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Serotonin syndrome: case report A 41-year-old woman developed serotonin syndrome during treatment with ketamine and fluoxetine. The woman had a history of anticardiolipin antibody syndrome, endometriosis, generalized anxiety disorder and major depressive disorder. She was admitted to a hospital for chronic endometriosis pain and received IV ketamine 40 mg/hour, for the following 4 days. Her home medication included fluoxetine 40 mg/day [route and indication not stated], coumadin, and diphenhydramine. On day 5, she developed visual hallucinations and was initially diagnosed with ketamine-induced delirium. The woman received treatment with haloperidol with reportedly good effect, and she was discharged on day 7. Upon returning home, she developed persistent altered mental status, and again presented to the hospital. On presentation, she was diaphoretic, and her other vital signs were as follows: temperature 37.6°C, blood pressure 154/100 mm Hg and heart rate 125 bpm. Physical examination revealed 4+ patellar and Achilles reflexes with left ankle clonus and crossed adductors. Mental status exam revealed increased latency of speech and thought, with illogical mannerisms and appearance. She said, she was not feeling herself and stared at walls for a long period, appearing internally confused and preoccupied. Her treatment started with lorazepam. Fourteen hours later, her temperature returned to normal, but she remained hypertensive, tachycardic and altered. She received 2 additional doses of lorazepam, and 17 hours later, her heart rate returned to normal. She was switched to oral lorazepam, and 2 hours later, her blood pressure normalised and physical exam showed normal reflexes. Based on the findings a diagnosis of serotonin syndrome secondary to ketamine and fluoxetine was confirmed. Eventually, she was recovered and discharged home. Gueits C, et al. Ketamine and serotonin syndrome: A case report. Current Psychiatry 19: E1-E2, No. 3, Mar 2020. Available from: URL: https://www.mdedge.com/psychiatry/ article/217948/depression/ketamine-and-serotonin-syndrome-case-report 803517668

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Reactions 28 Nov 2020 No. 1832