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Published on: January 15, 2017
A perfect storm in the emergency department
Alan H Yee1, Eelco F M Wijdicks
1Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA. yee.alan@mayo.edu
Serotonin syndrome, a condition from excess serotonin, can cause severe myoclonus. This case highlights its occurrence in an elderly patient due to poor drug elimination, emphasizing the need for careful medication review.
Area of Science:
- Neuroscience
- Pharmacology
- Geriatric Medicine
Background:
- Serotonin syndrome is a potentially life-threatening condition caused by excessive serotonergic activity.
- Key clinical features include severe myoclonus and marked restlessness.
- It is an iatrogenic disorder, often linked to medication management.
Observation:
- A 74-year-old female with Alzheimer's dementia presented with behavioral changes.
- Her medication regimen included risperidone and citalopram.
- The patient developed symptoms of serotonin syndrome, including myoclonus, diaphoresis, and fever.
Findings:
- The patient's symptoms of serotonin syndrome were directly linked to her medication regimen.
- Discontinuation of risperidone and citalopram led to complete resolution of symptoms.
- This case illustrates serotonin syndrome resulting from impaired drug elimination in an elderly patient.
Implications:
- Elderly patients with dementia presenting with severe myoclonus warrant consideration for serotonin syndrome.
- Early recognition and management are crucial to prevent severe complications such as rhabdomyolysis, renal failure, and coma.
- This case underscores the importance of medication reconciliation and monitoring in geriatric pharmacotherapy.
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