Serotonin Syndrome Induced by Combined Use of Tramadol and Escitalopram: A Case Report

Abstract

Serotonin syndrome is a potentially fatal increase in serotonergic activity in both the central nervous system and peripheral nervous system. The etiology can vary from therapeutic drug use, deliberate overdose or drug interactions that all lead to an increase in serotonin activity. There are a number of drugs from different classes that can cause serotonin syndrome either alone at high doses or when combined. We present here a case of a 74-year-old Caucasian female that presented to the emergency room with altered mental status, tachypnea, tachycardia and agitation. She reported taking her usual escitalopram as well as tramadol given to her by a friend to alleviate a headache. She was found tachycardic with a fever of 102.9 F. She very quickly became combative and had to be sedated and intubated. Laboratory test results were remarkable for severe rhabdomyolysis for which she was treated aggressively with hydration. The patient was extubated on the fifth day after admission once her vitals were stable. Unfortunately, she then developed an intracranial bleed. She was ultimately transferred to another facility with the expectation of being evaluated by a neurosurgeon for the bleed. This patient was diagnosed with serotonin syndrome.




J Med Cases. 2016;7(12):554-557
doi: https://doi.org/10.14740/jmc2702e