![]() ![]() ![]() Diagnostic criteria, specific clinical features, identifying causative agents and laboratory investigations can be used to differentiate the two syndromes. In addition, pediatric patients may present atypically as compared with adult patients with the same condition. Serotonin syndrome and neuroleptic malignant syndrome have overlapping presentations and can be a source of considerable diagnostic confusion, especially in cases of polypharmacy. tends to cause rigidity, hyperthermia, and autonomic hyperactivity, but it is usually caused by selective serotonin reuptake inhibitors (SSRIs) or other. His mental status, tremors, and laboratory values began to improve over the next 2 days, and eventually transitioned to the inpatient psychiatric unit on hospital day 7.ĭiagnosis of NMS or SS can be difficult when there is overlap between syndromes, particularly in the setting of multiple potential offending agents or underlying developmental delay. His course was complicated by hypertension and agitation managed with dexmedetomidine infusion and benzodiazepines. He was supportively treated with lorazepam and intravenous fluids while discontinuing potential offending agents. He was disoriented, intermittently agitated, and tremulous with increased tonicity, clonus in the lower extremities, and mydriasis. On arrival, the patient was noted to be tachycardia and hypertensive for age. Ten days before presentation, his outpatient psychiatrist had made multiple medication changes including discontinuation of cyproheptadine (an appetite stimulant) and initiation of aripiprazole. is important to differentiate between serotonin syndrome and NMS not only because the treatment approaches for the two conditions may differ but also. We report a case of a pediatric patient with complicated psychiatric history that developed features of both syndromes in the setting of polypharmacy.Ī 12-year-old boy with a history of developmental delay, attention-deficit hyperactivity disorder, and posttraumatic stress disorder presented to the emergency department with behavior changes consisting of delayed reactions, gait instability, drooling, and slowed movements. Although the mechanisms differ, they can be clinically difficult to distinguish. Neuroleptic malignant syndrome (NMS) and serotonin syndrome (SS) are serious medical conditions associated with commonly prescribed psychiatric medications. Neuroleptic malignant syndrome (NMS) is a life-threatening condition associated with the use of neuroleptic agents and is characterized by a clinical syndrome of mental status change, muscle rigidity, fever, and autonomic instability. ![]()
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