A & A case reports
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A 31-year-old man who had surgery after a gunshot injury was recovering in the intensive care unit when a sudden deterioration in his condition occurred after enteral administration of methylene blue to detect a fistula. Serotonin syndrome was diagnosed based on hyperthermia, ocular clonus, and excessive diaphoresis.
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Methylene blue, a drug used to treat vasoplegia and methemoglobinemia, also inhibits monoamine oxidase-A. When given in combination with serotonergic medications, methylene blue can lead to serotonin excess syndrome. ⋯ Patients undergoing cardiopulmonary bypass for cardiac surgery are a specific population at risk for postbypass vasoplegic shock. The use of methylene blue to treat vasoplegia in this group of patients should be weighed in light of their current medications and potential drug interactions.