it was listed in his medical record

it was listed in his medical record andoverdose should have been considered. He also displayedmental status changes (confusion and memory loss),slight tachycardia, and mildly increased serum CK thatalthough nonspecific, could occur in serotonin syndrome. Another confounding factor was the fact that thetime of his most recent dose was not known, as symptomsof serotonin syndrome often begin to abate within 24 h ofdiscontinuing tramadol.PCP is a well-known N-methyl-D-aspartate receptor antagonist; however, evidence suggests it also exerts agonist-like effects at serotonin 5-HT2 receptors(3). Although serotonin syndrome has not been linkedto PCP, there are accounts of rhabdomyolysis withand without acute renal failure in cases of PCP intoxication (4).