Serotonin syndrome following a single 50 mg dose of sertraline in a child

Figures & data

Table 1.  Signs and symptoms of serotonin syndrome in children as reported in the literature

Overdose/unknown ingested (6,7,10)	Single or Therapeutic Dose (8, 9)
Hyperthermia	Hyperthermia
Diaphoresis	Myoclonus, muscle fasciculations
Tachycardia	Shivering
Hypertension	Tachycardia
Dilated pupils	Hypertension, hypotension
Emesis	Rhabdomyolysis
Alert yet drowsy	Restlessness, tremor
Delirium	Presence of Babinski's sign
Tremor	Combative behaviors
Hyperactivity	Increased irritability, agitation
Hyperflexia	Decreased response to stimuli
Increased irritability, agitation
Insomnia
Decreased response to stimuli
Combative behaviors
Mood swings
Hallucinations

Fig. 1.  Time course of the patient's axillary temperature.

Fig. 2.  Time course of the patient's serum creatinine (▪) and creatine phosphokinase (Δ) levels. The shaded area represents the duration of urine alkalinization.

Table 2.  Score definitions of the Adverse Drug Reaction (ADR) Probability Scale by Naranjo et al

Score Definition	Total Score
Definite ADR	≥ 9
Probable ADR	5–8
Possible ADR	1–4
Doubtful ADR	0

Table 3.  Case score composition for sertraline using the Adverse Drug Reaction Probability Scale by Naranjo et al. (10)

Assessment question (Score for yes, no, do not know or not done)	Yes	No	Do not know or not done
Are there previous conclusive reports on this reaction?	+1
(+1, 0, 0)
Did the adverse event appear after the suspected drug was given?	+2
(+2, −1, 0)
Did the adverse reaction improve when the drug was discontinued or a specific antagonist was given?	+1
(+1, 0, 0)
Did the adverse reaction appear when the drug was readministered?			0
(+2, −1, 0)
Are there alternative causes that could have caused the reaction?		+2
(−1, +2, 0)
Did the reaction reappear when a placebo was given?			0
(−1, +1, 0)
Was the drug detected in any body fluid in toxic concentrations?			0
(+1, 0, 0)
Was the reaction more severe when the dose was increased, or less severe when the dose was decreased?			0
(+1, 0, 0)
Did the patient have a similar reaction to the same or similar drugs in any previous exposure?			0
(+1, 0, 0)
Total Score		6

M Pao, and T Tipnis. Serotonin syndrome after sertraline overdose in a 5-year-old child. Arch Pediatr Adolec Med 1997; 151:1064–7.

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