Diseases of the nervous system

Serotonin syndrome - signs, symptoms, causes, treatment

Serotonin syndrome is potentially dangerousA reaction that occurs as a result of the consumption of narcotic substances or the administration of drugs that increase serotonergic transmission. Such a reaction is quite rare, but this does not reduce its mortal danger. Often, it arises from the use of antidepressants, as a result of poisoning or a critical reaction to a combination of medications or drugs taken.

Causes of Serotonin Syndrome

Modern medicine develops seven-mileSteps. Every year, provisory companies struggle to improve the countless number of medicines of various pharmaceutical groups, including antidepressants and other psychoactive drugs. Today, in the development of psychotropic drugs used in the treatment of depressive conditions, the emphasis is on finding agents that positively affect the functioning of the serotonergic system, in other words, increasing the production of serotonin in the transmission of impulses in cells. With an insufficient level of serotonin in neurons, a depressive state occurs.
Thus, due to the misuse of antidepressants, a life-threatening complication, called serotonin syndrome, can develop.
Serotonin syndrome, what is it? This term serves to denote the response of the body, generated by the impact of certain drugs and drugs, the components of which can affect the concentration of serotonin. In other words, serotonin syndrome is a so-called intoxication with serotonin, which affects most of the most important processes that occur in the cells of the body.
The most commonly described syndrome occurs asThe consequence of taking monoamine oxidase inhibitors and / or using third-generation antidepressants, namely selective serotonin reuptake inhibitors. The main cause of the onset of the condition in question is an excessive serotonin level in the space located between the neuronal membranes (synaptic cleft), or in excess excitation of serotonin receptors located on the neuronal membrane.
Also, this complication can developAt the beginning of the use of antidepressants of the third generation when their single dosage is exceeded. In addition, there were cases of the emergence of serotonin syndrome following the use of antidepressants and alcohol-containing beverages at the same time. Often, this reaction may occur after the abolition of one antidepressant and taking another.
Provoke serotonin syndrome, in addition to(Eg, ritonavir) and antiemetics (metoclopramide), migraine medications (sumatriptan) and cough (Dextromethorphan), and weight loss drugs (Sibutramine).
Thus, the main and only factor,Which affects the occurrence of the syndrome under consideration, is the use of a substance directly affecting the production of the "happiness hormone", that is, the synthesis of serotonin. Hence, we can distinguish the main causes that give rise to the described complication, namely, a negative reaction to the combined use of certain drugs, drug poisoning, recreational use of narcotic drugs, and an individual reaction to the substance.

Symptoms of a serotonin syndrome

This syndrome is considered quite rarePhenomenon, but it is quite dangerous. Therefore, in order to receive the necessary medical assistance in time, it is necessary to diagnose the disease correctly. To this end, we need to understand the serotonin syndrome, what it is, and to know its main manifestations.
Serotonin syndrome, first of all, is a complication manifested by a specific reaction of the body in the form of certain symptoms.
The classic serotonin syndrome coversA triad of symptoms presented by mental disorders, autonomic changes and neuromuscular disorders. Below are the described symptoms of the serotonin syndrome in more detail.
Signs of change in the psyche appear in the firstAnd are characterized by a rapid increase. So, for example, they can make their debut with a slight excitement, and end with hallucinations up to a coma.
The presence of serotonin syndrome is signaled by the following manifestations:
- Insignificant emotional arousal;
- Decline of strength, drowsiness;
-
;
- joy up to
, The desire to run urgently somewhere, to do something;
-
;
-
, Reaching to
, For example, a person can spasmodically rush about the room in search of a desired exit;
- anxiety and euphoria come to replace each other;
Confusion of consciousness,
,
;
- Sometimes a heavy coma.
Vegetative changes are represented, in the first turn, by disorders of the digestive system:
- nausea followed by vomiting;
- epigastric pains with gas formation and diarrhea; - severe headaches;

- Increased respiration and tachycardia;
- fever or chills;
- pressure drops;
Excessive sweating and tear.

