CHIEF COMPLAINT: Possible serotonin syndrome.
HISTORY OF PRESENT ILLNESS: The patient presents to the emergency room for evaluation of altered mental status. According to her mother, she has been taking Adderall for attention deficit disorder. The dose was just increased within the last week. She also started taking an over-the-counter supplement that was meant to increase serotonin and melatonin. Last night, the patient did not sleep at all. She was having psychotic episodes where she was having auditory hallucinations and was very paranoid. This is certainly out of character for her normal demeanor states her mother. She typically does not have any problems with mentation such as this.
Today, she has felt that she is not thinking as clearly as she normally does. She has trouble with memory. She is having a difficult time answering questions. She was answering questions appropriately; however, she is having a difficult time phonating the actual words. Her mother states that she has been like this over the last 24 hours.
PAST MEDICAL HISTORY: Significant for UTIs in the past; however, she has an attention deficit disorder. She has no chronic disease otherwise.
MEDICATIONS: Adderall and serotonin supplement.
ALLERGIES: No known drug allergies.
SOCIAL HISTORY: She denies alcohol, tobacco or illicit drug use.
FAMILY HISTORY: Noncontributory.
REVIEW OF SYSTEMS: As mentioned, otherwise negative.
PHYSICAL EXAMINATION:
GENERAL: The patient is awake, alert, and oriented x3, in no acute distress.
HEENT: Normocephalic and atraumatic. Pupils are equal, round, and reactive to light and accommodation. Extraocular movements are intact.
NECK: No lymphadenopathy, no carotid bruits. Neck veins are flat.
CHEST: Good breath sounds bilaterally with no wheezes, rales or rhonchi.
HEART: Regular rate and rhythm with no murmurs, rubs or gallops.
ABDOMEN: Soft, nontender, and nondistended. Good bowel sounds without organomegaly.
EXTREMITIES: No clubbing, cyanosis or edema. There is no muscular rigidity in any of the four extremities.
NEUROLOGIC: Cranial nerves are intact. Reflexes are normal. There is no hyperreflexia noted.
EMERGENCY DEPARTMENT COURSE: This patient was seen and evaluated for evaluation of possible serotonin syndrome. She called her psychiatrist with the symptoms mentioned in the history present illness. This psychiatrist recommended that she be evaluated in the emergency room. She has no signs of muscular rigidity. She has no malignant hypertension or significant tachycardia on exam. Her mentation is slow, but she is answering questions appropriately. She does not certainly seem to be having any psychotic episode at this time. She does have urinalysis that did show urinary tract infection.
DISCHARGE DIAGNOSIS: Medications side effect/serotonin syndrome.
PLAN: At this time, she will be treated with Cipro 250 mg twice daily for three days for a simple cystitis. She was advised cessation of the Adderall and cessation of the supplement, as this is the treatment for serotonin syndrome. It is more than likely that she had a side effect from one of these medicines or the combination of the two medicines together. She certainly should not take any more and discuss this with her psychiatrist tomorrow who has been kept abreast of the situation.
DISPOSITION: The patient is discharged to home in stable condition.
