|Day 1 8:33 a.m.||After taking SNRI, hot flush, stiffness around the neck and shoulder, diaphoresis, and muscle rigidity in the masseter appeared. BP 112/78 mmHg, 77 bpm, BT 37.4 °C||
Intravenous administration of dantrolene 40 mg for muscle rigidity. No abnormalities were found in the blood test.
|10:10||No raise in serum serotonin level (4 ng/ml)||
Diagnosed as serotonin syndrome|
Serotonergic agents (duloxetine and mirtazapine) were stopped immediately.
|12:45||Myoclonus and tremor on the upper extremities. Tachycardia (120 bpm) and diaphoresis|
|13:00||Myoclonic seizures on the upper extremities and neck. Tachycardia (140 bpm), BP 162/102 mmHg, respiratory rate 28/min|
|13:20||Myoclonic seizures on the shoulders and neck. Tachycardia (140 bpm), BP 169/120 mmHg, respiratory rate 35/min||Admitted to the intensive care unit. Clonazepam 1.0 mg (per oral), intralipid (20%) 100 ml, and started landiolol 0.01 mg/kg/min|
No myoclonus was seen after the initial dose of cyproheptadine.|
Vital was stabilized soon.
|Cyproheptadine 12 mg (per oral)|
|22:00||Cyproheptadine 4 mg (per oral)|
|Day 2 6:00||
Cyproheptadine 4 mg (per oral)|
Moved to general ward
|Day 4||Discharged from the hospital|