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[Serotonin syndrome during
fluoxetine poisoning in a patient taking
moclobemide]
[Article in French]
Chambost M,
Liron L, Peillon D, Combe C.
Service de Reanimation, Centre
Hospitalier de Villefranche sur Saone, France.
mchamb@ch-villefranche.fr
PURPOSE: To present a case of delayed
serotonin syndome (SS), a less well-known adverse effect of fluoxetine
intoxication. CLINICAL PRESENTATION: A 21-yr-old woman was admitted
following voluntary intoxication with fluoxetine and benzodiazepines. At
the time of admission, she was slightly drowsy and hypotonic but, eight
hours later, she developed severe hypertonic coma despite blood
concentrations of fluoxetine within the therapeutic range. Repeated
toxicological analyses revealed the presence of moclobemide at
non-measurable concentrations, suggesting earlier ingestion of this
monoamine oxydase inhibitor. Having excluded all other likely causes of
the neurological syndrome observed, a SS was postulated. Treatment was
symptomatic with mechanical ventilation, sedation with thiopental and
fentanyl, and neuromuscular block with pancuronium bromide. The patient
recovered spontaneously 20 hr later. CONCLUSION: Physicians managing
patients presenting with fluoxetine intoxication must be aware of the
potential risk of SS. Treatment is symptomatic, but SS may be severe and
require vital support in the intensive care environment. Review of
published reports does not allow the authors to recommend a specific
anesthetic management.
Publication Types:
PMID: 10730736 [PubMed - indexed for
MEDLINE]
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