Clinical Case 5 Part 1

An 18 year old man James, is brought to the ED by his friend, George. It is a Saturday and they have spent the day together playing video games and drinking alcohol.

George tells you that he has been trying to cheer James up because James has been depressed recently and has been talking about suicide. James has seen his GP and was prescribed Sertraline for his low mood.

James has seemed restless and anxious this afternoon, finding it difficult to sit still. He then began sweating profusely and became confused, finding it increasingly difficult to follow the computer game.

In the ED, James is tachycardic, hypertensive and has a raised temperature. On examination, he has a fine tremor and hyperreflexia. There are no other significant findings on examination. James confides in you that earlier in the day, he took an overdose of his Nan’s Tramadol which he had taken from her medicines cabinet.

Bloods show an AKI with raised CK. There are no raised inflammatory markers, LFTs and TFTs are normal, as is the CT head and ECG.

You strongly suspect serotonin syndrome.

Whilst you are trying to explain this to James, he gets up to leave and he tells you that he is going home as he doesn’t like hospitals and he doesn’t want to be treated.

He then collapses and becomes unresponsive.