Serotonin Syndrome due to Sertralin Overdose

Yıl 2017, , 234 - 239, 18.12.2017

Gülçin Aydın , İşın Gençay , Selim Çolak , Muharrem Atasever

https://doi.org/10.24938/kutfd.339173

Öz

Serotonin
syndrome results from serotonergic drug therapy and characterized by
neoromuscular irritability resulting from extreme serotonergic activity and
autonomic instability. Herein, we aimed to present a 23 year-old female
patient, who took 56 tablets of sertralin (2800mg) for suicidal attempt. The
patient was admitted to the emergency service in two hours.  Patient was hospitalized in ICU after gastric
lavage was accomplished in the emergency service. The patient was diagnosed as
serotonin syndrome after tachycardia, tachypnea, tonic-clonic contractions of
the extremities, agitation, hallucination, hyperthermia and generalized
convulsions were observed. In fact, after gastric lavage with activated charcoal
to prevent absorption and intravenous hydration for elimination of the drug, as
well as cyproheptadine treatment to reverse the serotonergic activity, external
cooling for hyperthermia treatment and midazolam infusion for convulsions, the
patient was able to get out of this clinical condition. To conclude, early
recognition of drug overdose, mental and neurological conditions as well as
early initiation of antagonistic therapy and other supportive medications
enabled us to achieve a successful treatment.

Anahtar Kelimeler

Serotonin syndrome, autonomic instability, pharmacalogical antagonism

YÜKSEK DOZ SERTRALİN ALIMINA BAĞLI GELİŞEN SEROTONİN SENDROMU

Öz

Serotonin
sendromu serotonerjik ilaçların kullanılması sırasında ortaya
çıkan ve aşırı serotonerjik aktivite
sonucu nöromüsküler irritabilite ve otonomik instabiliteyle karakterize olan
bir sendromdur. Yirmi
üç yaşındaki kadın hasta toplamda 2800 mg sertralin içeren 56 tablet ilacı
intihar amaçlı aldıktan 2 saat sonra acil servise başvurdu. Midesinin
yıkanmasını takiben yoğun bakım ünitesine alınan hastada ilaç alımından sonra ortaya çıkan taşikardi,
takipne ve ekstremitelerde tonik-klonik kasılmalar, ajitasyon, halüsinasyon,
hipertermi ve generalize konvülsiyonlar, hastada serotonin sendromu tablosunun
geliştiğini düşündürdü. Nitekim hastanın midesinin yıkanmasını takiben aktif
kömür verilerek ilacın emiliminin durdurulması yanı sıra intravenöz hidrasyonla
eliminasyonunun hızlandırılması, oral siproheptadinle serotonerjik ajanın etkilerinin geri döndürülmesi, hipertermiye yönelik eksternal soğutma ve konvülziyonlara yönelik midazolam intravenöz infüzyon uygulanması
sayesinde hastanın bu tablodan çıkarılması mümkün oldu. Sonuç olarak
serotonerjik ilaç kullanım öyküsünün saptanması, mental, otonomik ve nörolojik
bulguların erken fark edilip farmakolojik antagonizmanın ve diğer destekleyici
medikal tedavilerin erken dönemde uygulanması sayesinde hastanın tedavisi
başarılı bir şekilde gerçekleştirilebildi.

Anahtar Kelimeler

otonomik instabilite, Serotonin sendromu, farmakolojik antagonizma

Kaynakça

• 1. Jones D, Story DA. Serotonin syndrome and the anaesthetist. Anaesth Intensive Care. 2005 Apr;33(2):181-7.
• 2. Gaffney RR , Schreibman IR. Serotonin Syndrome in a Patient on Trazodone and Duloxetine Who Received Fentanyl following a Percutaneous Liver Biopsy. Gastroenterol. 2015 May 6;9(2):132-6. doi: 10.1159/000382069.
• 3. Boyer E, Shannon M: The serotonin syndrome. N Engl J Med 2005;352:1112–1120.
• 4. G. K. Isbister, S. J. Bowe, A. Dawson, and I. M. Whyte, “Relative toxicity of selective serotonin reuptake inhibitors (SSRIs) in overdose,” Journal of Toxicology—Clinical Toxicology, vol. 42, no. 3, pp. 277–285, 2004.
• 5. D. Bijl, “The serotonin syndrome,” The Netherlands Journal of Medicine, vol. 62, no. 9, pp. 309–313, 2004.
• 6. Grenha J, Garrido A, Brito H, Oliveira MJ, Santos F. Serotonin syndrome after sertraline overdose in a child: Pediatr. 2013;2013:897902. doi: 10.1155/2013/897902. Epub 2013 Dec 19.
• 7.C. Frank, “Recognition and treatment of serotonin syndrome,” Canadian Family Physician, vol. 54, no. 7, pp. 988–992, 2008.
• 8. Park SH1, Wackernah RC, Stimmel GL. Serotonin syndrome: is it a reason to avoid the use of tramadol with antidepressants? J Pharm Pract. 2014 Feb;27(1):71-8. doi: 10.1177/0897190013504957. Epub 2013 Oct 23.
• 9. Ables AZ, Nagubilli R. Prevention, recognition, and management of serotonin syndrome. Am Fam Physician. 2010 May 1;81(9):1139-42.
• 10. Sternbach H. The serotonin syndrome. Am J Psychiatry 1991;148:705-13.
• 11. Radomski JW, Dursun SM, Reveley MA, Kutcher SP. An exploratory approach to the serotonin syndrome: an update of clinical phenomenology and revised diagnositic criteria. Med Hypotheses 2000:55:218-24.