Workup
Approach Considerations
The following laboratory studies are indicated in patients with selective serotonin reuptake inhibitor (SSRI) toxicity [13] :
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Rapid bedside glucose determination
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Serum pH
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Electrolytes, including calcium, magnesium, and phosphorus - Check for anion gap acidosis that may be present in co-ingestions (see the Anion Gap calculator).
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Creatine kinase (CK)
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Urinalysis and urine toxicologic screen
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Urine pregnancy test (when indicated)
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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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