Symptoms of serotonin syndrome

The clinic of neuromuscular dysfunction with this syndrome is characterized by a variety of manifestations - from trembling of the limbs to the most severe seizures.
Symptoms of serotonin syndrome are often represented by three manifestations: changes in the psyche, hyperactivity of the ganglionic nervous system and disorders associated with hyperactivity.
The presence of serotonin syndrome in differential diagnosis is clearly indicated by the following symptoms:
, Expressed in rhythmic twitchingsLimbs and trunk, involuntary muscular contractions of non-rhythmic nature, numbness, rotation of the eyeballs (nystagmus), unexpected rolling of the eyes, movement coordination disorders, epileptic seizures, fuzzy speech.
Manifestations of serotonergic syndrome are oftenArise after the use of drugs or drugs in the first hours. Fifty percent of this complication begins in two hours, twenty-five percent on the first day, and the remaining twenty-five percent within the next two days.
Serotonin syndrome in patients of the age category can occur after three days. The described complication has three degrees of severity.
An easy degree is not significantAn increase in the frequency of the heart rhythm, an increase in sweating, and a small tremor in the limbs. Pupils slightly widened, reflexes slightly elevated along with normal body temperature. Naturally, with such a clinic, a person will not run to the hospital. Also, he may not relate the symptoms described above to taking antidepressants. Therefore, the first degree is often overlooked by patients.
Serotonin syndrome is of average severityA significant increase in the heart rate, increased intestinal peristalsis, epigastric pain, increased blood pressure, fever, nystagmus, pupil dilatation, motor and mental arousal, increased reflexes, and trembling of the limbs.
Serotonin syndrome in the severe stage isA serious threat to human life. It manifests itself in the following clinical manifestations: increased blood pressure, hyperthermia, severe tachycardia, delusional state, disorientation in time, space and personality with brightly colored emotional hallucinations, a sharp increase in muscle tone, profuse sweating, impaired consciousness. Also, blood clotting disorders develop, muscle disintegration and metabolic acidosis occur. In the future dysfunction of the kidneys and liver is noted, there is a multi-organ failure.
Severe degree of the syndrome in question can lead to coma. Often it leads to death. Fortunately, the malignant course of this complication is quite rare.

Treatment of serotonin syndrome

Today, to get rid of serotoninSyndrome of special therapeutic measures, unfortunately, has not been developed. Modern medicine has only general recommendations regarding the treatment of the complication in question. In this case, all recommendations are based on the description of individual cases.
The primary and main event in theTreatment of serotonergic syndrome is the abolition of all serotonergic drugs. This step in most patients leads to a decrease in clinical manifestations within six to twelve hours, and within 24 hours to their complete elimination.
The second necessary step is toSymptomatic therapy and subsequent individual care. In more severe conditions, the use of serotonin antagonist medications (for example, Tiproheptadine) is practiced. Also desintoxication therapy and a number of other measures, focused on maintaining homeostasis, are necessary.
To reduce body temperature,External cooling and Paracetamol. At temperatures above 40 ° C there is a threat to life. Therefore, it is necessary to use intensive cooling from the outside, the introduction of muscle relaxants, aimed at preventing the occurrence of rhabdomyolysis (destruction of muscle cells) and DIC syndrome. To maintain blood pressure within the norm for hypertension, direct sympathomimetics (for example, epinephrine or norepinephrine) are used in small doses. To remove muscle stiffness, which is associated with serotonin syndrome, benzodiazepines (Lorazepam) can be used.
In the treatment of the disorder in question,Drugs like Dantrolen (Miorelaxant, based on calcium channel blockade), bromocriptine (dopamine receptor stimulant), and propranolol (non-selective beta-blocker) are contraindicated due to increased mortality of patients.
Due to the fact that today there are no effectiveMethods that would allow one hundred percent to determine serotonin syndrome, it is often difficult to prescribe adequate treatment. Therefore, doctors are forced to focus on a number of indirect data. One of the most reliable are two schemes of evaluation criteria for serotonergic syndrome, but they are not equally effective.
The Sternbough criteria include the following points:
- the appointment of drugs from the so-called "risk group", which took place recently;
- Neuroleptics were not used to treat the patient or their dosage before the attack was not increased;
- infectious diseases, signs of an overdose of drugs or a history of withdrawal in history are absent;
- the presence of at least three symptoms from belowSuggested: excitation, chills, hyperreflexia, diarrhea, fever, confusion, myoclonus, increased sweating, impaired coordination, tremor.
Criteria of Günther contain two points -The confirmed fact of using substances from the "risk group" and the presence of one of the following symptoms: induction or spontaneous muscle contractions or an eye clone, hyperthermia, excessive excitation, hyperreflexia, trembling (if there are no pathologies of the nervous system in the anamnesis).
In most cases, the complication in questionDoes not lead to a permanent deterioration in health, and the existing clinical manifestations with adequate and timely therapy go without a trace for several days.

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