severe hyperthermia in SS

 Q: In severe hyperthermia associated with serotonin syndrome which is more effective? (select one) 

A) acetaminophen 

B) neuromuscular blockades 

 Answer: B

Antipyretic agents have no role in hyperthermia associated with serotonin syndrome as this hyperthermia is not hypothalamic regulated. The major reason for hyperthermia in serotonin syndrome is an increase in muscular activity.

This is one of the reasons that in extremely severe hyperthermia (read: only in extremely severe hyperthermia like above 41-degrees centigrade) intubation is preferred so a patient can be sedated well and muscle rigidity can be controlled with a long-acting nondepolarizing neuromuscular blocking agent such as vecuronium. 

Control of hyperthermia and muscle rigidity may prevent all further domino effects like seizures, coma, DIC, V. Tach, and metabolic acidosis.

#neurology

References:

1. Mills KC. Serotonin syndrome. A clinical update. Crit Care Clin 1997; 13:763. 

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