Síndrome serotoninérgico como reacción adversa infrecuente ante la sinergia entre Linezolid y Fentanilo: presentación de caso / Serotonin syndrome as an infrequent adverse reaction to synergy between Linezolid and Fentanyl: case presentation

Resumen El síndrome serotoninérgico es una condición potencialmente mortal causada por medicamentos que afectan el metabolismo de la serotonina o que actúan como agonistas directos del receptor de esta o una combinación de ambos. El síndrome da lugar a una variedad de manifestaciones mentales, autonómicas y neuromusculares, que pueden variar desde leves hasta potencialmente mortales. Se reporta el caso clínico de un paciente el cual desarrolló este síndrome por la coadministración y sinergismo de linezolid y fentanilo, con una gran variedad de características clínicas, desde las más sutiles, como cifras tensionales altas de difícil manejo mientras se encontraba bajo el efecto de sedoanalgesia, hasta las manifestaciones más floridas del síndrome posterior a la suspensión de esta. La asociación de estos medicamentos representa una etiología poco informada que puede favorecer la aparición del síndrome, mientras que el uso de benzodiazepinas puede enmascarar el cuadro dificultando su diagnóstico. MÉD.UIS.2020;33(3): 59-66

Abstract Serotonin syndrome is a life-threatening condition caused by medications that affect serotonin metabolism or that act as direct agonists for serotonin receptor or a combination of both. The syndrome gives rise to a variety of mental, autonomic, and neuromuscular manifestations, which can range from mild to life-threatening. We report a clinical case of a patient who developed this syndrome due to the co-administration and synergism of linezolid and fentanyl, with a wide variety of clinical characteristics, from the most subtle, such as high blood pressure levels difficult to manage while under the effect of sedoanalgesia, to the most florid manifestations of the syndrome after 48 hours of its suspension. The association of these drugs represents a poorly reported etiology that may favor the appearance of the syndrome, while the use of benzodiazepines may mask the condition, making its diagnosis difficult. MÉD.UIS.2020;33(3): 59-66

Adverse immune reactions and non-immune medications for perioperative use. / Reacciones adversas inmunitarias y no inmunitarias a fármacos de uso perioperatorio.

Reactions to medications can occur through a mechanism mediated by immunoglobulin or otherwise, not both. Drug allergy is a type of adverse reaction to the drug and comprises a range of hypersensitivity reactions mediated by different immunological mechanisms with diverse clinical manifestations. A rate of 3.2 fatal cases of anaphylaxis associated with drugs per 100,000 inhabitants per year is estimated, which seems to be approximately 10 times higher in hospitalized patients. The incidence of perioperative anaphylactic reactions is estimated at 1 in 10,000-20,000 anesthetic procedures. The diagnosis is based on a careful clinical history and physical examination. In some cases, skin tests, progressive challenges and methods to induce tolerance to the medication may be required. In hospitalized patients and at perioperative intervals, muscle relaxants, neuroleptics and morphinomimetics are frequently used and adverse reactions may occur to these drugs. This review shows a general description of the reactions of these medications, emphasizes allergic reactions and analyzes strategies for the diagnosis and treatment of these reactions.

Las reacciones a medicamentos pueden ocurrir por mecanismos mediados o no por imunoglobulina E. La alergia a fármacos es un tipo de interacción adversa y comprende una gama de reacciones de hipersensibilidad mediadas por distintos mecanismos inmunológicos con diversas manifestaciones clínicas. Se estima una tasa anual de 3.2 casos fatales de anafilaxia asociados con los fármacos por cada 100 000 habitantes, que parece ser aproximadamente 10 veces mayor en los pacientes hospitalizados. La incidencia de reacciones anafilácticas perioperatorias se estima en uno de cada 10 000-20 000 procedimientos anestésicos. El diagnóstico se basa en una cuidadosa historia clínica y en el examen físico. En algunos casos pueden requerirse pruebas cutáneas, pruebas de retos progresivos y procedimientos de inducción de tolerancia al medicamento. En los pacientes hospitalizados y en el intervalo perioperatorio frecuentemente se emplean relajantes musculares, neurolépticos y morfinomiméticos, por lo que pueden presentarse respuestas adversas a estos fármacos. En esta revisión se hace énfasis en las reacciones alérgicas a los medicamentos y se abordan estrategias para su diagnóstico y manejo.

