Serotonin syndrome in the emergency medical service

Specijalizacija hitne medicine je u Hrvatskoj nova specijalizalizacija no svejedno se susreće sa problemima koje imaju i odjeli hitne medicine u zapadnim zemljama s dugom tradicijom. Serotoninski sindrom (SS), potencijalno smrtno stanje, je rijetko spominjan sindrom, a čak 85 % liječnika nije svjesno njegovog postojanja. Uslijed nespecifičnosti dijagnostike, varijabilnosti u kliničkoj slici, preklapanja simptomatologije sa malignim neuroleptičnim sindromom te neznanja velikog broja medicinskog osoblja o postojanju serotoninskog sindroma, poremećaj se učestalo ne dijagnosticira. Ovaj sindrom, ponekad oslovljavan kao serotoninska toksičnost, je uzrokovan velikim brojem lijekova koje bolesnici učestalo imaju kao kroničnu terapiju ili je akutno prime u hitnoj službi. Većina stručne literature koja postoji o serotoninskom sindromu su prikazi slučajeva sa bolesnicima koji su imali blagu ili umjereno tešku kliničku sliku SS, međutim u teškom kliničkom obliku radi se o potencijalno smrtonosnom stanju. Ovaj pregledni članak opisuje prezentaciju i liječenje bolesnika sa SS uz osvrt na lijekove i interakcije lijekova koji mogu uzrokovati ovaj sindrom. Podizanje svijesti medicinskog osoblja o serotoninskom sindromu, posebno onih koji rade u hitnoj službi te su prvi kontakt sa bolesnicima, omogućilo bi pravovremeno prepoznavanje sindroma te uz adekvatno liječenje dovelo do značajne redukcije broja smrtnih ishoda.Emergency medicine is new speciality in Croatia but nevertheless it is still confronted with problems of well-established emergency medicine facilities in western countries. Serotonin syndrome (SS), potentially life threatening toxic state, is seldom talked about syndrome and almost 85% of physicians are unaware of its existence. Due to its lack of specific laboratory findings, variability in clinical presentation, overlapping with neuroleptic malignant syndrome and medical staff unfamiliarity with it, serotonin syndrome is insufficiently recognized. This syndrome, also called serotonin toxicity, is caused by striking number of drugs and drug combination most of which our daily ER patients use. From 1960. there have been published case reports of serotonin syndrome and it is established that majority of patients have mild or moderate form of syndrome. One must not be fooled by that fact because, when severe, serotonin syndrome is potentially life threatening toxic state. This review addresses the presentation and management of serotonin syndrome and discusses the drugs and interactions that can precipitate this syndrome. The importance of increasing awareness of emergency medicine health professional cannot be highlighted enough, especially due to the fact that emergency medicine health professional are the first medical contact with seriously ill patients. With knowledge about SS misdiagnosis and mortality rate of SS could be drastically reduced