YÜKSEK DOZ SERTRALİN ALIMINA BAĞLI GELİŞEN SEROTONİN SENDROMU

Serotonin sendromu serotonerjik ilaçların kullanılması sırasında ortaya çıkan ve aşırı serotonerjik aktivite sonucu nöromüsküler irritabilite ve otonomik instabiliteyle karakterize olan bir sendromdur. Yirmi üç yaşındaki kadın hasta toplamda 2800 mg sertralin içeren 56 tablet ilacı intihar amaçlı aldıktan 2 saat sonra acil servise başvurdu. Midesinin yıkanmasını takiben yoğun bakım ünitesine alınan hastada ilaç alımından sonra ortaya çıkan taşikardi, takipne ve ekstremitelerde tonik-klonik kasılmalar, ajitasyon, halüsinasyon, hipertermi ve generalize konvülsiyonlar, hastada serotonin sendromu tablosunun geliştiğini düşündürdü. Nitekim hastanın midesinin yıkanmasını takiben aktif kömür verilerek ilacın emiliminin durdurulması yanı sıra intravenöz hidrasyonla eliminasyonunun hızlandırılması, oral siproheptadinle serotonerjik ajanın etkilerinin geri döndürülmesi, hipertermiye yönelik eksternal soğutma ve konvülziyonlara yönelik midazolam intravenöz infüzyon uygulanması sayesinde hastanın bu tablodan çıkarılması mümkün oldu. Sonuç olarak serotonerjik ilaç kullanım öyküsünün saptanması, mental, otonomik ve nörolojik bulguların erken fark edilip farmakolojik antagonizmanın ve diğer destekleyici medikal tedavilerin erken dönemde uygulanması sayesinde hastanın tedavisi başarılı bir şekilde gerçekleştirilebildi.

Anahtar Kelimeler:

otonomik instabilite, Serotonin sendromu, farmakolojik antagonizma

Serotonin Syndrome due to Sertralin Overdose

Serotonin syndrome results from serotonergic drug therapy and characterized by neoromuscular irritability resulting from extreme serotonergic activity and autonomic instability. Herein, we aimed to present a 23 year-old female patient, who took 56 tablets of sertralin (2800mg) for suicidal attempt. The patient was admitted to the emergency service in two hours. Patient was hospitalized in ICU after gastric lavage was accomplished in the emergency service. The patient was diagnosed as serotonin syndrome after tachycardia, tachypnea, tonic-clonic contractions of the extremities, agitation, hallucination, hyperthermia and generalized convulsions were observed. In fact, after gastric lavage with activated charcoal to prevent absorption and intravenous hydration for elimination of the drug, as well as cyproheptadine treatment to reverse the serotonergic activity, external cooling for hyperthermia treatment and midazolam infusion for convulsions, the patient was able to get out of this clinical condition. To conclude, early recognition of drug overdose, mental and neurological conditions as well as early initiation of antagonistic therapy and other supportive medications enabled us to achieve a successful treatment.

Keywords:

Serotonin syndrome, autonomic instability, pharmacalogical antagonism,

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