Serotoninergic Syndrome in fluoxetine overdose by a patient on moclobemide

Purpose: To present a case of delayed serotonin syndome (SS), a less well-k nown adverse effect of fluoxetine intoxication. Clinical presentation: A 21-yr-old woman was admitted following voluntary i ntoxication with fluoxetine and benzodiazepines. At the time of admission, she was slightly drowsy and hypotonic but, eight hours later, she developed severe hypertonic coma despite blood concentrations of fluoxetine within t he therapeutic range. Repeated toxicological analyses revealed the presence of moclobemide at non-measurable concentrations, suggesting earlier ingest ion of this monoamine oxydase inhibitor. Having excluded all other likely c auses of the neurological syndrome observed, a SS was postulated, Treatment . was symptomatic with mechanical ventilation, sedation with thiopental and fentanyl, and neuromuscular block with pancuronium bromide. The patient re covered spontaneously 20 hr later. Conclusion: Physicians managing patients presenting with fluoxetine intoxic ation must be aware of the potential risk of SS. Treatment is symptomatic, but SS may be severe and require vital support in the intensive care enviro nment. Review of published reports does not allow the authors to recommend a specific anesthetic management.