From the Guidelines
Yes, serotonin syndrome can cause nausea, as it is one of the common gastrointestinal symptoms associated with this condition, along with vomiting and diarrhea. Serotonin syndrome is a potentially life-threatening condition that occurs when there is excessive serotonin activity in the nervous system, typically due to medication interactions or overdose. This occurs because serotonin plays a significant role in regulating gut motility and sensation, and excessive serotonin can stimulate the chemoreceptor trigger zone in the brain that controls vomiting 1. Other symptoms of serotonin syndrome include agitation, confusion, rapid heart rate, high blood pressure, dilated pupils, muscle rigidity, tremors, and in severe cases, seizures and hyperthermia.
Key Symptoms and Treatment
- Nausea and vomiting are common symptoms, as well as diarrhea, due to the effect of serotonin on the gut.
- Treatment typically involves discontinuing the offending medications and providing supportive care, which may include hospitalization for severe cases 1.
- Medications that commonly contribute to serotonin syndrome include selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), monoamine oxidase inhibitors (MAOIs), and certain pain medications like tramadol.
Importance of Prompt Medical Attention
If serotonin syndrome is suspected, it is crucial to seek immediate medical attention as it can rapidly progress to a medical emergency. The condition can lead to severe complications, including rhabdomyolysis, metabolic acidosis, renal failure, seizures, and disseminated intravascular coagulopathy, with a mortality rate of approximately 11% 1.
From the Research
Symptoms of Serotonin Syndrome
- Alteration of mental status
- Abnormalities of neuromuscular tone
- Autonomic hyperactivity 2
- Neuromuscular abnormalities, such as tremor, hyperreflexia, or myoclonus 3
- Mental state changes 4
- Nausea is not explicitly mentioned as a symptom in the provided studies, however, autonomic hyperactivity which can include nausea is mentioned 2, 4, 5
Clinical Features and Diagnosis
- The diagnosis requires a history of exposure to agents active at serotonin receptors and the presence of alterations in mental status, autonomic instability, and neuromuscular abnormalities 3
- The Hunter criteria are often used for diagnosing serotonin syndrome, but they may not be the gold standard as they can miss more cases than other diagnostic criteria systems 6
- Serotonin syndrome can occur in the absence of an elevated temperature, and fast onset may not be a reliable clinical sign 6
Management and Treatment
- Management of serotonin syndrome involves withdrawal of the offending agent(s), aggressive supportive care to treat hyperthermia and autonomic dysfunction, and occasionally the administration of serotonin antagonists--cyproheptadine or chlorpromazine 2
- Cyproheptadine may be used as an adjunct to supportive care in the treatment of serotonin syndrome 3