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Review Article
- Diagnosis and treatment of serotonin syndrome
- Je Sung You, Sung Phil Chung
- J Korean Soc Clin Toxicol. 2024;22(2):11-17. Published online December 31, 2024
- DOI: https://doi.org/10.22537/jksct.2024.00008
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Abstract
PDF - Serotonin syndrome is a drug-induced clinical syndrome caused by increased serotonin activity in the central nervous system. It occurs when starting a serotonergic drug, increasing its dose (including overdoses) or using a serotonergic drug in combination with other drugs. It manifests along a broad spectrum, ranging from mild side effects to life-threatening conditions. This condition should be suspected if patients have altered mental states, autonomic dysfunction, or neuromuscular symptoms such as clonus and tremor after using serotonergic drugs. Although the Hunter criteria have been widely used, new diagnostic criteria have recently been proposed to screen severe serotonin toxicity. It is necessary to differentiate it from neuroleptic malignant syndrome, which is associated with taking antipsychotic drugs that exert dopamine-antagonistic effects. If serotonin syndrome is suspected, the relevant drug should be stopped, and the patient should be treated with benzodiazepines. Severely ill patients with hyperthermia or neuromuscular symptoms require aggressive treatment. Serotonin receptor antagonists such as cyproheptadine or chlorpromazine have been tried as antidotes, but the level of evidence for their therapeutic effectiveness is very low.
- Delayed death after chlorfenapyr poisoning
- Jang Young Lee
- J Korean Soc Clin Toxicol. 2021;19(1):51-54. Published online June 30, 2021
- DOI: https://doi.org/10.22537/jksct.2021.19.1.51
- 1,328 View
- 13 Download
- 3 Citations
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Abstract
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- Chlorfenapyr is a widely used insecticide, that is very lethal if ingested. It exhibits delayed toxicity in which there are few symptoms at first which suddenly worsen after a few days. A 66-year-old female patient ingested about 90 mL of chlorfenapyr liquid hydrating agent (Chlofenapyr 10%) and showed stable vital signs with no specific symptoms and findings other than a mild fever, vomiting, and nausea. From the 3rd day of ingestion, creatine kinase was high, and rhabdomyolysis was suspected. From the 4th day of ingestion, pancreatic enzymes began to gradually increase. A diffusion-weighted image showed a multifocal high signal intensity in the white matter and corpus callosum area. On the 8th day after ingestion, she suffered a high fever and a heart attack and died. Thus, if a patient is suspected of taking chlorfenapyr, he/she needs active treatment and monitoring even if he/she does not exhibit any symptoms.
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Citations
Citations to this article as recorded by
- Understanding Chlorfenapyr Toxicity: An Overview of Acute Human Exposure and Clinical Outcomes
Dalia Alsaied Moustafa Ahmed, Nermin Mahmoud Emam, Mohamed Moharram Badawy
Journal of Applied Toxicology.2026;[Epub] CrossRef - Toxicological Review of an Uncoupler, Chlorfenapyr
Sun Cheun Kim
Korean Journal of Legal Medicine.2025; 49(2): 35. CrossRef - A Fatal Case of Chlorfenapyr Poisoning and the Therapeutic Implications of Serum Chlorfenapyr and Tralopyril Levels
Ming-Jin Chung, Yan-Chiao Mao, Chia-Tien Hsu, Mu-Chi Chung, Tsai-Jung Wang, Tung-Min Yu, Po-Yu Liu, Pin-Kuei Fu, Chia-Ming Hsieh
Medicina.2022; 58(11): 1630. CrossRef
- Understanding Chlorfenapyr Toxicity: An Overview of Acute Human Exposure and Clinical Outcomes
- Datura Stramonium Intoxication of Which Resulted in Changing Mentality - A Case Report -
- Je-Sung You, Yeoun-Woo Nam, Jin-Hee Lee, Sung-Pil Chung, Seung-Ho Kim, In-Cheol Park
- J Korean Soc Clin Toxicol. 2006;4(1):52-54. Published online June 30, 2006
- 960 View
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Abstract
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- Datura stramonium is a wild growing plant, consumption of which can result in severe toxicity. It contains a variety alkaloids include atropine, hyoscamine, and scopolamine that can all cause anticholonergic poisoning. It has been use of herb medicine in Korea. Side effects from ingesting Datura stramonium include dry mouth, blurred vision, photophobia, and may be followed by hyperthermia, confusion, agitation, hallucination, and aggressive behavior. In severe toxicity, it can cause seizure, coma, life-threatening arrhythmia, and death. We experienced one patient who developed stupor mentality caused by Datura stramonium. Severe presentation, especially mental change of Datura stramonium should draw attention. Poisoning associated with Datura stramonium can be prevented through educational public health program.
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Korean Society of Clinical Toxicology