Key result
In multi-drug-poisoned patients, exposure to SRIs significantly increased the risk of seizures (p=0.04), serotonin syndrome (p=0.01), and requirement for mechanical ventilation (p=0.03).
Why the study?
Does exposure to serotonin reuptake inhibitors worsen outcomes in patients referred to the emergency department for deliberate multi-drug exposure?
Cohort (n=444)
Does exposure to serotonin reuptake inhibitors worsen outcomes in patients referred to the emergency department for deliberate multi-drug exposure?
p-value: p=0.04 for seizures, 0.01 for serotonin syndrome, 0.03 for mechanical ventilation
In deliberate multi-drug poisonings, exposure to serotonin reuptake inhibitors significantly increases the risk of seizures and the need for mechanical ventilation, highlighting the need for improved clinical recognition of serotonin syndrome.
SRI co-exposure may elevate complication risks in multi-drug overdoses; hypothesis-generating observation requiring prospective validation before practice change.
Incidence of poisonings with serotonin reuptake inhibitors (SRIs) is growing. SRI toxicity is considered low, but its actual impact in multi-drug poisonings remains unclear. Our objective was to evaluate the consequences of SRI exposure in patients referred to the emergency department (ED) for deliberate multi-drug exposure. Patients admitted for multi-drug exposure involving at least one SRI were matched with patients who did not ingest any SRI, according to age, gender, type of drug and ingested doses. Features of serotonin syndrome according to Sternbach's criteria and Hunter's serotonin toxicity criteria were evaluated from records. In 4 years, 148 SRI-exposed patients were included and compared to 296 matched controls. The SRIs mainly involved were escitalopram (22%), venlafaxine (20%), fluoxetine (19%), citalopram (15%) and paroxetine (11%). Serotonin syndrome was diagnosed in one patient, but actually occurred in five SRI-exposed patients based on the retrospective evaluation of records. Twenty patients (14%) exhibited one or more serotonin syndrome criteria. At least two of 11 of Sternbach's criteria and two of nine of Hunter's serotonin toxicity criteria were missing in each chart. Using a conditional logistic regression analysis, seizures (p = 0.04) and serotonin syndrome (p = 0.01 based on Sternbach's criteria and p = 0.004 based on Hunter's serotonin toxicity criteria) more frequently occurred in SRI-exposed patients. Requirement for mechanical ventilation was significantly increased (p = 0.03), although admission to the intensive care unit was not. In multi-drug-poisoned patients admitted to the ED, exposure to SRIs significantly increases the risk of seizures and requirement for mechanically ventilation. Diagnosis of serotonin syndrome remains insufficient justifying improved training.
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Beaune et al. (2014) conducted a cohort in Deliberate multi-drug exposure (n=444). Serotonin reuptake inhibitors (SRIs) vs. No SRI exposure was evaluated on Seizures, serotonin syndrome, and requirement for mechanical ventilation (p=0.04 for seizures, 0.01 for serotonin syndrome, 0.03 for mechanical ventilation). In multi-drug-poisoned patients, exposure to SRIs significantly increased the risk of seizures (p=0.04), serotonin syndrome (p=0.01), and requirement for mechanical ventilation (p=0.03).
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