Manejo perioperatorio de nuevos fármacos psiquiátricos / Perioperative management of new psychiatric drugs

Psychoactive drugs, including antidepressants and antipsychotics, are currently one of the most commonly used drugs, so we often find patients who consume them during the perioperative period. Historically, they have been associated with multiple and serious adverse effects, such as serotonin syndrome, but nowadays these are infrequent, especially due to the good safety profile of the new drugs most commonly used. Therefore, it is recommended to keep these drugs in the perioperative period, to avoid adverse effects related to their suspension. Among the novel and most used antidepressants are the so-called duals, such as venlafaxine, desvenlafaxine and duloxetine, these are safe and it is recommended to maintain their use. The same is recommended with drugs such as trazodone, bupropion and mirtazapine. Another antidepressant, vortioxetine, has not reported significant adverse effects in the perioperative period, so it is recommended to maintain its use. Agomelatine, derived from melatonin, is considered safe to maintain and could have beneficial effects by reducing preoperative anxiety and eventually reducing the incidence of postoperative delirium in susceptible patients. Antipsychotics are safe in the perioperative period and, in general, it is recommended to maintain their use.

Los fármacos psiquiátricos, entre los que se encuentran los antidepresivos y antipsicóticos, son de los fármacos más utilizados en la actualidad, por lo que con frecuencia nos encontramos con pacientes que los consumen en el perioperatorio. Históricamente se han relacionado con múltiples y graves efectos adversos, como el síndrome serotoninérgico, pero hoy en día estos son infrecuentes, sobre todo por el buen perfil de seguridad que presentan los nuevos fármacos más utilizados. Por lo anterior, es que en general se recomienda mantener estas drogas en el perioperatorio, para evitar efectos adversos relacionados con su suspensión. Entre los antidepresivos más utilizados se encuentran los denominados duales, como venlafaxina, desvenlafaxina y duloxetina, estos son seguros y se recomienda mantener su uso. Lo mismo se recomienda con drogas como trazodona, bupropión y mirtazapina. Otro más novedoso, la vortioxetina, hasta el día de hoy no ha reportado efectos adversos relevantes en el perioperatorio, por lo que se recomienda mantener su uso. La agomelatina, derivada de la melatonina, se considera segura de mantener y podrían tener efectos beneficiosos al reducir la ansiedad preoperatoria y eventualmente reducir la incidencia de delirium postoperatorio en los pacientes susceptibles. Los antipsicóticos son seguros en el perioperatorio y en general se recomienda mantener su uso.

Un diagnóstico no pensado: toxicidad serotoninérgica secundaria a interacción medicamentosa. Caso clínico / An unintended diagnosis: Serotonergic toxicity secondary to drug interactions. Case reports

La toxicidad serotoninérgica es un trastorno con potencial riesgo de vida asociado con un incremento de la actividad serotoninérgica en el sistema nervioso central. Se observa con el uso terapéutico o sobredosis intencional de medicamentos e interacciones inadvertidas (inhibidores selectivos de la recaptación de serotonina-isoniacida). Aunque esta patología está incrementándose, todavía no es bien reconocida por los médicos y sus manifestaciones pueden ser erróneamente atribuidas a otras causas. El objetivo de este artículo es presentar un caso clínico, colaborar con el diagnóstico y mejorar el cuidado de estos pacientes.

Serotonin toxicity is a potentially life-threatening condition associated with increased serotonergic activity in the central nervous system. It is seen with therapeutic medication use, intentional self-poisoning and inadvertent interactions (SSRI-isoniazid). Although this pathology is increasingly common, it is not well recognized by physicians and manifestations may be wrongly attributed to another cause. The aim of this paper is to describe the clinical picture of a patient, to collaborate on diagnosis and to improve medical care of these patients.

[An unintended diagnosis: Serotonergic toxicity secondary to drug interactions. Case reports]. / Un diagnóstico no pensado: toxicidad serotoninérgica secundaria a interacción medicamentosa. Caso clínico.

