Everything Nurses >> Rx Corner >> NMS vs Serotonin Syndrome vs Anticholinergic Syndrome
NMS vs Serotonin Syndrome vs Anticholinergic Syndrome
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Posted over 3 years ago OK, yesterday took care of a pt, with H/O pysch meds poor history so unsure which ones he took. He was m.r. and presented with increased confusion, aphasia, elevated wbc, elevated creatine kinase, muscle rigidity........he went unconscious and had seizure like tremors in his arms and legs (right at the end of my shift darn it), O2 sat dropped to low 90's on R/A, no response to sternal rub, and sinus tach in 120's. I gave a med that I was really unfamiliar with 'Physostigmine 2 mg'. Now, after doing a little research, it seems to me, that he had neuraleptic malignant syndrome, and NOT Serotonin Syndrome or anticholinergic syndrome. And that drug would not have been appropriate (the doc's told me to give it). We did give Ativan 2ms IV as well. Any nurses have experience with any of these syndromes? |
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| Posted over 3 years ago Well, it's not our role to diagnose, so even if you are right you would still have to give the med, though you could have suggested something else be on standby. The tremors in the extremeties sounds like clonus, which is common in serotonin syndrome. It can be very hard to tell the difference between serotonin syndrome and neuroleptic malignant syndrome. I do question the use of Physostigmine, though. I'm not reading that it is used to treat either syndrome. However, the use of Ativan was very appropriate: it is part of the management for both syndromes, and is also useful in the treatment of hyperthermia. I think this is one of those weird cases that teaches us a lot for the next time we run into it. I've seen serotonin syndrome, and we managed it with Ativan, but not NMS. How did the patient do? |
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| Posted over 3 years ago I'll let you know, when I find out. He was still in the ICU today. |
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| Posted over 3 years ago Oh, yea I thought the ativan was appropriate too (I've given tons of that for any seizure like activity including DT's etc). But the 'Physostigmine 2 mg' just didn't seem to fit with any experience that I've had. I found out later that it is actually only intended for ICU level or higher. I had my azz covered in that I called pharmacy and spoke with the pharmacist, had the pt on a moniter, and had the MD there. I don't know if I would have given it, if I had known that it was ICU level or higher though. I think I would have let someone from the rapid response team step forward. I let my ACLS expire, after I left the ER. |
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| Posted over 3 years ago You don't need to have ACLS to administer high level meds, but you SHOULD refuse to give any medication you don't feel qualified to administer, so I don't blame you for feeling you might have refused to give it had you understood the implications. Fortunately, things seemed to go well for you, and the outcome in the moment was OK. I hope your patient does OK. |
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| Posted over 3 years ago pt still hospitalized in an IMCU. I'm told it was 'anticholinergic syndrome' with serotonin syndrome a close second. Plan is for lengthy inpt hospitalization to get meds under control. |
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| Posted over 3 years ago Sounds like a good outcome then . . . eventually. Glad to hear he's going to make it :) |
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| Posted over 3 years ago Bravo as I have certainly learned something on both of your post exchanges here, hats off to a job well done. Hopefully I will have this level of clinician know how on this subject matter someday.
High hopes & God speed - Tim, R.N. |
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