PDF(Pubmed)
Abstract：
UNASSIGNED: Serotonin syndrome (SS) is an iatrogenic life-threatening condition caused by serotonergic agents. The treatment for SS involves the administration of a serotonin antagonist (cyproheptadine). However, the dosing schedule for cyproheptadine is not uniform in the literature.
UNASSIGNED: We retrospectively evaluated 23 adult patients (>18 years) admitted to the Neurology Department and met the Hunter criteria for SS.
UNASSIGNED: The mean age was 35.2 years, and 52% were female. Ten patients were managed in the intensive care unit (ICU), whereas thirteen patients were admitted to the ward. Hyperreflexia was the most common clinical feature (100%), followed by clonus (91%), tachycardia (83%), and tremor (83%). Other common clinical features were rigidity (65%), increased bowel sound (61%), diaphoresis (48%), fever (43%), hypertension (39%), and myoclonus (30%). All but one patient received two or more serotonergic drugs. Tramadol was the most common serotonergic agent (39%), followed by sodium valproate (21%), and amitriptyline (21%). Cyproheptadine was administered to all patients. All patients admitted in the ICU received a loading dose of 12 mg followed by 2 mg every 2 h for at least 24 h. All patients admitted to the ward were given 4 mg of cyproheptadine three times each day. Every patient showed at least some response to cyproheptadine within 24 h. The total doses of cyproheptadine and the length of treatment differed between patients.
UNASSIGNED: Any response to cyproheptadine at a therapeutic dose within 24 h, even a partial one, could be a diagnostic indicator of the existence of SS.
UNASSIGNED: We retrospectively evaluated 23 adult patients (>18 years) admitted to the Neurology Department and met the Hunter criteria for SS.
UNASSIGNED: The mean age was 35.2 years, and 52% were female. Ten patients were managed in the intensive care unit (ICU), whereas thirteen patients were admitted to the ward. Hyperreflexia was the most common clinical feature (100%), followed by clonus (91%), tachycardia (83%), and tremor (83%). Other common clinical features were rigidity (65%), increased bowel sound (61%), diaphoresis (48%), fever (43%), hypertension (39%), and myoclonus (30%). All but one patient received two or more serotonergic drugs. Tramadol was the most common serotonergic agent (39%), followed by sodium valproate (21%), and amitriptyline (21%). Cyproheptadine was administered to all patients. All patients admitted in the ICU received a loading dose of 12 mg followed by 2 mg every 2 h for at least 24 h. All patients admitted to the ward were given 4 mg of cyproheptadine three times each day. Every patient showed at least some response to cyproheptadine within 24 h. The total doses of cyproheptadine and the length of treatment differed between patients.
UNASSIGNED: Any response to cyproheptadine at a therapeutic dose within 24 h, even a partial one, could be a diagnostic indicator of the existence of SS.
摘要：
■5-羟色胺综合征(SS)是由5-羟色胺能药物引起的医源性危及生命的病症。SS的治疗包括给予5-羟色胺拮抗剂(赛庚啶)。然而,赛庚啶的给药方案在文献中并不统一.
■我们回顾性评估了23例神经内科收治的符合Hunter标准的SS患者（>18岁）。
■平均年龄为35.2岁，52%是女性。10名患者在重症监护病房(ICU)接受治疗，而13名病人被送进病房。反射亢进是最常见的临床特征（100%），其次是克隆（91%），心动过速（83%），震颤（83%）。其他常见的临床特征是僵硬（65%），肠鸣音增加（61%），发汗（48%），发烧（43%），高血压（39%），和肌阵挛症（30％）。除一名患者外，所有患者均接受了两种或多种5-羟色胺能药物。曲马多是最常见的5-羟色胺能药物（39%），其次是丙戊酸钠（21%），和阿米替林(21%)。所有患者均接受赛庚啶治疗。入住ICU的所有患者均接受12mg的负荷剂量，然后每2小时2mg，持续至少24小时。入住病房的所有患者每天3次给予4mg赛庚啶。每个患者在24小时内对赛庚啶至少有一些反应。赛庚啶的总剂量和治疗时间在患者之间有所不同。
■治疗剂量在24小时内对赛庚啶的任何反应，即使是部分的，可能是SS存在的诊断指标。
■我们回顾性评估了23例神经内科收治的符合Hunter标准的SS患者（>18岁）。
■平均年龄为35.2岁，52%是女性。10名患者在重症监护病房(ICU)接受治疗，而13名病人被送进病房。反射亢进是最常见的临床特征（100%），其次是克隆（91%），心动过速（83%），震颤（83%）。其他常见的临床特征是僵硬（65%），肠鸣音增加（61%），发汗（48%），发烧（43%），高血压（39%），和肌阵挛症（30％）。除一名患者外，所有患者均接受了两种或多种5-羟色胺能药物。曲马多是最常见的5-羟色胺能药物（39%），其次是丙戊酸钠（21%），和阿米替林(21%)。所有患者均接受赛庚啶治疗。入住ICU的所有患者均接受12mg的负荷剂量，然后每2小时2mg，持续至少24小时。入住病房的所有患者每天3次给予4mg赛庚啶。每个患者在24小时内对赛庚啶至少有一些反应。赛庚啶的总剂量和治疗时间在患者之间有所不同。
■治疗剂量在24小时内对赛庚啶的任何反应，即使是部分的，可能是SS存在的诊断指标。
