Monday, July 27, 2009

Michael Jackson's Pepsi Commercial Accident

The Cause of MJ's Death



Wikipedia:
Propofol (marketed under the trade name Diprivan) is a short-acting, intravenous, nonbarbiturate sedative agent used for the induction of general anesthesia for adults and children, maintenance of general anesthesia, sedation in medical contexts, such as intensive care unit (ICU) sedation for intubated, mechanically ventilated adults, and in procedures such as colonoscopy and endoscopy, as well as in dental surgery. It has largely replaced sodium thiopental (trade name Pentothal) for induction of anesthesia. Recovery after propofol anaesthesia is more rapid and 'clear' as compared to thiopental.

Typically during surgery, opioids such as fentanyl are also given since propofol is not considered an analgesic drug. Propofol is approved for use in more than 50 countries. It is also commonly used in veterinary medicine.

Pharmacology
Propofol is highly protein bound in vivo and is metabolised by conjugation in the liver. Its rate of clearance exceeds hepatic blood flow, suggesting an extrahepatic site of elimination as well. It has several mechanisms of action, both through potentiation of GABA-A receptor activity, thereby slowing the channel closing time, and also acting as a sodium channel blocker. Recent research has also suggested the endocannabinoid system may contribute significantly to propofol's anesthetic action and to its unique properties.

The elimination half-life of propofol has been estimated to be between 2–24 hours. However, its duration of clinical effect is much shorter because propofol is rapidly distributed into peripheral tissues. When used for IV sedation, propofol typically wears off in minutes. Propofol is versatile; the drug can be given for short or prolonged sedation as well as for general anesthesia. Its use is not associated with nausea as is often seen with opioid medications. These characteristics of rapid onset and recovery along with its amnestic effects have led to its widespread use for sedation and anesthesia.

Side Effects
Aside from the hypotension (mainly through vasodilatation) and transient apnea following induction doses, one of propofol's most frequent side effects is pain on injection, especially in smaller veins. This pain can be mitigated by pretreatment with lidocaine. Patients tend to show great variability in their response to propofol, at times showing profound sedation with small doses. A more serious but rare side effect is dystonia. Mild myoclonic movements are common, as with other intravenous hypnotic agents. Propofol appears to be safe for use in porphyria, and has not been known to trigger malignant hyperpyrexia.

Another recently described rare, but serious, side effect is propofol infusion syndrome. This potentially lethal metabolic derangement has been reported in critically-ill patients after a prolonged infusion of high-dose propofol in combination with catecholamines and/or corticosteroids.

Abuse
Despite a lack of analgesic properties, abuse of propofol has been reported. It can produce mild euphoria, sexual hallucinations, and disinhibition. Such recreational abuse has been described amongst medical staff such as anaesthetists who have access to the drug. However, abuse of the drug is relatively rare due to its potency and the level of monitoring required to take it, and it has not been scheduled by the US Drug Enforcement Administration. The steep dose response curve of the drug makes such abuse very dangerous without proper monitoring, and at least three deaths from self-administration have been recorded. The autopsy of entertainer Michael Jackson found propofol in his system and is believed to be a contributing factor in his death.

Sunday, July 26, 2009

Walter Cronkite: The Man, The Myth, The Legend

TheFix:
The papers are chock full of wonderful obituaries remembering legendary news anchor Walter Cronkite who died yesterday at the age of 92.

Among the sentiments shared are:

Washington Post: "Cronkite's career reflected the arc of journalism in the mid-20th century" from wire service reporter to radio voice to, finally, television.

New York Times' Douglas Martin: "He became something of a national institution, with an unflappable delivery, a distinctively avuncular voice and a daily benediction: 'And that's the way it is.'"

President Barack Obama: "He brought us all those stories large and small which would come to define the 20th century. That's why we love Walter, because in an era before blogs and e-mail, cell phones and cable, he was the news. Walter invited us to believe in him, and he never let us down."

