Sertraline overdose: Serotonin syndrome: case report

A 16-year-old girl developed serotonin syndrome after taking sertraline in a suicide attempt.

The girl was seen at the emergency department 13 hours after ingesting 20 pills of 100mg sertraline (a total of 2000mg). On arrival, she showed marked emotional tension, was poorly cooperative with poverty of speech; she complained of nausea and gastric pain. Physical examination findings included nystagmus, mydriasis and hand and leg tremors. Laboratory results showed a WBC count of 18 x 103/uL with neutrophil and lymphocyte percentages of 8.1% and 4.3%, respectively. She was hyperglycaemic, but her liver and kidney function test results were normal. She had a HR of 150 bpm, BP of 130/60mm Hg, and peripheral oxygen saturation of 97%. Her Glasgow Coma Scale score was 15.

The girl was admitted and IV fluids were started, followed by activated charcoal administration. Further investigation revealed that she was verbally coherent, oriented to time and space, and was able to recount the recent events surrounding her current condition. She had about a two-year history of recurrent hypomanic and dysthymic episodes and an eating disorder, for which she had started psychotherapy a few weeks previously. Twenty-four hours after admission, she developed a delusion of reference focused on sex identity, with intense anxiety and depressed mood, and was unable to sleep. Vital signs remained stable and laboratory tests were normal. Forty-eight hours following hospitalisation, her psychiatric symptoms persisted but were less intense. Lorazepam and risperidone were prescribed, but not given, because of spontaneous symptom resolution within 50 hours of admission. She was subsequently transferred to the paediatric service for further evaluation and treatment.

Author comment: "However, sertraline overdose causes a toxic hyperserotoniergic state known as serotonin syndrome".

Pitzianti M, et al. Asynchronicity of Organic and Psychiatric Symptoms in a Case of Sertraline Intoxication. Clinical Neuropharmacology 39: 269-71, No. 5, Sep-Oct 2016. Available from: URL: http://doi.org/10.1097/WNF.0000000000000169 - Italy 803222076