IBCC chapter & cast: Serotonin syndrome

Serotonin syndromes comes up a lot in critical care medicine. Sometimes we are admitting patients because of a primary diagnosis of serotonin syndrome. Other times we are afraid of causing serotonin syndrome ourselves, due to polypharmacy. In both scenarios, there may be uncertainty regarding whether or not a patient has serotonin syndrome.

This chapter explores the causes, presentation, and treatment of serotonin syndrome. There are precisely zero human RCTs on the treatment of serotonin syndrome, so this leaves considerable room for debate. A treatment algorithm is proposed which I believe is reasonable (while fully acknowledging that there are numerous other potential strategies to treat this disease and no conclusive evidence regarding which is best).