A 30-year-old man takes sertraline and tramadol. He develops agitation, sweating, diarrhoea, tremor, hyperreflexia and clonus with a temperature of 39 degrees Celsius. What is the likely diagnosis and first action?
Answer and explanation
Correct answer: D. Serotonin syndrome, with the serotonergic drugs stopped and supportive care
- Step 1: Clonus and hyperreflexia with serotonergic drugs point to serotonin toxicity.
- Step 2: Treatment is to stop the offending drugs, give supportive care and benzodiazepines, with cyproheptadine in severe cases.
Answer
Serotonin syndrome, with the serotonergic drugs stopped and supportive care.
Why not the others: Panic disorder, treated with a short course of a benzodiazepine alone: Panic disorder does not explain clonus and hyperthermia. Neuroleptic malignant syndrome, treated by adding a dopamine agonist and cooling: NMS follows dopamine antagonists and has rigidity rather than clonus. Alcohol withdrawal, treated with a reducing course of chlordiazepoxide: Alcohol withdrawal does not fit the drug history.
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