Don Hewitt, executive producer of CBS News, creator of "60 Minutes":
"America had a love affair with Walter Cronkite."

Katie Couric, anchor and managing editor, "The CBS Evening News":
"There is something that is so quintessentially American about Walter Cronkite ... his honesty and candor in difficult times…if someone has integrity, to me, that is the finest attribute they can have. That means honor at a time when so many people are dishonorable. I think Walter Cronkite was and will always be the personification of those qualities."

Mickey Hart, drummer of the Grateful Dead:
"He was a freedom fighter and he was an honest, truthful guy that used his power while he was here on earth well, he was for the good… It just so happens that everybody's trust was put in the right place. That's the lucky part of all this."

President Bill Clinton:
"The passing of the years did not diminish as nearly as I could tell, one iota, his interest in, and love for his country and his desire to see the world get better."

George Clooney, actor/director:
"His legacy will be one of the great legacies of great Americans. It sounds overstated, but it isn't. He’s that important to us. Not just to generations before him but to generations coming up… That's probably good that there will never be a most trusted man in America again because if we’re not lucky enough to get Walter Cronkite, then we might be in a lot of trouble."

Brian Williams, anchor and managing editor, "NBC Nightly News":
"Walter got early on that this job is part hand holding, so that all of us in this line of work - who on days like 9/11 have been forced into any kind of explanatory role - Walter is with you whether you see him in the studio or not!"

Andy Rooney, correspondent, "60 Minutes": "He was the best newsman, he was just dedicated to news, he really cared about what the news was and he thought it was important to tell it to the American people, it's that simple."

Charlie Gibson, anchor, ABC "World News": "Walter's early lessons would be well kept in mind by all of us who have followed him. And that is to keep it on the news. Tell people what happened that day, keep it short, keep it direct, and keep it accurate."


CBS, the network that Cronkite helped put on the map via his nightly newscast, released a series of clips featuring the man known to many Americans as simply "Uncle Walter".



Saturday, July 25, 2009

Chelsea Tops AC Milan 2-1 in Baltimore

WashingtonPost:
In his homecoming, Oguchi Onyewu was nearly the hero.

With his new club, AC Milan, trailing in the 90th minute Friday night at M&T Bank Stadium, the Sherwood graduate got free for a header on a corner kick.

Onyewu's bid went just wide, and the Rossoneri fell to Chelsea, 2-1, spoiling the U.S. international's return to Maryland and keeping him winless in two appearances with Milan.

The sellout crowd of 71,203 stood and roared its approval when Onyewu's #14 lit up in green on the referee's glowing board at midfield signaling a substitution, and the 6-foot-2 defender entered for just his second appearance with the Rossoneri.


But just two minutes after his warm entrance, Onyewu's appearance was spoiled on a shot by Chelsea's Yuri Zhirkov following a frantic flurry of shots near the top of the box that gave Chelsea a 2-1 lead, and eventually the win.

Two brilliant goals in the first 45 minutes were worth the admission alone, the first a 35-yard laser from Chelsea forward Didier Drogba that found the upper corner on the far post. The second, Milan's equalizer, was a powerful shot from the seemingly ageless Clarence Seedorf on top of the 18-yard box on a feed from Brazilian star Ronaldinho, who held off a defender and touched back to the Dutch midfielder.


Ronaldinho, who was greeted with the loudest cheers during player introductions, seemed aware of the need to entertain the fans, showing his brilliance all over the field at different moments -- a bicycle-kick attempt inside the box that caromed off a teammate and a cheeky hop-touch pass in the first half and a nutmeg of a defender and curling free kick off the crossbar in the second.




Thursday, July 23, 2009

Hokies Earn More Than Wahoos

RichmondBizSense:

The survey is done and the results are in: If you want to make bank as a recent grad, Virginia Tech is the place to go.

