Characteristics of Serotonergic Crises

• Elevated temperature (as high as 106-107 F)

• Abnormal muscle movements from jerking to seizures. Very peculiar looking; it is classically described as “wet dog shakes”. They are usually confused with psychiatric disorders.

Case of Libby Zion: She was a young woman, 19, who died at Cornell hospital in the 80’s. She came into the ER taking a MAOI with a fever, vague abdominal complaints, and weird shaking. The intern admitted her and wrote her up as having questioned hysteria bc of her strange shaking. He observed her and gave her cooling blankets for her fever. When she became agitated, he gave her haldol and demerol, but then she died. Subsequently, what was said was that the intern lacked sleep and there was no communication between the intern and his superiors. Thus, it was concluded that interns need to be more rested, but what really caused the women’s death? Well, a day before she was admitted, the pt was given a synthetic opiate that interacts with MAOIs by her dentist and took cold meds prescribed to her by her pediatrician that also interacts with MAOIs. She herself was known to use cocaine and a variety of other drugs => thus, she came to ER with a serotonergic crisis. So, it wouldn’t have mattered how well rested the intern was; he was just not able to recognize that the pt was having a serotonic crisis, but now we will.

May also see: hypotension, anxiety, agitation, shivering, confusion, seizures, shock, and death.

Only way to treat = supportive care. There is no antidote. Cool down the pt and give fluids.

Category: Pharmacology Notes