Guidelines for Serotonin Syndrome in Pediatrics

Medicina (B Aires). 2026 Aug;86 Suppl 3:162-171.

ABSTRACT

This document is presented as a narrative guide based on the available evidence, adapted to the pediatric population. Since clinical trials in children are nonexistent, much of the information comes from case reports, narrative reviews, and extrapolation from adult studies. Serotonin syndrome is a potentially life-threatening condition caused by excessive serotonergic activity within the central nervous system. It is clinically characterized by a triad of neuromuscular hyperactivity, autonomic instability, and altered mental status. Diagnosis is clinical and relies on recent exposure to serotonergic agents and the application of the Hunter Criteria, which show high sensitivity and specificity in adults and are extrapolated to pediatric patients. Causative agents include selective serotonin reuptake inhibitors, monoamine oxidase inhibitors, analgesics such as tramadol and fentanyl, antibiotics like linezolid, antiemetics, recreational drugs, and herbal supplements. Management involves immediate discontinuation of the offending agent and supportive care, including hydration, benzodiazepines to control agitation, and external cooling measures. In moderate to severe cases, cyproheptadine may be used as a serotonin antagonist. Most patients recover within 24 to 72 hours after appropriate treatment. The prognosis is favorable when the syndrome is recognized early; however, delayed diagnosis can result in serious complications such as rhabdomyolysis, renal failure, or coagulopathies. Prevention relies on cautious prescribing, identification of potential drug interactions, and family education regarding safe medication storage. Further research is needed in pediatric populations to validate diagnostic criteria and optimize therapeutic strategies.

PMID:42659567