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Unsuspected serotonin toxicity in the ICU.

Catharina E van Ewijk1, Gabriel E Jacobs2,3, Armand R J Girbes4

  • 1Department of Intensive Care 7D16, VU University Medical Center, PO Box 7057, 1007 MB, Amsterdam, The Netherlands.

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|September 4, 2016
PubMed
Summary

Central serotonin toxicity may cause delirium in intensive care unit (ICU) patients. Many delirious patients showed signs of serotonin toxicity, but physicians often missed this diagnosis.

Keywords:
DeliriumIntensive careMedicationOpioidsSerotonin syndromeSerotonin toxicity

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Area of Science:

  • Neuroscience
  • Pharmacology
  • Critical Care Medicine

Background:

  • Delirium is common in intensive care units (ICUs) and medium care units (MCUs), but its causes are not fully understood.
  • Excess central serotonin can alter mental status and cause autonomic hyperactivity, mimicking delirium symptoms.
  • Serotonergic drugs are frequently used in ICUs/MCUs, suggesting a potential role in delirium development.

Purpose of the Study:

  • To determine the prevalence of delirium in ICU/MCU patients.
  • To assess the association between delirium, serotonergic drug administration, and serotonin toxicity characteristics.

Main Methods:

  • A 10-week prospective observational cohort study included patients aged 18+ diagnosed with delirium.
  • Delirium diagnosis was confirmed by CAM-ICU or haloperidol prescription.
  • Patients were screened for serotonergic drug use and physical signs of serotonin toxicity by trained physicians.

Main Results:

  • 61 delirious patients were enrolled; 72% had used drugs potentially causing serotonin toxicity.
  • 16% of those patients exhibited physical signs and met Hunter criteria for serotonin toxicity.
  • Treating physicians did not recognize serotonin toxicity in any of these cases.

Conclusions:

  • A significant number of ICU delirium cases may actually be central serotonin toxicity.
  • Physician awareness of serotonin toxicity as a cause of delirium is notably low.