Serotonin syn by dr subrat kumar patra

serotonin syndrome ppt

1. BY- Subrat kumar Patra IMS &SUM Hospital

2. INTRODUCTION • Potentially life threatening adverse drug reaction. • It may result from therapeutic drug use, intentional self-poisoning or inadvertent interactions between drugs • It is a predictable consequence of excess serotonergic agonism of central nervous system (CNS) receptors and peripheral serotonergic Receptors.

3. PATHOPHYSIOLOGY: • It is a predictable consequence of excess serotonergic agonism of central nervous system (CNS) receptors and peripheral serotonergic receptors • Many cases of serotonin toxicity occur in patients who have ingested drug combinations that synergistically increase synaptic serotonin • It may also occur as a symptom of overdose of a single serotonergic agent • Addition of drug that inhibit cytochrome P450 , when added to the therapeutic regimen of serotonergic drugs may precipitate serotonin syndrome

4. CLINICAL FEATURES: • The serotonin syndrome is often described as a clinical triad: 1. Mental-status changes 2. Autonomic hyperactivity 3. Neuromuscular abnormalities • The triad is not consistently present in all the patients with the disorder • Signs of excess serotonin range from tremor and diarrhoea in mild cases to delirium, neuromuscular rigidity and hyperthermia in life-threatening cases.

5. CLINICAL FEATURES: • The onset of symptoms is usually rapid, with clinical findings often occurring within minutes after a change in medication or self-poisoning. • Approximately 60 percent of patients with the serotonin syndrome present within six hours after initial use of medication, an overdose, or a change in dosing. • The serotonin syndrome is not believed to resolve spontaneously as long as precipitating agents continue to be administered.

6. MILD PRESENTATION • Patients with mild cases may be afebrile . Physical Examination Tachycardia Shivering Diaphoresis Mydriasis Neurologic Examination Tremor Myoclonus Hyperreflexia

7. MODERATE PRESENTATION • Abnormal vital signs – Tachycardia – Hypertension – Hyperthermia with core temp of 40 C • Physical Exam – Mydriasis , diaphoresis Hyperreflexia and clonus , greater in lower extremities.

8. SEVERE PRESENTATION Physical changes – Hypertension – Tachycardia that may deteriorate into shock – Agitated delirium,seizures – Muscular rigidity and hypertonicity , greater in lower extremities ;may mask clonus – Muscle hyperactivity with core temp greater than 41.1 C in life-threatening cases.

9. Differential Diagnosis • Anticholinergic poisoning • Malignant hyperthermia • Neuroleptic malignant syndrome

10. MANAGEMENT • Removal of the precipitating drug • Administration of 5-HT2a antagonists • Supportive care: correction of vital signs administration of intravenous fluids the control of autonomic instability the control of hyperthermia • Many cases of the serotonin syndrome typically resolve within 24 hours after the initiation of therapy and the discontinuation of serotonergic drugs, but symptoms may persist in patients.

11. 5HT2A Antagonists • Cyproheptadine is the recommended therapy for the serotonin syndrome • Treatment of the serotonin syndrome in adults may require 12 to 32 mg of the drug during a 24-hour period, a dose that binds 85 to 95 percent of serotonin receptors. • An initial dose of 12 mg of cyproheptadine and then 2 mg every two hours if symptoms continue. Maintenance dosing involves the administration of 8 mg of cyproheptadine every six hours.

12. Mild presentation Moderate Presentation Severe Presentation Supportive care Removal of Precipitating Drugs Treatment with benzodiazepines •Aggressive correction of cardiorespiratory and thermal abnormalities • Administration of 5-HT 2a antagonists Immediate Sedation Pharmacologic paralysis Mechanical Intubation

13. THANK YOU

14. REFERENCES Volpi-Abadie , J., Kaye, A. M., & Kaye, A. D. (2013). Serotonin Syndrome. The Ochsner Journal, 13(4), 533–540. Frank, C. (2008). Recognition and treatment of serotonin syndrome. Canadian Family Physician, 54(7), 988–992. http://www.mayoclinic.org/diseases-conditions/serotoninsyndrome/ diagnosis-treatment/treatment/txc-20305697 Boyer, E., Shannon, M. (2005) The Serotonin Syndrome. New England Journal of Medicine. 352, 1112-1120. Prevention, Diagnosis, and Management of Serotonin Syndrome http://www.aafp.org/afp/2010/0501/p1139.html Bijl D. The serotonin syndrome. Nether J Med.2004;62:309-313. Dr. Santhosh Kumar https://www.slideshare.net/SanthoshKumar291/serotonin-syndrome- 75848602/2 Opioid Receptors: Distinct Roles in Mood Disorders https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3594542/