title: A perfect storm in the emergency department.
abstract: BACKGROUND
  Serotonin syndrome is an iatrogenic disorder that results from serotonergic overactivity. Severe myoclonus and increased restlessness are hallmarks of the disorder.
  
  
  METHODS
  We report a case of serotonin syndrome related to poor drug elimination.
  
  
  RESULTS
  A 74-year-old white female with moderate to severe Alzheimer's dementia was brought to the emergency department for increasingly aggressive behavior. Upon admission, her risperidone dose was increased and citalopram continued. Several days later, she developed diffuse limb and facial myoclonus, spontaneous clonus, diaphoresis, and fever. Her symptoms completely resolved after discontinuation of these medications.
  
  
  CONCLUSIONS
  Serotonin syndrome should be considered in the differential when elderly patients present with severe myoclonus. If unrecognized, this syndrome can lead to more severe manifestations including rhabdomyolysis, renal failure, and coma.
authors.affiliation: Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA. yee.alan@mayo.edu
authors.forename: Alan H
authors.initials: AH
authors.lastname: Yee
authors.forename: Eelco F M
authors.initials: EF
authors.lastname: Wijdicks
mesh_terms: D000368:Aged; D000544:Alzheimer Disease / Q000188:drug therapy; D015283:Citalopram / Q000009:adverse effects* / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007049:Iatrogenic Disease; D009207:Myoclonus / Q000209:etiology; D011595:Psychomotor Agitation / Q000209:etiology; D018967:Risperidone / Q000009:adverse effects* / Q000627:therapeutic use; D020230:Serotonin Syndrome / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology*; D017367:Selective Serotonin Reuptake Inhibitors / Q000009:adverse effects / Q000627:therapeutic use
chemical_list: D015283:Citalopram; D018967:Risperidone; D017367:Selective Serotonin Reuptake Inhibitors