A recent survey posted on payscale.com found that the median income for recent graduates of Virginia Tech is $52,900 per year. That is $700 more than its closest competitor, the University of Virginia. That’s right, Cavaliers: The Hokies got you beat.

Dartmouth College was No. 1 on the list.

Tech was No. 72.

Tech also inched out UVA with the median salary mid-career as well, with $97,400 to UVA’s $97,200. But nobody in the region seems to make as much mid-career as the grads of Washington & Lee, whose mid-career salaries land a median of $104,000 annually.

The number of people surveyed is unclear, but it has a heavy margin of error for the Ivy League and small liberal arts schools such as the University of Richmond. For those institutions, the margin of error is 10 percent. The whole survey has a margin of 5 percent.

University of Richmond grads fare a little better than their rival William & Mary after graduation: UR grads are making $48,900 to W&M grads’ $46,900, although W&M grads seem to make more mid-career.

Both schools just manage to edge out VCU grads, who make a median of $42,000 annually after graduating.

See the rest of the schools in the region in order of highest to lowest starting salary.

Virginia Tech
Starting: $52,900
Mid-Career: $97,400

University of Virginia
Starting: $52,200
Mid-Career: $97,200

Washington and Lee
Starting: $51,800
Mid-Career: $104,000

George Mason University
Starting: $49,300
Mid-Career: $85,700

University of Richmond
Starting: $48,900
Mid-Career: $88,700

The College of William and Mary
Starting: $46,900
Mid-Career: $89,300

Hampton University
Starting: $45,300
Mid Career: $75,800

James Madison University
Starting: $47,300
Mid-Career: $77,100

Old Dominion University
Starting: $42,700
Mid-Career: $76,700

Virginia Commonwealth University
Starting: $42,300
Mid-Career: $70,100

Randolph-Macon College
Starting: $42,100
Mid-Career: $82,600

Liberty University
Starting: $39,700
Mid-Career: $76,900

Norfolk State University
Starting: $38,100
Mid-Career: $63,800

Wednesday, July 22, 2009

Going Green: Cars

Ecars:

"Biofuels are inefficient and ethically dubious"

From climate change point of view, biofuels are neutral in the long term: if the biomass providing the fuel is grown again, carbon dioxide is going in a circle (from field to car - from car to atmosphere - from atmosphere to field).

Biofuels have quite a lot hanging from their necks. They are mostly produced from farmed plants which can take space from food plants and cause food shortage and undernutrition in the producing country. Fertilizing and machine-assisted agriculture might cause surprising amount of emissions and pollution.

Growing demand of biofuels is creating a need for more fields, destroying tropical forests to make room. Tropical forests are many times more valuable to the ecosystem tham biofuels.

Fuel engine doesn't become any more efficient with biofuel, the engine is wasting 60-75 % of the energy to heat.

More information:

Pros and Cons of Different Biofuels

All Biofuels Are Not the Same

Hydrogen cars and electric cars are very similar: both cars get their motive power from an electric motor. The essential difference is the energy storage. In an electric car the energy is charged straight to the car's batteries, which then release the power to the motor.

For a hydrogen car, hydrogen is produced from water with electric current. Then the hydrogen is turned to electricity in a fuel cell. The electricity then powers the motor. In this process most of the original energy is wasted, only about 20% is available for use. The electric car has three times better efficiency than the hydrogen car.

Hydrogen car is also far from a complete product, experts are talking about 20 years. It's also very expensive compared to electric car, and still depends on distribution and price fluctuations of one fuel.

Green Cars Are Going Mainstream

AdvertisingAge:

Green cars are moving into the mainstream, with 59% of consumers coveting more environmentally friendly vehicles, according to a global survey by Aegis Group's market-research arm, Synovate.

The survey covered 13,500 urban respondents across 18 markets: Australia, Brazil, Canada, China, Egypt, France, Germany, Greece, India, Japan, Korea, Malaysia, South Africa, Thailand, Turkey, the United Arab Emirates, the U.K. and the U.S.

