Serotonin syndrome (mechanism of disease)

This is a flowchart on serotonin syndrome, covering the etiology, pathophysiology, and manifestations.
ADDITIONAL TAGS:
Rhabdomyolysis
Risk factors / SDOH
Cell / tissue damage
Structural factors
Medicine / iatrogenic
Infectious / microbial
Biochem / metabolic
Immunology / inflammation
Signs / symptoms
Tests / imaging / labs
Environmental, toxin
Hereditary / genetic
Smooth muscle physiology
Pathophysiology
Etiology
Manifestations
Serotonergic drugs:
Antidepressants (MAOIs, SSRIs, SNRIs, TCAs, vortioxetine, vilazodone, trazodone)
Anticonvulsants (e.g., valproate)
Opioids (e.g., tramadol, meperidine)
5-HT3 receptor antagonists (ondansetron)
Anxiolytics (e.g., buspirone)
NMDAR antagonists (dextromethorphan)
Serotonin recep agonist (triptans, ritonavir)
Antibiotics (e.g., linezolid)
Herbal supplements (e.g., St. John's wort, ginseng, tryptophan)
Recreational stimulants (MDMA, cocaine)
=2 serotonergic drugs concurrently
=1 serotonergic drugs concurrent with certain CYP450 inhibitors
↓ CYP450 activity → ↓ drug clearance → serotonergic drugs accumulate
→ ↑ serotonergic activity
CYP450 inhibitors (e.g., ciprofloxacin)
Switching between serotonergic drug without tapering
Drug overdose, intentional or accidental
Patient-specific pharmacokinetic / -dynamic factors
↓ CYP450 activity
Serotonin receptor polymorphisms
Excess serotonin
↑ stimulation of the postsynaptic 5-HT1A and 5-HT2A receptors
Diaphoresis
Tachycardia
Hypertension
Mydriasis
Hyperreflexia
Myoclonus
Clonus
Horizontal ocular clonus
Hypertonicity
Rigidity (esp in lower extrem)
Delirium
Psychomotor agitation
Coma
Autonomic dysfunction
Classic triad:
Neuromuscular excitability
→ hyperthermia
Altered mental status
Nausea, diarrhea, vomiting
Anxiety
Seizure
Hypotension (in MAOi toxicity)
Serotonin reaches central nervous system
Modulate gastrointestinal motility
Bronchoconstriction
Acute respiratory distress syndrome
Vasoconstriction
Acute kidney injury
Platelet aggregation
Disseminated intravascular coagulation
Complications:
Serotonin syndrome

[@tuhachusi]

Super helpful for me. Thank you a lot.

[@debigdogk9563]

My only suggestion would be that a nice mnemonics to remember those drugs implicated will be very helpful. Awesome teaching Thank you

[@debigdogk9563]

Wooow awesome, your videos are the best .❤❤❤❤❤❤

[@debigdogk9563]

Thank you for teaching 🎉🎉🎉🎉

[@PhardeenAlemi]

Thanks alot it has been pretty helpful ; how about adding treatment as well.