Timely Diagnosis of Serotonin Syndrome Helps Kauvery Hospital Save 60-Year-Old Man
- Although the patient exhibited all signs of sepsis, the medical team stayed alert, explored other possible causes, and made the correct diagnosis of a rare disorder
- The patient required multidisciplinary care in the ICU, as he also presented with muscle weakness and signs of kidney dysfunction
Salem, June 2025: Timely and accurate diagnosis of serotonin syndrome, a potentially life-threatening condition caused by excess serotonin affecting the brain and nervous system, helped Kauvery Hospital save a 60-year-old man who was admitted with high fever, altered consciousness, and breathlessness, along with other serious health complications.
The patient showed all signs of sepsis, a condition caused by the body’s extreme response to an infection, leading to organ damage and dangerously low blood pressure. However, the medical team remained vigilant and considered alternative causes, especially because the patient had an unusually high-grade fever — as high as 107°F — which is uncommon in typical sepsis cases. When the team discovered that the patient was on psychiatric medication, it prompted further investigation — leading to the diagnosis of serotonin syndrome. This timely identification enabled the doctors to initiate the right course of treatment, ultimately saving his life.
The patient required multidisciplinary care in the ICU, as he also presented with muscle weakness and signs of kidney dysfunction. The medical team initiated aggressive treatment, including intravenous hydration, active cooling to reduce his high fever, and comprehensive supportive care. He was closely monitored and managed by a team comprising intensivists, physicians, and nephrologists.
In his comments, Dr. S Vadhan Prasanna, Consultant-Critical Care, who headed the medical team, said, “Typically, patients with infection or sepsis present with fever below 103°F and signs of multiorgan failure. However, in this case, the patient had an unusually high-grade fever of 107°F. On further probing, his relative revealed that he was on psychiatric medications — specifically sertraline and clonazepam for depressive illness. This raised the suspicion of serotonin syndrome, a rare but serious condition. We evaluated him accordingly and initiated targeted treatment, including medications that block the effects of excess serotonin in the body. This out-of-the-box thinking led to the early initiation of targeted management, including active cooling measures, aggressive fluid resuscitation, electrolyte correction, and the use of cyproheptadine, a serotonin antagonist. The patient was managed in the intensive care unit with continuous monitoring and support from a dedicated team comprising intensivists, general physicians, nephrologists, and rehabilitation specialists.”
The doctor also noted that the patient had a stormy hospital course, marked by fluctuating levels of blood pressure,consciousness that required mechanical ventilation, the use of multiple medications to maintain blood pressure, and acute kidney injury. His residual muscle weakness — caused by the breakdown of muscle fibers — necessitated rehabilitation, which was provided by a skilled team of physiotherapists, respiratory therapists, and nurses.
It was a combination of diagnostic insight, and appropriate management of a rare condition that ultimately saved the patient’s life. After a brief stay in the ICU, the man was discharged and sent home.
