 96:635.

2. Sternbach H. The serotonin syndrome. American Journal of Psychiatry. 1991;148:705-13.

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