Many consumers get tax breaks for driving green, and know they will use less gas, so they are prepared to pay a bit more for an environmentally-friendly vehicle. With the U.S. government stipulating a move to green as part of GM's bailout conditions, the shift towards eco-driving is clearly accelerating.

The long-term problem is that hybrid cars are not really that green, but the more radical, effective solutions for automakers are risky and expensive. Electric cars need an infrastructure to support re-charging -- and even so, the batteries are, in themselves, an environmental hazard. And advances like BMW's hydrogen fuel and stop-start technology (where a car automatically goes into "sleep" mode when stationary) don't come cheap.

"It would cost about $5 billion to fit out 10% of the U.S. with new fuel outlets. Who's going to pay for that?" Mr. Grant said. "And consumers are also reluctant to risk money on technology that may not become mainstream -- they need to be able to sell their cars on. Everyone is staring at an abyss."

Some of the most enthusiastic green drivers were in Thailand (77%), Korea (76%), China (75%) and Brazil (72%).

Synovate's director of motor research for China, Kelvin Gin, said, "Last year's Olympic Games really highlighted issues with China's air quality, plus the government has made concessions for both green car manufacturers and the people who choose to buy and drive them. In fact ,there is $1.5 billion up for grabs for investment in manufacturing greener cars."

The Brazilian government also provides incentives for people to buy greener vehicles. By law, all cars now have to be flex fuel, which has quickly made green cars part of consumers' behavior and thinking in Brazil. Brazil is also -- controversially -- giving over a lot of land to the cultivation of bio-diesel crops, with the result that Brazilians are proud to be leaders in developing alternative fuel.

South Africans showed the least interest in green cars, with 53% choosing their "dream" car without any consideration for the environment. In India, where the auto market is still relatively vibrant and automakers are marketing "dream" cars to aspirational consumers, 47% would not take the environment into consideration when purchasing a car.


Tuesday, July 21, 2009

Smoking Weed At the MTV Movie Awards

Gawker:
#1 on my "Top 10 Coolest Things To Do While Presenting An MTV Movie Award" list. And great publicity for Pineapple Express too. Niceeeeeee.


video


Also James Franco was nominated for Best Comedic Performance, and James along with Seth Rogen and Danny McBride were nominated for Best Fight. Sadly, they didn't win, as the entire movie's fanbase was passed out during the online voting process.

Monday, July 20, 2009

Moon Landing, 40 Years Later

CBS:

Perched atop a Saturn 5 rocket, the astronauts were on their way to meet the challenge President Kennedy had made eight years earlier: to land a man on the moon and return him safely to earth before the end of the decade.

It took 400,000 workers and $24 billion, intended in large part to prove American superiority over the Soviets.

Kennedy's vision guided NASA's human space flight program from the beginning. Mercury, Gemini and Apollo missions were designed with his objective in mind.

Despite skeptics who thought it could not be accomplished, Kennedy's dream became a reality on July 20, 1969, when Apollo 11 commander Neil Armstrong took a small step for himself and a giant leap for humanity, leaving a dusty trail of footprints on the moon.


A total of 12 Apollo astronauts would reach the lunar surface over the next three years, collecting rocks, driving buggies and even practicing a little golf.


The success of America's big bet in space depended on the ability of young, unheralded engineers to build rocket engines that were both powerful enough and reliable enough to wrench the spacecraft from Earth's jealous grasp and send it winging to the lunar surface.

The result of their work was the mammoth Saturn V, the largest and most powerful launch vehicle of its time. It was as tall as a 40-story building, with engines that gulped swimming pools worth of fuel every second. Producing 7.5 million pounds of thrust at liftoff, Saturn V was so powerful that during a test at Cape Canaveral, it rained ceiling tiles on the head of CBS news anchor Walter Cronkite, watching from four miles away.


