Overlapping of Serotonin Syndrome with Neuroleptic Malignant Syndrome due to Linezolid-Fluoxetine and Olanzapine-Metoclopramide Interactions: A Case Report of Two Serious Adverse Drug Effects Caused by Medication Reconciliation Failure on Hospital Admission

Table 1

Characteristics of neuroleptic malignant syndrome, serotonin syndrome, and sepsis.

		Neuroleptic malignant syndrome	Serotonin syndrome	Sepsis
Precipitated by		Dopamine antagonists	Serotonergic agents	General; (i) Temperature > 38.3°C or < 36°C; (ii) Heart rate > 90 beats/minute; (iii) Respiratory rate > 20 beats/minute; (iv) Altered mental status; (v) Increased fluid balance (>20 mL/kg over 24 hr); (vi) Elevated blood glucose > 140 mg/dL (in absence of diabetes); Inflammatory; (i) WBC > 12 × 10^3 cells/mm^3 or <4 × 10^3 cells/mm^3 or >10% immature neutrophils; (ii) Elevated plasma C-reactive protein; (iii) Elevated plasma procalcitonin; Hemodynamic; (i) Hypotension (SBP < 90 mmHg; MAP < 70 mmHg; or SBP decrease > 40 mmHg in adults or <2 SD below normal for age); Tissue perfusion; (i) Plasma lactate > 1 mmol/L; (ii) Decrease capillary refill or mottling
Onset		Variable, 1–3 days	Variable, <12 hours
Identical features	Vital signs	Hypertension; Tachycardia; Tachypnoea; Hyperthermia (>40°C)	Hypertension; Tachycardia; Tachypnoea; Hyperthermia (>40°C)
	Mucosa	Hypersalivation	Hypersalivation
Overlapping features	Skin	Diaphoresis; Pallor	Diaphoresis
	Mental status	Variable, stupor, coma, alert	Variable, agitation, coma
	Muscles	“Lead-pipe” rigidity in all muscle groups	Increased tone, especially in lower extremities
Distinct features	Reflexes	Hyporeflexia	Hyperreflexia; Clonus (unless masked by increased muscle tone)
	Pupils	Normal	Dilated
	Bowel sounds	Normal or decreased	Hyperactive