Overview
Diagnosis
No single test can definitively diagnose serotonin syndrome. Doctors typically make a diagnosis by ruling out other possible conditions.
The diagnostic process usually begins with:
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Asking about your symptoms, medical history, and medications you are taking
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Conducting a physical examination
Additional tests may be used to confirm that symptoms are caused by serotonin syndrome rather than another condition. These may include:
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Measuring levels of medications in your system
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Checking for signs of infection
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Assessing body functions that could be affected by serotonin syndrome
Conditions that may mimic serotonin syndrome include:
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Serious reactions to certain medications, such as anesthetics, antipsychotic drugs, or other agents known to cause severe reactions
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Overdose of illicit drugs, antidepressants, or other medications that increase serotonin levels
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Damage related to illicit drug use
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Severe alcohol withdrawal
Your doctor may order further tests to rule out other causes, such as:
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Blood and urine tests
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Chest X-ray
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Computerized tomography (CT) scan
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Spinal tap (lumbar puncture)
Treatment
Treatment depends on the severity of symptoms.
For minor symptoms, stopping the medication causing serotonin syndrome may be sufficient.
For moderate to severe symptoms, hospitalization may be required, and treatment can include:
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Muscle relaxants such as benzodiazepines (diazepam, lorazepam) to control agitation, seizures, and muscle stiffness
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Serotonin antagonists like cyproheptadine if other treatments are ineffective, which block certain serotonin receptors
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Oxygen and intravenous fluids to maintain oxygen levels, treat dehydration, and manage fever
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Medications to control heart rate and blood pressure, including esmolol or nitroprusside; if blood pressure is too low, phenylephrine or epinephrine may be used
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Mechanical ventilation and muscle-paralyzing medication in cases of severe high fever
Milder cases often resolve within 24 to 72 hours after stopping serotonergic medications. However, symptoms caused by certain antidepressants may take several weeks to fully subside because these medications remain in the system longer.
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