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Serotonin Syndrome

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  1. Etiology
    1. Excessive Serotonin levels
    2. Associated with combinations of Serotoninergic drugs
    3. Exacerbated by drugs that increase Serotonin levels
      1. MAO inhibitors
      2. Tramadol (Ultram)
      3. Sibutramine (Meridia)
      4. Meperidine (Demerol)
      5. Sumatriptan (Imitrex)
      6. Lithium
      7. St. John's Wort
      8. Ginkgo Biloba
      9. Some Antipsychotic medications
  2. Diagnosis
    1. Mental Status Changes
      1. Confusion or disorientation (51%)
      2. Agitation or irritability (34%)
      3. Coma or unresponsiveness (29%)
    2. Autonomic changes
      1. Fever or hyperthermia (45%)
      2. Diaphoresis (45%)
      3. Sinus Tachycardia (36%)
      4. Hypertension (35%)
      5. Mydriasis (28%) or unreactive pupils (20%)
      6. Tachypnea (26%)
      7. Nausea (23%)
    3. Neuromuscular changes
      1. Myoclonic jerks (58%)
      2. Hyperreflexia (52%)
      3. Muscle rigidity (51%)
      4. Restlessness or hyperactivity (48%)
      5. Tremor (43%)
      6. Ataxia or Incoordination (40%)
      7. Clonus (23%)
    4. Exclude other possible causes
      1. Infectious, metabolic, Substance Abuse or withdrawal
      2. No recent Neuroleptic changes
  3. Management
    1. Discontinue Serotoninergic medication
    2. Provide supportive care
    3. Treat muscle rigidity and hyperthermia
      1. First line: Benzodiazepines
      2. Refractory: Paralytic Agents
    4. Consider Serotonin antagonists
      1. Cyproheptadine 4 mg PO q2-4 hours up to 0.5 mg/kg/day
      2. Methysergide
      3. Propranolol
  4. Course
    1. Resolution after stopping Serotoninergic medication
      1. Within 24 hours in 70% of cases
      2. Within 96 hours in almost all cases
    2. High acuity care
      1. Intensive care admission in up to 40% of cases
      2. Mechanical Ventilation in up to 25% of cases
    3. Rarely fatal: 11 deaths in literature
  5. References
    1. Mills (1995) Am Fam Physician 52(5):1475
    2. Corkeron (1995) Med J Aust 163:481
    3. Brown (1996) Ann Pharmacother 30:529
    4. Bodner (1995) Neurology 45:219

Malignant Carcinoid Syndrome (C0024586)

Definition (MSH)A symptom complex associated with CARCINOID TUMOR and characterized by attacks of severe flushing of the skin, diarrheal watery stools, bronchoconstriction, sudden drops in blood pressure, edema, and ascites. The carcinoid tumors are usually located in the gastrointestinal tract and metastasize to the liver. Symptoms are caused by tumor secretion of serotonin, prostaglandins, and other biologically active substances. Cardiac manifestations constitute CARCINOID HEART DISEASE. (Dorland, 27th ed; Stedman, 25th ed)
ConceptsDisease or Syndrome (T047)
ICD9259.2, 259.2
MSHD008303
EnglishCarcinoid syndrome, Excessive serotonin secretion, Hormonal tumor, Hormonal tumour, Hormone secretion by carcinoid tumor, Hormone secretion by carcinoid tumors, Hormone secretion by carcinoid tumour, Malignant Carcinoid Syndrome, Malignant Carcinoid Syndromes, Serotonin syndrome
Spanishsecrecion de hormonas por el tumor carcinoide, sindrome carcinoide, sindrome de serotonina, sindrome serotoninergico, tumor hormonal
Parent ConceptsOther and unspecified endocrine disorders (C0154223), Carcinoid Tumor (C0007095), Ectopic hormone secretion syndromes associated with neoplasias (C0851689), Endocrine Gland Neoplasms (C0014132), Ambiguous concept (C1274012), Primary malignant neoplasm of trunk (C1304852), Duplicate concept (C1274013)
SourcesCOSTAR, CSP, DXP, ICD9CM, LCH, MSH, MTH, MTHICD9, NCI, NDFRT, QMR, SCTSPA, SNOMEDCT
Derived from the NIH UMLS (Unified Medical Language System)



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