Severe serotonergic toxidrome

Severe serotonergic toxidrome is life threatening—urgently seek advice from a clinical toxicologist.

For rapidly progressive hyperthermia, urgently start rapid cooling techniques. Hyperthermic patients are usually volume depleted. The first-line treatment is cold intravenous fluid therapy. For detailed advice on cooling, see here.

For muscle rigidity with sustained clonus, sedate the patient (see recommendations for parenteral therapy for Moderate serotonergic toxidrome). Intubation and ventilation may be required.

For seizures, see management as for Seizure control for poisonings.