Ojum S. (1)
Serotonin syndrome is a life-threatening condition that may be caused by an unanticipated interaction of serotonergic drugs, this produces excess serotonin in the central nervous system. Medications of this category are routinely prescribed during treatment of blast injury. This drugs causes a drug reaction that affect serotonin level. Their effect on serotonin receptors should be taken into account to prevent the development of serotonin syndrome. A patient was transported from another hospital directly to the ICU to continue treatment of consequences of multiple blast injuries of lower limbs and abdomen, complicated by wound infection and clinical depression. Treatment with linezolid which is a serotonergic and duloxetine another serotonergic drug combined with repeated surgical interventions with opioid-based anaesthesia has resulted in development of the serotonin syndrome, manifesting as tremor and frequent clonic seizures. Complete revision of the prescribed pharmacological therapy as well the approach to sedation and anaesthesia has led to a complete resolution of clinical symptoms of this complication. In this case, improvement was achieved through discontinuation of fluoxetine and linezolid. All unfavourable drug interactions must be taken into account in management of complex blast injury. Limiting opioid use through regional anaesthesia and prescription of sedative agents that do not promote serotonin accumulation may prevent the development of serotonin syndrome in such patients.
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