Serotonin syndrome: When the happy hormone gets angry

Greg Eisinger, Mena Botros, Lauren Branditz

Research output: Chapter in Book/Report/Conference proceedingChapter

1 Scopus citations


Serotonin syndrome is a life-threatening condition caused by iatrogenic overactivation of 5HT1a and 5HT2a receptors characterized by the triad of encephalopathy, dysautonomia, and neuromuscular abnormalities. Although certain narcotics have been implicated, case reports related to fentanyl are scarce and the entire drug class is likely under-recognized as a potential precipitant in the clinical setting. We describe a postoperative patient who developed moderately severe serotonin syndrome while receiving a high-dose fentanyl infusion in the context of outpatient paroxetine therapy. The case was successfully managed by the withdrawal of the offending agents and treatment with cyproheptadine. We present a summary of the pathophysiology, diagnosis, and management of the serotonin syndrome.

Original languageEnglish (US)
Title of host publicationCase Studies in Emergency Medicine
Subtitle of host publicationLEARNing Rounds: Learn, Evaluate, Adopt, Right now
PublisherSpringer International Publishing
Number of pages11
ISBN (Electronic)9783030224455
ISBN (Print)9783030224448
StatePublished - Jan 1 2019


  • Critical care
  • Drug reactions
  • Fentanyl
  • Opioids
  • Serotonin syndrome
  • Toxicology

ASJC Scopus subject areas

  • Medicine(all)


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