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Observations placeholder

Serotonergic or Anticholinergic Toxidrome: Case Report of a 9-Year-Old Girl

Identifier

020086

Type of Spiritual Experience

Hallucination

Number of hallucinations: 1

Background

Sertraline (trade names Zoloft and others) is an antidepressant of the selective serotonin reuptake inhibitor (SSRI) class

Ondansetron, marketed under the brand name Zofran, is a medication used to prevent nausea and vomiting

Montelukast (trade name Singulair) is a leukotriene receptor antagonist (LTRA) used for the maintenance treatment of asthma and to relieve symptoms of seasonal allergies

Nitazoxanide is a broad-spectrum antiparasitic and broad-spectrum antiviral drug

Diphenhydramine is an antihistamine

Omeprazole, sold under the brand names Prilosec and Losec among others, is a medication used to treat gastroesophageal reflux disease, peptic ulcer disease

 

A description of the experience

Pediatr Emerg Care. 2015 Dec;31(12):846-50. doi: 10.1097/PEC.0000000000000515.

Serotonergic or Anticholinergic Toxidrome: Case Report of a 9-Year-Old Girl.

Gerardi DM1, Murphy TK, Toufexis M, Hanks C.

  • 1From the Rothman Center for Pediatric Neuropsychiatry-USF Health, St Petersburg, FL.

Abstract

OBJECTIVE:

The aim of this study was to report an acute onset of symptoms erroneously attributed to serotonin syndrome in a child who had been given both anticholinergic and serotonergic agents.

CASE SUMMARY:

A 9-year-old girl with chronic anxiety and gastrointestinal problems was prescribed oral sertraline 6.25 mg daily, as well as hyoscyamine, ondansetron, montelukast, and a course of nitazoxanide. She was also routinely given diphenhydramine and omeprazole. Three days after increasing sertraline to 12.5 mg, she presented to the emergency department with altered mental status, hallucinations, mydriasis, tachycardia, and pyrexia. She was admitted to the pediatric intensive care unit and subsequently treated unsuccessfully for serotonin syndrome, with blurred vision and clonus persisting at discharge 4 days after admittance. Upon follow-up with her outpatient clinic, all anticholinergic agents were discontinued, and symptoms slowly resolved.

CONCLUSIONS:

This case illustrates the importance of differential diagnosis between toxidromes and how clinical presentation can be altered by preexisting conditions as well as the use of medications that affect multiple neurotransmitter systems.

PMID:

26425930

The source of the experience

PubMed

Concepts, symbols and science items

Concepts

Symbols

Science Items

SSRIs

Activities and commonsteps

Commonsteps

References