Serotonin Syndrome in a Toddler from Sibutramine Adulterant

Serotonin syndrome (SS) is a rare yet potentially life-threatening condition resulting from excessive serotonin activity in the nervous system.This case report describes a 3-year-old girl who developed severe agitation and chorea following the accidental ingestion of three tablets of slymochoco, an unregulated dietary supplement containing sibutramine-a banned serotonin-norepinephrine reuptake inhibitor.The child presented with agitation, hypertonia, and generalized involuntary movements eight hours post-ingestion.Emergency treatment included intravenous diazepam, followed by oral chloral hydrate, leading to gradual symptom resolution within 48 hours.Sibutramine toxicity in children is uncommon, but can present SS with neuromuscular abnormalities, autonomic dysregulation, and altered mental status.Pediatric SS presents diagnostic challenges due to variability in symptoms, requiring vigilant assessment for neuromuscular findings such as clonus and hyperreflexia.Supportive care, including benzodiazepines for agitation, forms the cornerstone of management, whereas cyproheptadine may be used in severe cases.This case underscores the diagnostic challenges of SS in children, exacerbated by the continued presence of sibutramine in unregulated slimming agents.Clinicians should inquire about herbal and unregulated weight loss products when evaluating pediatric patients with unexplained autonomic or neuromuscular symptoms.