Serotonin toxicity is a potentially life-threatening condition associated with increased serotonergic activity in the central nervous system. It is seen with therapeutic medication use, intentional self-poisoning and inadvertent interactions (SSRI-isoniazid). Although this pathology is increasingly common, it is not well recognized by physicians and manifestations may be wrongly attributed to another cause. The aim of this paper is to describe the clinical picture of a patient, to collaborate on diagnosis and to improve medical care of these patients.

La toxicidad serotoninérgica es un trastorno con potencial riesgo de vida asociado con un incremento de la actividad serotoninérgica en el sistema nervioso central. Se observa con el uso terapéutico o sobredosis intencional de medicamentos e interacciones inadvertidas (inhibidores selectivos de la recaptación de serotonina-isoniacida). Aunque esta patología está incrementándose, todavía no es bien reconocida por los médicos y sus manifestaciones pueden ser erróneamente atribuidas a otras causas. El objetivo de este artículo es presentar un caso clínico, colaborar con el diagnóstico y mejorar el cuidado de estos pacientes.

Serotonin Syndrome Induced by Fentanyl in a Child: Case Report.

Serotonin syndrome (SS) is a potentially fatal condition associated with increased serotonergic activity in the central nervous system that can be attributed to certain drugs or interactions between drugs. There are some published articles reporting this syndrome caused by the combination of fentanyl and selective serotonin reuptake inhibitors antidepressants in adult patients; however, there are no reports of SS associated to the use of fentanyl as a single causative agent. The author reports a case of a 7-year-old boy who was admitted to the emergency department with neurological deterioration secondary to an intracerebral hemorrhage. The patient was operated to remove the bleeding. Postoperatively, he experienced a diversity of progressive neurological signs (shivering, tremor, hypertonia, hyperreflexia, clonus, bilateral mydriasis, and intracranial hypertension), which were initially considered to be signs of neurological deterioration, but finally, it was proved that they were part of a SS caused by fentanyl.The absence of concomitant use of another medications known to induce SS and the dramatic improving observed after stopping fentanyl strongly indicates that fentanyl was the causative agent in this case of SS.Fentanyl is a medication used frequently, and therefore, clinicians should be aware of this potential adverse effect when this drug is administered.

Safety assessment of FDA-approved (orlistat and lorcaserin) anti-obesity medications.

INTRODUCTION: Options for treating obesity remain limited despite it being a chronic, recurrent and morbid condition. New drugs that are proposed for its treatment encounter strong reluctance by regulatory agencies and many doctors. AREAS COVERED: This review will focus on the safety of an older drug, orlistat (the only one still approved in the European Union) and a newer recently FDA-approved one, lorcaserin. Both are approved as long-term monotherapy for obesity in the United States of America and they have demonstrated median weight loss of nearly 3% over placebo. EXPERT OPINION: Research, development and approval of new anti-obesity drugs are necessary for improved management of this chronic condition. Orlistat and lorcaserin are two FDA-approved drugs with limited overall efficacy. Nevertheless they are useful weapons for at least some obese individuals. Orlistat has a long and solid safety profile, whereas the safety of lorcaserin is still a matter of debate, mainly due to a lack of long-term data. However, lorcaserin's selective agonism on 5HT2c serotonin receptors diminishes concerns about valvulopathy associated with other serotonin agonists, such as fenfluramine.

Jaw stiffness and dental extractions due to pharmacodynamic interaction between mirtazapine and chlorpromazine / Bruxismo y extracciones dentales debido a la interacción farmacodinámica entre mirtazapina y la clorpromazina

A comprehensive assessment of the patient's drug related needs allows identifying health problems drug-induced. It has been demonstrated that each dollar spent on clinical pharmacy services reduces the pooled median cost of health by 4.81 dollars. Jaw stiffness (bruxism) can be a serotonergic manifestation related to drugs with serotonin reuptake inhibition activity. Clinical manifestations also include: agitation, tachycardia, high blood pressure, tremor, fever, dyspnea, diarrhea, mental confusion and insomnia

Anxiolytic-like effect of lavender essential oil inhalation in mice: participation of serotonergic but not GABAA/benzodiazepine neurotransmission.

