Pediatric Selective Serotonin Reuptake Inhibitor Toxicity Workup

  • Author: Mohamed K Badawy, MD, FAAP; Chief Editor: Timothy E Corden, MD   more...
 
Updated: Nov 8, 2011
 

Approach Considerations

The following laboratory studies are indicated in patients with selective serotonin reuptake inhibitor (SSRI) toxicity:

  • Rapid bedside glucose determination
  • Serum pH
  • Electrolytes, including calcium, magnesium, and phosphorus - Check for anion gap acidosis that may be present in co-ingestions.
  • Serum salicylate and acetaminophen levels
  • Creatine kinase (CK)
  • Urinalysis and urine toxicologic screen
  • Urine pregnancy test (when indicated)
  • Serotonin and 5-hydroxyindolacetic acid measurement - Although serotonin and its metabolite (5-hydroxyindolacetic acid) can be measured, these data are not readily available and, therefore, have limited clinical use.

Chest radiography is indicated if any signs of respiratory distress are present or to confirm endotracheal tube placement. Although radiographic findings of suspected aspirations might initially be absent, an initial radiograph is often helpful.

Electrocardiography is helpful to screen for any arrhythmia or conduction disturbances (ie, prolongation of the QRS or QTc interval) that may be due to co-ingestions.

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Contributor Information and Disclosures
Author

Mohamed K Badawy, MD, FAAP  Assistant Professor of Emergency Medicine and Pediatrics, University of Texas Southwestern Medical School; Associate Medical Director, Division of Emergency Medicine, Children's Medical Center Dallas

Mohamed K Badawy, MD, FAAP is a member of the following medical societies: Ambulatory Pediatric Association, American Academy of Pediatrics, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

Frank Anthony Maffei, MD, FAAP  Associate Professor of Pediatrics, Temple University School of Medicine; Medical Director, Pediatric Intensive Care Unit, Janet Weis Children's Hospital at Geisinger Health System

Frank Anthony Maffei, MD, FAAP is a member of the following medical societies: American Academy of Pediatrics

Disclosure: Nothing to disclose.

Chief Editor

Timothy E Corden, MD  Associate Professor of Pediatrics, Co-Director, Policy Core, Injury Research Center, Medical College of Wisconsin; Associate Director, PICU, Children's Hospital of Wisconsin

Timothy E Corden, MD is a member of the following medical societies: American Academy of Pediatrics, Phi Beta Kappa, Society of Critical Care Medicine, and Wisconsin Medical Society

Disclosure: Nothing to disclose.

Additional Contributors

Michael E Mullins, MD Assistant Professor, Department of Emergency Medicine, Washington University School of Medicine

Michael E Mullins, MD is a member of the following medical societies: American Academy of Clinical Toxicology and American College of Emergency Physicians

Disclosure: Johnson & Johnson stock ownership None; Savient Pharmaceuticals stock ownership None

Jeffrey R Tucker, MD Assistant Professor, Department of Pediatrics, Division of Emergency Medicine, University of Connecticut and Connecticut Children's Medical Center

Disclosure: Merck Salary Employment

Mary L Windle, PharmD, Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

References

  1. Schneeweiss S, Patrick AR, Solomon DH, et al. Comparative Safety of Antidepressant Agents for Children and Adolescents Regarding Suicidal Acts. Pediatrics. Apr 12 2010;[Medline].

  2. Hawton K, Bergen H, Simkin S, Cooper J, Waters K, Gunnell D, et al. Toxicity of antidepressants: rates of suicide relative to prescribing and non-fatal overdose. Br J Psychiatry. May 2010;196(5):354-8. [Medline]. [Full Text].

  3. Parks V, Philipp AW, Raje S, Plotka A, Schechter LE, Connell J, et al. Concomitant blockade of 5-HT(1A) receptor and 5-HT transporter: Use of the Hunter Serotonin Toxicity Criteria in a clinical pharmacology study. Eur Neuropsychopharmacol. Jul 4 2011;[Medline].

  4. Gordon JB. SSRIs and St.John's Wort: possible toxicity?. Am Fam Physician. Mar 1 1998;57(5):950,953. [Medline].

  5. Josey ES, Tackett RL. St. John's wort: a new alternative for depression?. Int J Clin Pharmacol Ther. Mar 1999;37(3):111-9. [Medline].

  6. Watson WA, Litovitz TL, Rodgers GC, et al. 2004 Annual report of the American Association of Poison Control Centers Toxic Exposure Surveillance System. Am J Emerg Med. Sep 2005;23(5):589-666. [Medline].

  7. Sternbach H. The serotonin syndrome. Am J Psychiatry. Jun 1991;148(6):705-13. [Medline].

  8. Attar-Herzberg D, Apel A, Gang N, Dvir D, Mayan H. The serotonin syndrome: initial misdiagnosis. Isr Med Assoc J. Jun 2009;11(6):367-70. [Medline].

  9. [Guideline] Nelson LS, Erdman AR, Booze LL, et al. Selective serotonin reuptake inhibitor poisoning: An evidence-based consensus guideline for out-of-hospital management. Clin Toxicol (Phila). May 2007;45(4):315-32. [Medline].

 
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