Serotonin Syndrome: An unusual cause of acute confusion and fever in the elderly

Serotonin Syndrome: An unusual cause of acute confusion and fever in the elderly

Abstract

Delirium is a common cause for hospital admission among elderly patients. Although infection is the most common explanation, there is a large number of other potential causes. We present a case of acute delirium due to serotonin syndrome, precipitated by concomitant prescription of clarithromycin and fluoxetine. The symptoms improved following treatment with a benzodiazepine and discontinuation of the fluoxetine. The diagnosis and management of serotonin syndrome is discussed.

[download-attachments container="div" style="list" display_icon="1" display_count="1" display__size="0"]

References

  1. Whyte, IM. Serotonin Toxicity/Syndrome. Medical Toxicology. Philadelphia 2004, Williams and Wilkins, 103-6.
  2. Lai MW, Klein-Schwartz W, Rogers GC, et al. 2005 Annual Report of the American Association of Poison Control Centers’ national poisoning and exposure database. Clin Toxicology (Phila). 2006; 44(6-7): 803-932.
  3. Ables AZ, Nagubilli R. Prevention, diagnosis and management of Serotonin Syndrome. American Family Physician. 2010; 81(9): 1139-1142.
  4. Pollak PT, Sketris IS, MacKenzie SL, et al. Delirium probably induced by clarithromycin in a patient receiving fluoxetine. Ann Pharmacother. 1995;
    29(5): 486-488.
  5. Young J, Inouye SK. Delirium in older people. BMJ. 2007; 334: 842-846. Birmes P, Coppin D, Schmitt L, et al. Serotonin syndrome: a brief review.
    Canadian Med Assoc J. 2003; 168(11): 1439-1442.
  6. Dunkley EJ, Isbister GK, Sibbritt D, et al. The Hunter Serotonin Toxicity Criteria: simple and accurate diagnostic decision rules for serotonin
    toxicity. QJM. 2003; 96(9): 635-642.
  7. Isbister GK, Buckley NA, Whyte IM. Serotonin toxicity: a practical approach to diagnosis and treatment. Med J Australia. 2007; 187(6): 361-365.
  8. Richelson E, Souder T. Binding of psychotropic drugs to human brain receptors, focus on newer generation compounds. Life Sci. 2000; 68:29-39.

Request Permissions

To request copyright permission to republish or share portions of our works, please visit Copyright Clearance Center’s (CCC) Marketplace website by clicking the button below:

Get Permission

Serotonin Syndrome: An unusual cause of acute confusion and fever in the elderly

10th March 2016
PMID: 22111101
Authors Affiliations
Gary Peter Misselbrook MBBS, MRCP(UK), PgDip (Med Tox), ST4 Acute and General Internal Medicine and Intensive Care Medicine Hampshire Hospitals NHS Foundation Trust
Raj Shekhar MBBS, MD, MRCP, Consultant Stroke Physician, Queen Elizabeth Foundation Hospital Kings Lynn NHS Trust

Serotonin Syndrome: An unusual cause of acute confusion and fever in the elderly

Cite this article as:

Misselbrook GP, Shekhar R. Serotonin syndrome: an unusual cause of acute confusion and fever in the elderly. Acute Med. 2011;10(4):206-8. PMID: 22111101.

Serotonin Syndrome: An unusual cause of acute confusion and fever in the elderly

Share this article

Click the icon of the social media platform on which you would like to share this article.


Shopping Basket
Scroll to Top