ETHNOPHARMACOLOGICAL RELEVANCE: Lavandula angustifolia (lavender) inhalation has been used in folk medicine for the treatment of anxiety, and clinical and animal studies have corroborated its anxiolytic effect, although its mechanism of action is still not fully understood. AIMS OF THE STUDY: The objective of the present study was to determine whether the GABAA/benzodiazepine complex or serotonin neurotransmission mediates the anxiolytic-like effect of lavender essential oil. MATERIALS AND METHODS: Male Swiss mice were subjected to the marble-burying test after being exposed to the aroma of lavender essential oil (1-5%), amyl acetate (5%; used as a behaviorally neutral odor), or distilled water for 15 min via inhalation. Additionally, the effect of 5% lavender essential oil was also evaluated in mice subjected to the elevated plus maze. GABAA/benzodiazepine mediation was evaluated by pretreating the mice with the GABAA receptor antagonist picrotoxin before the marble burying test and [(3)H]flunitrazepam binding to the benzodiazepine site on the GABAA receptor. Serotonergic mediation was studied by pretreating the mice with O-methyl-[3H]-N-(2-[4-(2-methoxyphenyl)-1-piperazinyl]ethyl)-N-(2-pyridinyl) cyclohexanecarboxamide trihydrochloride (WAY100635), a serotonin 5-HT1A receptor antagonist before the marble burying test. We also evaluated changes in the pharmacologically induced serotonin syndrome and the effects of combined administration of subeffective doses of lavender essential oil and the 5-HT1A receptor agonist 8-hydroxy-2-(di-n-propylamino)tetralin (8-OH-DPAT). RESULTS: Lavender essential oil (1-5%) decreased the number of marbles buried compared with the control and amyl acetate groups. In the elevated plus maze, 5% lavender essential oil inhalation increased the percentage of time spent on and number of entries into the open arms compared with controls. No effect was seen in the number of closed arm entries or number of beam interruptions in the automated activity chamber. Pretreatment with the GABAA receptor antagonist picrotoxin (0.5mg/kg) did not modify the behavioral effect of 5% lavender essential oil in the marble-burying test. Lavender essential oil also did not alter [(3)H]flunitrazepam binding to the benzodiazepine site on the GABAA receptor. Pretreatment with the serotonin 5-HT1A receptor antagonist WAY100635 (3mg/kg) blocked the anxiolytic-like effect of lavender essential oil and the 5-HT1A receptor agonist 8-OH-DPAT (3mg/kg). A combination of ineffective doses of 8-OH-DPAT (0.5mg/kg) and lavender essential oil (0.1%) reduced the number of marbles buried. Finally, 5% lavender essential oil attenuated the serotonin syndrome induced by 40 mg/kg fluoxetine plus 80 mg/kg 5-hydroxytryptophan. CONCLUSIONS: These results indicate an important role for the serotonergic system in the anxiolytic-like effect of lavender essential oil.

Síndrome serotonínico pediátrico: reporte de un caso / Serotonin syndrome pediatric: case report

El síndrome serotonínico es un cuadro neurológico agudo debido a hiperactividad serotoninérgica, por la interacción de drogas que refuerzan o mimetizan la acción del neurotrasmisor. La incidencia del síndrome de serotonina es ascendente por la disponibilidad creciente de fármacos serotoninérgicos como los antidepresivos. Por ello es importante que los médicos reconozcan y manejen adecuadamente el síndrome serotonínico. Este reporte de caso se refiere a una intoxicación accidental por el neuroléptico atípico olanzapina en un niño de 2 años, quien desarrolló manifestaciones clínicas como agitación, sudoración, mioclonías, clonus espontáneo e hipertermia, considerados como criterios diagnóstico del cuadro. La terapia consistió en descontaminación interna con lavado gástrico, carbón activado y sulfato de sodio, ciproheptadina, propranolol y furosemida. Su evolución fue satisfactoria. En nuestro país hay disponibilidad de la mayoría de los fármacos causales y tienen amplio uso, por lo que es probable el subregistro del síndrome. De allí la importancia de este reporte de caso

