Abstract：
Serotonin syndrome (toxicity), resulting from an excessive accumulation of serotonin in the central nervous system, it can occur due to various factors such as the initiation of medication, overdose or drug interactions. Diagnosing serotonin toxicity presents challenges as there are no definitive criteria. This review delves into the pathophysiology, incidence, clinical assessment and management of serotonin toxicity, stressing the significance of promptly recognizing and managing severe cases. Diagnosis relies primarily relies on clinical assessment due to the absence of specific laboratory tests. The Hunter Serotonin Toxicity criteria are commonly utilized but have only been validated in the overdose setting. Assessing the severity of toxicity is crucial for guiding management decisions. Supportive care, discontinuation of causative agents and symptomatic treatment are prioritized in management. Mild toxicity often requires withdrawal or reduction of the serotonergic agent, while more severe toxicity requires more aggressive resuscitative and supportive care. Severe serotonin toxicity characterized by hyperthermia and rigidity requires aggressive supportive measures, including benzodiazepines, intubation, paralysis and active cooling. Animal studies suggest potential benefits of 5-HT2A receptor antagonists in preventing hyperthermia and fatalities, but only at high doses. Their clinical effectiveness remains uncertain, and evidence is predominately from case series and case reports. Although commonly used, serotonin antagonists like cyproheptadine lack conclusive evidence of efficacy. Other serotonin antagonists such as chlorpromazine and olanzapine have been explored but evidence is limited to case reports. Hence, the cornerstone of treating severe cases does not lie in \'antidote\' administration or even diagnosis but in effective early resuscitative and supportive care.
摘要：
5-羟色胺综合征（毒性），由于中枢神经系统中血清素的过度积累，它可能是由于各种因素而发生的，例如开始用药，过量或药物相互作用。诊断血清素毒性存在挑战，因为没有明确的标准。这篇综述深入研究了病理生理学，发病率,血清素毒性的临床评估和管理，强调及时识别和管理重症病例的重要性。由于缺乏特定的实验室检查，诊断主要依赖于临床评估。通常使用Hunter5-羟色胺毒性标准，但仅在过量情况下得到验证。评估毒性的严重程度对于指导管理决策至关重要。支持性护理,治疗中优先考虑停用病原体和对症治疗.轻度毒性通常需要停用或减少5-羟色胺能药物，而更严重的毒性需要更积极的复苏和支持治疗。以高温和强直为特征的严重5-羟色胺毒性需要积极的支持措施，包括苯二氮卓类药物,插管,瘫痪和主动冷却。动物研究表明，5-HT2A受体拮抗剂在预防热疗和死亡方面的潜在益处。但只有高剂量。他们的临床疗效仍不确定，证据主要来自病例系列和病例报告。虽然常用,5-羟色胺拮抗剂如赛庚啶缺乏疗效的确凿证据。已经探索了其他5-羟色胺拮抗剂，例如氯丙嗪和奥氮平，但证据仅限于病例报告。因此，治疗重症病例的基石不在于"解毒剂"给药或甚至诊断,而在于有效的早期复苏和支持治疗。