In November, Neil Armstrong agreed for the first time to a television profile, speaking to 60 Minutes correspondent Ed Bradley about his extraordinary life.

This story originally aired on Nov. 6, 2005.

Saturday, July 18, 2009

College Words of the Week

DOUCHEBAG
A person with a shitty personality that needs to "take themself the fuck down" or "go home and get their fucking shine box." A douchebag usually assumes the form of a hair-gelling pretty-boy but can also be described as an overzealous, pompous, or vexatious asshole that most people wish were killed with a Mortal Kombat fatality.

Damn, i thought "Beverly Hills 90210" won the permanent award for most douchebags casted in one weekly television show, but then someone had to go make that show, "Friends."


HAMBONE
An overly preppy guy, usually a fratty who wears too much cologne and a popped collar. The type of guy everyone loves to hate. He is usually good looking but very stupid. His female counterpart is the hooknasty.

Aaron Carter is such a fucking hambone.


HOOKNASTY
A term usually applied to the blonde, fake n' bake orange girls who frequent frat parties and the beds of student athletes. She usually dresses for male attention: short skirt, tight shirt, thong hanging out, lots of makeup to cover up the ugly. Not all hooknasties are in sororities, but every sorostitute is a hooknasty. Often shamelessly performs the walk of shame. Is proud to talk about her sexploits and how she didn't use a condom.

Hey, go bareback that hooknasty if you want herpes!


MONEY SLUT
These ladies are the filth of society. They search out a partner and the only attribute that is of interest to them is financial. Often seen with gentlemen twice their age, or in large expensive vehicles. They very rarely have children as they are too selfish to look after anyone except themselves. These ladies are the same as whores, except they have to stay with the client until he dies, then claims the money that the client (husband) has left her.

Mark: Yeah, she's a "Money Slut", I even had a piece of her ass last May. She's loaded now though.

Sunday, July 5, 2009

All-VT Defense, ACC Era

TSL:
by Chris Coleman, TechSideline.com

Virginia Tech has played five seasons in the ACC, and their three ACC Championships are evidence that they've had a lot of good players. For the next two weeks, we'll take a look the All-VT team over the ACC era. All players from 2004 through 2008 are eligible, and this week we'll start with the defense.

All-VT Defense, ACC Era
Pos. Player Year
DE

Jason Worilds

2008
DT

Jim Davis

2004
DT

Carlton Powell

2007
DE

Chris Ellis

2007
Mike

Vince Hall

2006
Backer

Xavier Adibi

2007
Whip

Cody Grimm

2008
CB

Brandon Flowers

2007
FS

Vincent Fuller

2004
ROV

Aaron Rouse

2005
CB

Jimmy Williams

2004


Let's start up front, where football games are won and lost. It's tough to not have guys like Darryl Tapp and Jonathan Lewis on this list, but the Hokies have had a number of very good defensive linemen since joining the ACC.

Jason Worilds is arguably the best defensive end in the ACC. As a sophomore in 2008, he had 18.5 tackles for loss and eight sacks, despite playing with just one healthy shoulder all season. Worilds is poised to have a huge junior season in 2009.

On the other end is Chris Ellis, Tech's First Team All-ACC defensive end in 2007. Ellis had nine tackles for loss and 8.5 sacks, but he also had 37 quarterback hurries. He was constantly in the backfield making life miserable for opposing quarterbacks. He went on to be a third round pick of the Buffalo Bills.

On the inside, Jim Davis makes the list at tackle for his impressive 2004 season. He made 12 tackles for loss from his defensive tackle position. He came up with a huge sack against UNC quarterback Darian Durant, and who can forget the passes he batted down in Miami's final drive in the game that clinched Tech's first ACC Championship? Davis was also one of the team leaders of the 2004 Hokies, who reversed a three-year slide in Hokie football and served notice that Tech was going to be a force in their new conference.