Serotonin syndrome is an acute neurologic picture due to serotonergic hyperactivity, due to the interaction of drugs that enhance or mimic the action of the serotonin. The incidence of serotonin syndrome is rising because of the growing availability of serotonergic drugs such as antidepressants. It is therefore important that clinicians recognize and manage appropriately this syndrome. This case report refers to an accidental poisoning by the atypical neuroleptic olanzapine in a 2 year old boy who developed clinical manifestations such as agitation, sweating, myoclonus, spontaneous clonus and hyperthermia, considered as diagnostic criteria for the syndrome. Therapy consisted of internal decontamination with gastric lavage, activated charcoal and sodium sulfate, cyproheptadine, propranolol and furosemide. The clinical outcome was satisfactory. In our country the majority of the causal drugs are easily available and widely employed, for which reason it is probable that this syndrome is under registered. Hence the importance of this case report

Sintomas patogenéticos de serotonina: relato de um grupo de auto-experimentadores / Proving symptoms of serotonin: report of a group of self-experimenters

O valor da auto-experimentação realizada pelo homeopata é inestimável, segundo Hahnemann, seja para o auto-conhecimento, para seu o aprendizado como observador e, principalmente, para a vivência dos princípios homeopáticos. Assim, formou-se, em 2005, em Londrina um grupo de auto-experimentação, composto por vários profissionais homeopatas. Vinte auto-experimentadores (12 no primeiro grupo, em 2005, e 8 no segundo grupo, em 2008) provaram sulfato de serotonina na preparação homeopática 30cH e, posteriormente, os sintomas observados pelos dois grupos foram comparados com aqueles descritos na literatura para a síndrome serotoninérgica (SS). O medicamento Serotonina 30cH despertou 370 sintomas, expressos pelos 20 auto-experimentadores, sendo que os sintomas foram reunidos em 47 grupos. Desses sintomas, muitos apareceram nos dois grupos, compostos por experimentadores diferentes, em momentos diversos. O resultado da comparação entre os sintomas da SS e aqueles surgidos nas auto-experimentações mostrou que dos 32 sintomas da SS relatados pela literatura consultada, 17 deles ocorreram nas auto-experimentações. A auto-experimentação foi uma oportunidade ímpar para a vivência dos princípios homeopáticos e um excelente exercício de auto-observação. A riqueza dos sintomas experimentados aliada à reprodução dos mesmos na segunda experimentação e à coincidência com vários sintomas da SS tornam a serotonina agitada e diluída um medicamento homeopático para ser utilizado na clínica.

The value of the self-experimentation the homeopathic physician carries out on him/herself is priceless, according to Hahnemann, be it to acquire self-knowledge, to learn how to observe or chiefly, to experience the homeopathic principles. Consequently, it was formed in 2005 in Londrina a group of self-experimentation, composed by several homeopathic professionals. Twenty self-experimenters (12 in the first group, in 2005, and 8 in the second group, in 2008) tested serotonin sulfate in homeopathic high dilution 30cH; later on, the symptoms observed by both groups were compared with the ones described in the literature in serotonin syndrome (SS). Homeopathic medicine Serotonin 30cH awakened 370 symptoms among 20 experimenters, which were grouped in 47 classes. From these symptoms, many appeared in volunteers from both groups, which were composed by different volunteers in differen moments. The result of the comparison between the symptoms of SS and the ones reported in the self-experimentations showed that, from de 32 symptoms of SS reported by the literature, 17 also happened in our study. This self-experimentation was an unique opportunity to experience the homeopathic principles...

Sintomas patogenéticos de serotonina: relato de um grupo de auto-experimentadores / Proving symptoms of serotonin: report of a group of self-experimenters

