Serotonin Syndrome

27 y/o female presents hot and altered to the ED after cocaine binge. Learners should recognize serotonin syndrome as the likely cause. Patient will develop Torsades and require multiple management interventions.

  • Donika Orlich    
  • Mateo Orrantia   
  • March 20, 2024, 5:03 p.m.   

  • Critical Care, Toxicology   
  • Residents, Physicians   
  • Airway Equip., Manakin - LF, Manakin - HF, Rhythm Box   

  • 4   
  • 40 - 60 Min   
  • Rural Hospital   

  • PRACTISS Verified   
Serotonin Syndrome

A 27-year-old female presents hot and altered to the ED with EMS. The likely cause is serotonin syndrome, precipitated by being on citalopram and methadone in the setting of a recent cocaine binge (all increase serotonin levels). She will develop Torsades de Pointes as a complication that must be treated with MgSO4. She will become increasingly agitated and febrile, requiring IV benzodiazepines, active cooling, and consideration of intubation with paralysis to achieve normothermia.

Goals and Learning Objectives
Technical/Equipment Recommendations
Supporting Roles and Scripts - OPTIONAL (Info can be given by Facilitator)
Moulage and Scenario Set-Up
Printable Supporting Documents (Will also be accessible at relevant Scenario Stage)

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Original Author: Donika Orlich
Date: 2016
Originally published on: 
 EM Sim Cases
Most Recent Modification: July 2021
Modified by: Mateo Orrantia