Carlton Powell gets the nod for the other defensive tackle spot. Powell is perhaps the most underrated defensive tackle of the Beamer Bowl Era. He had 7.5 tackles for loss in 2007, and was unblockable by most ACC offensive linemen. He was a fifth round pick of the Denver Broncos.

Vince Hall makes the list at mike linebacker for his junior season in 2006. Hall had 128 tackles that year, including 10.5 tackles for loss. Arguably the best linebacker in the ACC that season, he anchored a defense that finished #1 in total defense.

Xavier Adibi is included at the backer position for his impressive senior season in 2007. In 2007, Adibi led the team with 115 tackles, including 12 tackles for loss and three sacks. He is the most athletic inside linebacker the Hokies have ever had. He came up with huge plays throughout the 2007 season, and he is now a starting linebacker for the Houston Texans.

There have been more physically gifted whip linebackers than Cody Grimm, but none can match him for production. Despite starting just one game in 2008, Grimm finished with 71 tackles, 14 tackles for loss and 7.5 sacks. He was a playmaker all year for the Hokies, and he is perhaps the best blitzing whip the Hokies have ever had.

There are plenty of players to pick from in Tech's secondary. Brandon Flowers is the best cornerback the Hokies have ever had. He was a lockdown corner in 2006 and 2007, but we'll give him the nod for his 2007 season. Flowers finished that year with 86 tackles and eight tackles for loss. He also had five interceptions, and he broke up nine more passes. He now starts for the Kansas City Chiefs.

The other cornerback spot goes to Jimmy Williams for his 2004 season. In 2004, Williams was arguably the best defensive player on Tech's team. Playing the boundary corner position, he was outstanding against the run. He made huge plays against UVA in 2004, stopping a run by quarterback Marques Hagans near the goal line, and saving a touchdown on a long run by Alvin Pearman. He also had five interceptions and broke up 14 passes.

Vincent Fuller had a great 2004 season as Tech's free safety. He had three interceptions, but he was much more important than his stats indicated. Fuller was the leader of the secondary, and his speed allowed him to get from sideline to sideline. He currently plays for the Tennessee Titans.

Finally, Aaron Rouse gets the nod at rover for his 2005 season. He finished with 77 tackles, including 4.5 tackles for loss. Rouse also led the team with four interceptions. He was equally effective against the run and pass. Rouse now plays for the Green Bay Packers, where he has starting experience in the secondary.

2009 Wimbledon Final

BBC:

Roger Federer became the greatest player in Grand Slam history as he beat Andy Roddick in five dramatic sets for a sixth Wimbledon and 15th major title.

The Swiss won 5-7, 7-6 (8-6), 7-6 (7-5), 3-6, 16-14 in four hours and 16 minutes to surpass Pete Sampras's 14 Grand Slam wins and regain the title he lost to Rafael Nadal last year.

And Sampras was back at Wimbledon for the first time since 2002 to watch from the Royal Box as Federer made history.

Federer, 27, will now return to the top of the world rankings ahead of Nadal.

But he had to dig deep against an in-form Roddick, who had four points for a two-set lead and then battled back to force an epic fifth set as the match became the longest men's singles final ever in terms of games played.

"He played unbelievable," Federer told BBC Sport, adding: "It feels great. It was a crazy match with an unbelievable end and my head's still spinning, but it's an unbelievable moment in my career."

Federer, who claimed a first French Open title last month, has now won Wimbledon six times, the US Open five times, the Australian Open three times and Roland Garros once.

Sampras was the last man to set a new mark in Grand Slams when he beat Pat Rafter in an emotional final at Wimbledon in 2000, and the American chose to return to the All England Club to witness Federer's achievement.