O valor da auto-experimentação realizada pelo homeopata é inestimável, segundo Hahnemann, seja para o auto-conhecimento, para seu o aprendizado como observador e, principalmente, para a vivência dos princípios homeopáticos. Assim, formou-se, em 2005, em Londrina um grupo de auto-experimentação, composto por vários profissionais homeopatas. Vinte auto-experimentadores (12 no primeiro grupo, em 2005, e 8 no segundo grupo, em 2008) provaram sulfato de serotonina na preparação homeopática 30cH e, posteriormente, os sintomas observados pelos dois grupos foram comparados com aqueles descritos na literatura para a síndrome serotoninérgica (SS). O medicamento Serotonina 30cH despertou 370 sintomas, expressos pelos 20 auto-experimentadores, sendo que os sintomas foram reunidos em 47 grupos. Desses sintomas, muitos apareceram nos dois grupos, compostos por experimentadores diferentes, em momentos diversos. O resultado da comparação entre os sintomas da SS e aqueles surgidos nas auto-experimentações mostrou que dos 32 sintomas da SS relatados pela literatura consultada, 17 deles ocorreram nas auto-experimentações. A auto-experimentação foi uma oportunidade ímpar para a vivência dos princípios homeopáticos e um excelente exercício de auto-observação. A riqueza dos sintomas experimentados aliada à reprodução dos mesmos na segunda experimentação e à coincidência com vários sintomas da SS tornam a serotonina agitada e diluída um medicamento homeopático para ser utilizado na clínica.(AU)

Risk of serotonin syndrome with complementary and alternative medicines: importance to child and adolescent psychiatry.

OBJECTIVES: Evaluate how child and adolescent psychiatrists rate themselves regarding their knowledge and clinical skills in assessing interactions between non-prescribed complementary and alternative medicines (CAM) and prescribed medications. METHODOLOGY: A brief questionnaire about the practice of asking patients about CAM use was given to child and adolescent psychiatrists. RESULTS: The questionnaire was completed by 20 child and adolescent psychiatrists. Only 35% of the sample stated that they always asked about CAM use although 55% stated that they aware of the importance of prescribed drug interactions with CAM. Of the sample, 90% stated that they could recognize serotonin syndrome, but only 65% answered correctly to the description of the syndrome. Given a list of possible CAM that could interact with prescribed drugs to produce serotonin syndrome, only 10% identified all the drugs correctly. CONCLUSION: CAM training should be included in training programs and in continued education curriculums for practicing child psychiatrists.

Serotonin syndrome following sibutramine poisoning in a child, with sequential quantification of sibutramine and its primary and secondary amine metabolites in plasma.

OBJECTIVE: To report a case of serotonin syndrome (SS) after sibutramine overdose in a child. CASE REPORT: A 4-year-old girl was admitted 25 h after accidentally ingesting approximately 27 pills of sibutramine (15 mg, approximately 23 mg/kg). The child developed clinical features suggestive of SS, including diaphoresis, tachycardia, hypertension, agitation, insomnia, incoordination, hypertonia (lower limbs >> upper limbs), and hallucinations. Serum creatine phosphokinase levels reached a peak on day 3 (2,577 U/L, reference value <145), suggesting mild rhabdomyolysis. No relevant changes were detected in other laboratory examinations or in the electrocardiogram throughout the period of hospitalization. The quantification of sibutramine and the active metabolites, M1 (mono-desmethyl sibutramine) and M2 (di-desmethyl sibutramine), by liquid chromatography/electrospray ionization tandem mass spectrometry in six sequential samples collected from 25 to 147 h post-ingestion revealed a nonlinear decrease in the log-scale plasma concentrations. Treatment was only supportive and involved prolonged sedation to control the agitation, sleeplessness, and hypertension; no cyproheptadine was used. The patient was discharged on day 6 and follow-up revealed no sequelae. CONCLUSION: To our knowledge, this is the first report of SS after sibutramine overdose in a child, with sequential monitoring of the plasma levels of the drug and its two active metabolites. The growing consumption of weight reducing pills may increase the risk of unintentional acute toxic exposures in children.

Síndrome serotonínico secundario al uso de paroxetina en una paciente en hemodiálisis periódica / Serotonin syndrome secondary to the use of paroxetine in a patient under systematic hemodißlisis regime

El síndrome serotonínico es una situación clínica que se caracteriza por alteraciones del estado mental, inestabilidad autonómica y anormalidades neuromusculares como tremor, hiperreflexia o mioclonías y que puede aparecer como complicación por el uso de medicamentos que incrementan los niveles de serotonina como los inhibidores de la recaptación selectiva de serotonina, o la asociación de estos con otras drogas como los inhibidores de la monoaminooxidasa. Se presenta el caso de una paciente de 78 años de edad con insuficiencia renal crónica terminal por hipertensión arterial, bajo tratamiento de hemodiálisis periódica, que desarrolla un síndrome serotonínico secundario al uso de 20 mg diarios de paroxetina que se comenzaron a administrar por un cuadro depresivo, previamente fueron descartadas enfermedades infecciosas, metabólicas, neurológicas y la sobredosis de algún medicamento. La paciente mejoró después de la suspensión de la paroxetina(AU)

