DOI: 10.36347/sjmcr.2015.v03i12.016

Pages: 1196-1198

Aim of this case report is to present patient with serotonin syndrome after acute poisoning with Hypericum perforatum oil. A 26 year-old female patient was admitted to Clinic, for altered mental status, nausea, gastrointestinal discomfort, vomiting, diarrhea, agitation, four hours after suicidal poisoning with 50 ml. St John’s wort oil. On admission, she was confused, lethargic, non-communicative, with short periods of extreme agitation, disoriented with GCS 9. Her physical examination was positive for tachycardia, hypertension and elevated body temperature. Neurologic exam was positive for hyperreflexia to all for limbs, clonus on dorsiflextion of feet with positive Babinsky sign, muscular rigidity, mydriasis on both eyes. Her laboratory results revealed moderate rhabdomyolysis. Toxicology analysis were positive but in normal therapeutic range, only for Paroxetine, as part of her everyday therapy for depression. Toxicology analysis for hypericin and hyperforin was impossible to make, because we didn’t have tests for it. Serotonin syndrome caused by acute poisoning with St John’s oil was considered after ruling out cerebrovascular accidents and infection as potential etiologies for the patient’s condition. The treatment started with one dose of Diazepam (5mg IV push), and another 6 hours later, than continued with aggressively hydration (saline and dextrose fluids, with bicarbonates), 80 mg Propranolol and 40 mg Furosemid. The patient was rapidly cooled, and we continued in next twelve hours. Within 24 hours, the patient’s mental status and physical status totally improved and she was transferred to Clinic for Psychiatry for further treatment.