GRAND SLAM TITLES
15 - Roger Federer
14 - Pete Sampras
12 - Roy Emerson
11 - Rod Laver
11 - Bjorn Borg
10 - Bill Tilden
8 - Ken Rosewall
8 - Ivan Lendl
8 - Andre Agassi
8 - Jimmy Connors
8 - Fred Perry

2008 Wimbledon Final

Rafael Nadal vs. Roger Federer
Fifth Set Replay



ESPN:
WIMBLEDON, England -- Two points from victory, the No. 1-ranked Federer couldn't pull it out, instead succumbing to No. 2 Nadal 6-4, 6-4, 6-7 (5), 6-7 (8), 9-7 Sunday night in a 4-hour, 48-minute test of wills that was the longest men's final in Wimbledon history - and quite possibly the greatest.

Through rain, wind and descending darkness, the two greatest players of their generation swapped spectacular shots, until, against a slate sky, Nadal earned the right to fling his racket aside and collapse on his back, champion of the All England Club at last, giving Spain its first Wimbledon men's title since Manolo Santana won in 1966.

"Is impossible to explain what I felt in that moment, no?" Nadal said after accepting the golden trophy that has belonged to Federer since 2003.

The first man since Bjorn Borg in 1980 to win Wimbledon and the French Open in the same year, Nadal stopped Federer's streaks of 40 victories in a row at the All England Club, and a record 65 in a row on grass, thereby stamping his supremacy in their rivalry, no matter what the rankings say.

No man since 1927 had come back to win a Wimbledon final after losing the first two sets, and none had overcome a match point to seize victory since 1948. If anyone could, it figured to be Federer, especially on this particular lawn.

He hadn't lost a match on grass since 2002, and he hadn't lost a set during this tournament before Sunday. He also hadn't faced anyone nearly as talented and indefatigable as Nadal.

"Rafa keeps you thinking, and that's what the best players do to each other in the end," Federer said. "That's what we both do to each other."

It was their sixth Grand Slam final, already more than between any other pair of men in the 40-year Open era, and there could be several to follow. Federer is only 26, after all, and Nadal is 22. Federer has led the rankings for a record 231 consecutive weeks, and Nadal has been second for a record 154.

Nadal defeated Federer at the French Open en route to each of his championships there, in the 2005 semifinals and the past three finals, including a 6-1, 6-3, 6-0 rout last month that was Federer's most lopsided loss in 180 career Grand Slam matches.

Nadal lost to Federer in the 2006 Wimbledon final in four sets, and the 2007 final in five. Although the latter was certainly suspenseful, it featured neither the drama nor the all-around excellence of Sunday's encounter, which ended at 9:15 p.m., when Federer pushed a forehand into the net on Nadal's fourth match point.

Wednesday, July 1, 2009

Too Much Of A Good Thing: Serotonin Syndrome

Serotonin syndrome is a potentially life-threatening adverse drug reaction that may occur following therapeutic drug use, inadvertent interactions between drugs, overdose of particular drugs, or the recreational use of certain drugs. Serotonin syndrome is not an idiosyncratic drug reaction; it is a predictable consequence of excess serotonergic activity at central nervous system (CNS) and peripheral serotonin receptors.

The excess serotonin activity produces a spectrum of specific symptoms including cognitive, autonomic, and somatic effects. The symptoms may range from barely perceptible to fatal. Numerous drugs and drug combinations have been reported to produce serotonin syndrome. Diagnosis of serotonin syndrome includes observing the symptoms produced and a thorough investigation of the patient's history. The syndrome has a characteristic picture but can be mistaken for other illnesses in some patients, particularly those with neuroleptic malignant syndrome. No laboratory tests can currently confirm the diagnosis.

The symptoms are often described as a clinical triad of abnormalities:
  • Cognitive effects: mental confusion, hypomania, hallucinations, agitation, headache, coma
  • Autonomic effects: shivering, sweating, hyperthermia, hypertension, tachycardia, nausea, diarrhea
  • Somatic effects: myoclonus (muscle twitching), hyperreflexia (manifested by clonus), tremor