Selective Serotonin Reuptake Inhibitor Toxicity Workup

  • Author: Tracy A Cushing, MD, MPH, FACEP, FAWM; Chief Editor: Asim Tarabar, MD   more...
 
Updated: Apr 19, 2012
 

Approach Considerations

Diagnosis of serotonin toxicity begins with a detailed history of the patient's medications, of changes to regimen, and of suicide attempts; queries into the availability of serotonergic drugs; and a careful physical examination. Laboratory tests used in the diagnosis of serotonin toxicity include the following:

  • Serum and urine toxicology screen - Opiates/opioids (meperidine), salicylates, acetaminophen, TCAs, amphetamines, phencyclidine (detection of dextromethorphan by cross-reactivity), and cocaine
  • Total creatine phosphokinase
  • Urine myoglobin
  • Basic electrolytes, including calcium, magnesium, and phosphorus levels, as well as lactate and ketone levels - To evaluate for metabolic acidosis
  • Blood urea nitrogen (BUN) and creatinine levels
  • Serum pH level
  • Liver function tests
  • Complete blood count and blood cultures if febrile
  • Prothrombin time/activated partial thromboplastin time in severe cases; disseminated intravascular coagulation panels, if necessary
  • Pregnancy testing, if indicated
  • Electrocardiography - To determine rhythm, morphology, and intervals, particularly in suspected co-ingestions

Imaging studies

Imaging studies include chest radiograph after intubation or in any patient with hypoxia or aspiration. Head computed tomography (CT) scanning can be conducted in any patient with suspected trauma, new-onset seizures, or hypertension and localizing neurologic findings

Procedures

Intubation should be considered in any unstable patient or any patient with altered mental status who cannot protect his or her airway. Lumbar puncture is indicated in any patient with fever and altered mental status.

Proceed to Treatment & Management
 
 
Contributor Information and Disclosures
Author

Tracy A Cushing, MD, MPH, FACEP, FAWM  Assistant Professor, Department of Emergency Medicine, University of Colorado School of Medicine; Attending Physician, Denver Health Medical Center

Tracy A Cushing, MD, MPH, FACEP, FAWM is a member of the following medical societies: American College of Emergency Physicians, Society for Academic Emergency Medicine, and Wilderness Medical Society

Disclosure: Nothing to disclose.

Coauthor(s)

Theodore I Benzer, MD, PhD  Assistant Professor in Medicine, Harvard Medical School; Director of Clinical Operations, Director of Toxicology, Chair of Quality and Safety, Department of Emergency Medicine, Massachusetts General Hospital

Theodore I Benzer, MD, PhD is a member of the following medical societies: Alpha Omega Alpha and American College of Emergency Physicians

Disclosure: Nothing to disclose.

Chief Editor

Asim Tarabar, MD  Assistant Professor, Director, Medical Toxicology, Department of Emergency Medicine, Yale University School of Medicine; Consulting Staff, Department of Emergency Medicine, Yale-New Haven Hospital

Disclosure: Nothing to disclose.

Additional Contributors

John G Benitez, MD, MPH Associate Professor, Department of Medicine, Medical Toxicology, Vanderbilt University Medical Center; Managing Director, Tennessee Poison Center

John G Benitez, MD, MPH is a member of the following medical societies: American Academy of Clinical Toxicology, American Academy of Emergency Medicine, American College of Medical Toxicology, American College of Preventive Medicine, Society for Academic Emergency Medicine, Undersea and Hyperbaric Medical Society, and Wilderness Medical Society

Disclosure: Nothing to disclose.

Miguel C Fernandez, MD, FAAEM, FACEP, FACMT, FACCT Associate Clinical Professor, Department of Surgery/Emergency Medicine and Toxicology, University of Texas School of Medicine at San Antonio; Medical and Managing Director, South Texas Poison Center

Miguel C Fernandez, MD, FAAEM, FACEP, FACMT, FACCT is a member of the following medical societies: American Academy of Emergency Medicine, American College of Clinical Toxicologists, American College of Emergency Physicians, American College of Medical Toxicology, American College of Occupational and Environmental Medicine, Society for Academic Emergency Medicine, and Texas Medical Association

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

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