Just how bad can a severe case of serotonin syndrome be?

[infantannihilator]

Apologies if this isn't the correct sub, I scanned the list several times and I couldn't think of any better sub to get some valid information from knowledgeable persons.

I'm in NA and I have a friend in the group who relapsed and overdosed and has been in the hospital now for over two weeks. He is not in a good state. Originally we all thought he had overdosed on fentanyl, as opiates were his drug of choice. However at the last meeting we saw him he seemed very strung out, had sores on his face and I assumed he had switched to doing meth or something of the sort.

Apparently when he OD'd he was completely non responsive. He was in the hospital in a coma on a ventilator and apparently a DNR was ordered but when they removed the breathing tube and such he breathed on his own and has come back to consciousness in some capacity. I went to the hospital today and found out that it wasnt fentanyl he OD'd on, that he did not actually die, and that they found cocaine in his system. Apparently he had seizures at some point and had never had them before. My friend I was with was asked if he knew if the guy was taking any SSRIs or any other sort of medication because they think he may have serotonin syndrome. It's been about two weeks now and he is basically a vegetable. He is conscious but can't speak and his body is all contorted with no apparent ability to move his limbs in a controlled manner. It's like he can tell we're there but he has that dead look in his eyes and at best he can make a moaning sound. It is truly absolutely frightening, especially given cocaine was once my doc and I overdosed and had seizures from it myself in the past. Apparently a week ago he was able to say his name and then deteriorated, but he's been getting more receptive to things going on around him they say, and his gf is trying to get him to blink to try and say things since he cannot speak anymore. I assume some major brain damage occurred.

So many things could have happened and the worst part is no one has any clue since no one was with him when this happened, no one knows if he had any seizures, if his heart stopped, had a heart attack, or what, just that there was cocaine in his system and it was not fentanyl.

I've never heard of serotonin syndrome being this severe, so I'm just wondering if anyone here has any medical type insight. I'm prayin for my friend, but the outlook seems very bleak.

 

[clubcard]

Well, my sister's BF had a heart attack & stroke after lots of cocaine & alcohol and he's still in a unit some 4 years later but he knows where is is, he knows who people are but he has very little speech. He was in a similar condition; I mean it was THAT bad but he is still improving. I'm sure bloods will have been drawn and in these circumstances multiple full-bloods will have been worked so they know what they are doing. The brain can relearn, you are more likely to hear good news than bad news from this point onwards.

 

[RandomClean3]

Seems what you'd expect from a cocaine OD. Serotonin syndrome at it's worst kills you in a couple of hours, but that happens with MAO inhibitors, Also when serotonin syndrome is suspected, the patient is given cyproheptadine and lorazepam and it resolves within a few hours (Unless the patient dies). Even if not treated, once the drug that caused it has been metabolized it stops. To me, this is a bad overdose, cocaine alone is unlikely to cause serotonin syndrome, people OD before that happens. A friend in Ontario told me there were a bunch of overdoses after a batch of coke was cut with a fentanyl analogue, it could be an RC like U-47700. Also I find it really odd they didn't test for SSRIs for so long, they should know every drug that was in his system, not ask his friends.
Think of it like this, serotonin syndrome is nothing more than too much extracelular serotonin, that's all there's to it. So it makes no sense whatsoever that the doctors are saying he ''has'' serotonin syndrome. Cocaine lasts an hour, main reason it doesn't cause it, it's gone too fast. The seizures are a toxic effect of the drug itself. There's one possibility they may have overlooked (slim), that he took something that acts as a MAO inhibitor. aMT, PMA, PMMA, 4-TMA, although this is way more common with xtc than coke. He should be checked for levamisole, it's extremely common as a cutting agent for cocaine and pretty toxic.
TBH the drug market is so dirty right now I can't say much without knowing what was in his blood. Again, could have been cocaine alone, and given his current state, I'd guess he suffered a heart attack, respiratory failure or what sounds more likely, a stroke. But he has to be checked for everything if his condition is worsening, MRI scan, blood work, CT scan since they don't know what type of stroke (if there is a stroke) it is.
The entire thing could be simply a cocaine overdose, combined intoxication, cardiovascular events caused by cocaine, overdose on an unidentified substance like RC opioids, just too many things. I thought if I kept writing something helpful would pop up, but I'm just as clueless, with that information I can't tell what's happening to the poor guy...

 

[Bravoncius Roxford]

Apologies if this isn't the correct sub, I scanned the list several times and I couldn't think of any better sub to get some valid information from knowledgeable persons.

I'm in NA and I have a friend in the group who relapsed and overdosed and has been in the hospital now for over two weeks. He is not in a good state. Originally we all thought he had overdosed on fentanyl, as opiates were his drug of choice. However at the last meeting we saw him he seemed very strung out, had sores on his face and I assumed he had switched to doing meth or something of the sort.

Apparently when he OD'd he was completely non responsive. He was in the hospital in a coma on a ventilator and apparently a DNR was ordered but when they removed the breathing tube and such he breathed on his own and has come back to consciousness in some capacity. I went to the hospital today and found out that it wasnt fentanyl he OD'd on, that he did not actually die, and that they found cocaine in his system. Apparently he had seizures at some point and had never had them before. My friend I was with was asked if he knew if the guy was taking any SSRIs or any other sort of medication because they think he may have serotonin syndrome. It's been about two weeks now and he is basically a vegetable. He is conscious but can't speak and his body is all contorted with no apparent ability to move his limbs in a controlled manner. It's like he can tell we're there but he has that dead look in his eyes and at best he can make a moaning sound. It is truly absolutely frightening, especially given cocaine was once my doc and I overdosed and had seizures from it myself in the past. Apparently a week ago he was able to say his name and then deteriorated, but he's been getting more receptive to things going on around him they say, and his gf is trying to get him to blink to try and say things since he cannot speak anymore. I assume some major brain damage occurred.

So many things could have happened and the worst part is no one has any clue since no one was with him when this happened, no one knows if he had any seizures, if his heart stopped, had a heart attack, or what, just that there was cocaine in his system and it was not fentanyl.

I've never heard of serotonin syndrome being this severe, so I'm just wondering if anyone here has any medical type insight. I'm prayin for my friend, but the outlook seems very bleak.

It can be bad enough to kill you. For instance, if your body temperature rises above 42 centigrades, you die. And even if it rises to 40 or 41 degrees, you can suffer permanent brain damage if it stays that high for more than a couple hours.

But fortunately, SS is very rare. You need to combine two drugs that both strongly raise serotonin by different pathways for that to happen. Usually a potent reuptake inhibitor of serotonin with a potent non-selective MAO inhibitor. Say, combining paroxetine with phenelzine. And even then, combining these two drugs at normal therapeutic doses only results in mild symptoms of SS. The severe SS that kills you happens when you have an overdose of a strong serotonin reuptake inhibitor with a MAOI. Say, taking 200 mg of paroxetine with 1,000 mg of phenelzine at once. That is a serious medical emergency, but fortunately, people taking powerful serotonergic drugs that act by different pathways in huge doses in combination is very rare.