216. Burning up- Serotonin Syndrome and Neuroleptic Malignant Syndrome

This podcast episode, presented by Dr. Thomas Kiebalo, focuses on differentiating between serotonin syndrome and neuroleptic malignant syndrome (NMS) in hyperthermic patients. The episode begins with a case study of Libby Zeon, whose death was attributed to serotonin syndrome, highlighting the importance of recognizing hyperthermia syndromes. Dr. Kiebalo explains the pathophysiology of both serotonin syndrome, caused by excessive serotonin in the synaptic cleft, and NMS, linked to dopamine blockade. The discussion covers assessment strategies, diagnostic criteria like the Hunter criteria for serotonin syndrome and the mnemonic HARM for NMS, and key distinctions in timing, mental status changes, autonomic hyperactivity, and neuromuscular abnormalities between the two conditions. The podcast also outlines necessary lab work and treatment principles, including immediate discontinuation of offending agents, supportive care, and potential antidotal therapies, and concludes with a review of a Canadian trial examining the association of lisinolid with serotonin syndrome in patients on antidepressants.