Q: 44 years old female is admitted to ICU with symptoms consistent with Serotonin toxicity, i.e., agitation, restlessness, confusion, tachycardia, autonomic dysfunction, ocular clonus, and hyperthermia up to 41 C. Patient required intubation. Cooling measures started. Acetaminophen can be used as an adjuvant treatment to control hyperthermia?
A) True
B) False
Answer: B
Antipyretics have no role in treating hyperthermia due to serotonin syndrome because the rise in body temperature is due to an increase in muscular activity, not an alteration in the hypothalamic temperature set point. In extreme cases, like our patient in the above question, supportive treatment with intubation, sedation, and neuro-muscular blockade (NMB) should be initiated.
Cyproheptadine is recommended as an antidote. Cyproheptadine is a histamine-1 receptor antagonist with nonspecific 5-HT1A and 5-HT2A antagonistic properties and weak anticholinergic activity.
#toxicology
References:
1. Boyer EW, Shannon M. The serotonin syndrome. N Engl J Med 2005; 352:1112.
2. Graudins A, Stearman A, Chan B. Treatment of the serotonin syndrome with cyproheptadine. J Emerg Med 1998; 16:615.
3. Scotton WJ, Hill LJ, Williams AC, Barnes NM. Serotonin Syndrome: Pathophysiology, Clinical Features, Management, and Potential Future Directions. Int J Tryptophan Res. 2019 Sep 9;12:1178646919873925. doi: 10.1177/1178646919873925. PMID: 31523132; PMCID: PMC6734608.
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