Serotonin syndrome is a clinical situation characterized by altered state of mind, autonomic instability and neuromuscular anomalies such as tremor, hyperreflexia or myoclonia, which are symptoms that may occur as a result of the use of drugs that increase serotonin levels when acting as selective serotonin reuptake inhibitors or their association with other drugs as monoaminoxidase inhibitors. This paper presented the case of a 78 years-old female patient suffering from terminal chronic renal failure caused by hypertension, low therapy of periodic hemodyalisis which gave rise to serotonin syndrome secondary to the daily use of 20 mg paroxetine prescribed for a depression condition. Infectious, metabolic, neurological diseases as well as some drug overdose were ruled out. The patient improved her condition after paroxetine treatment was suspended(AU)

Síndrome serotonínico secundario al uso de paroxetina en una paciente en hemodiálisis periódica / Serotonin syndrome secondary to the use of paroxetine in a patient under systematic hemodißlisis regime

El síndrome serotonínico es una situación clínica que se caracteriza por alteraciones del estado mental, inestabilidad autonómica y anormalidades neuromusculares como tremor, hiperreflexia o mioclonías y que puede aparecer como complicación por el uso de medicamentos que incrementan los niveles de serotonina como los inhibidores de la recaptación selectiva de serotonina, o la asociación de estos con otras drogas como los inhibidores de la monoaminooxidasa. Se presenta el caso de una paciente de 78 años de edad con insuficiencia renal crónica terminal por hipertensión arterial, bajo tratamiento de hemodiálisis periódica, que desarrolla un síndrome serotonínico secundario al uso de 20 mg diarios de paroxetina que se comenzaron a administrar por un cuadro depresivo, previamente fueron descartadas enfermedades infecciosas, metabólicas, neurológicas y la sobredosis de algún medicamento. La paciente mejoró después de la suspensión de la paroxetina.

Serotonin syndrome is a clinical situation characterized by altered state of mind, autonomic instability and neuromuscular anomalies such as tremor, hyperreflexia or myoclonia, which are symptoms that may occur as a result of the use of drugs that increase serotonin levels when acting as selective serotonin reuptake inhibitors or their association with other drugs as monoaminoxidase inhibitors. This paper presented the case of a 78 years-old female patient suffering from terminal chronic renal failure caused by hypertension, low therapy of periodic hemodyalisis which gave rise to serotonin syndrome secondary to the daily use of 20 mg paroxetine prescribed for a depression condition. Infectious, metabolic, neurological diseases as well as some drug overdose were ruled out. The patient improved her condition after paroxetine treatment was suspended.

Síndrome serotoninérgico secundario al uso de sertralina: reporte de un caso y revisión de la literatura / Serotonin syndrome secondary to the use of sertraline: case report and review

El síndrome serotoninérgico (SS) es un trastorno asociado al uso de fármacos agonistas de la serotonina, de manifestaciones clínicas variables y potencialmente letal. Su incidencia es incierta, debido a que cerca del 85 por ciento de los médicos desconoce su existencia, pero se cree que existe un aumento de ésta debido al aumento del uso de este tipo de medicamentos tanto en patologías psiquiátricas como no psiquiátricas. El SS es secundario a una estimulación excesiva de los receptores para serotonina tanto a nivel central como periférico. Sus manifestaciones incluyen alteración de conciencia variable, alteraciones neuromusculares e hiperactividad autonómica. Por lo general se resuelve de manera espontánea luego de 24 horas de suspendido el fármaco, sin embargo, puede progresar a falla multisistémica y ser letal. En el presente artículo presentamos el caso de una paciente de 80 años de edad, de sexo femenino, cursando con una depresión, que horas después de recibir la primera dosis de sertralina evolucionó con un SS. Se exponen la historia clínica, tratamiento y evolución.