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Serotonin Syndrome after Clomipramine Overdose in a Child
Meltem Çobanoğulları Direk1, Veli Yıldırım2, Serkan Güneş2
1Division of Pediatric Neurology, Department of Pediatrics, University of Mersin School of Medicine, Mersin, Turkey.
Insights
Serotonin syndrome (SS) is a serious condition caused by excess serotonin. This case highlights the importance of recognizing SS in pediatric patients, even with limited clinician experience.
Area of Science:
- Pediatric Neurology
- Clinical Toxicology
Background:
- Serotonin syndrome (SS) is a potentially life-threatening condition resulting from increased central nervous system serotonergic activity.
- Serotonergic drug use is increasing in pediatric populations, yet awareness among healthcare providers remains limited.
Observation:
- A 12-year-old girl presented with altered consciousness and involuntary extremity contractions.
- Physical examination revealed agitation, hyperthermia, mydriasis, tremors, hyperreflexia, clonus, flushed skin, diaphoresis, and nystagmus.
Findings:
- The patient was diagnosed with serotonin syndrome based on clinical presentation, history, and laboratory results.
- The condition was linked to the concurrent use of clomipramine and risperidone.
Implications:
- This case underscores the critical need for enhanced awareness and diagnostic skills regarding serotonin syndrome in pediatric care.
- Clinicians should maintain a high index of suspicion for SS in children presenting with relevant symptoms, especially those on serotonergic medications.
Abstract:
Serotonin syndrome (SS) is a potentially life-threatening condition associated with increased serotonergic activity in central nervous system and may occur during the use of serotonergic drugs. Although increasing frequency of serotonergic drug use in children, pediatricians, emergency medicine and pediatric intensive care specialists have not enough knowledge and experience about SS that is a potentially life-threatening condition. A 12-year-old girl patient was admitted to our emergency room with the history of involuntary contractions on her extremities and alteration of consciousness. Her physical examination showed agitation, hyperthermia, dilated pupils, tremor, increased deep tendon reflexes, positive spontaneous clonus, agitation, flushed skin and diaphoresis, excessive perspiration, and continuous horizontal ocular movements. The patient diagnosed as SS by clinical history, physical and laboratory findings. In this paper, we will discuss SS occurred in a 12-year-old girl after concurrent clomipramine and risperidone use.