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His initial presentation of a large mixed drug overdose manifested as serotonin syndrome, which had a protracted course complicated by ethanol withdrawal. He eventually stabilised and was transferred to the general ward, and was subsequently discharged from hospital on day 47 with continuing psychiatric care. This case demonstrates the challenges and considerations in diagnosis and management of large mixed drug overdoses where multiple toxidromes overlap.<\/jats:p>","DOI":"10.1136\/bcr-2016-215554","type":"journal-article","created":{"date-parts":[[2016,6,23]],"date-time":"2016-06-23T23:26:40Z","timestamp":1466724400000},"page":"bcr2016215554","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Challenges in a large mixed drug overdose patient"],"prefix":"10.1136","volume":"2016","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8727-149X","authenticated-orcid":false,"given":"Paige","family":"Zhang","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Emily","family":"Austin","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Margaret","family":"Thompson","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Steve","family":"Lin","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2016,6,22]]},"reference":[{"key":"2025042703372751000_2016.jun22_1.bcr2016215554.1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2125.2009.03458.x"},{"key":"2025042703372751000_2016.jun22_1.bcr2016215554.2","doi-asserted-by":"publisher","DOI":"10.1136\/emj.2009.075549"},{"key":"2025042703372751000_2016.jun22_1.bcr2016215554.3","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.1987.00370010131028"},{"key":"2025042703372751000_2016.jun22_1.bcr2016215554.4","first-page":"310","article-title":"Overview of serotonin syndrome","volume":"24","author":"Iqbal","year":"2012","journal-title":"Ann Clin Psychiatry"},{"key":"2025042703372751000_2016.jun22_1.bcr2016215554.5","doi-asserted-by":"publisher","DOI":"10.1111\/j.1360-0443.1989.tb00737.x"},{"key":"2025042703372751000_2016.jun22_1.bcr2016215554.6","first-page":"155","article-title":"Serotonin syndrome vs neuroleptic malignant syndrome: a contrast of causes, diagnoses, and management","volume":"24","author":"Perry","year":"2012","journal-title":"Ann Clin Psychiatry"},{"key":"2025042703372751000_2016.jun22_1.bcr2016215554.7","doi-asserted-by":"crossref","first-page":"361","DOI":"10.5694\/j.1326-5377.2007.tb01282.x","article-title":"Serotonin toxicity: a practical approach to diagnosis and treatment","volume":"187","author":"Isbister","year":"2007","journal-title":"Med J Aust"},{"key":"2025042703372751000_2016.jun22_1.bcr2016215554.8","doi-asserted-by":"publisher","DOI":"10.1007\/s12028-013-9914-2"},{"key":"2025042703372751000_2016.jun22_1.bcr2016215554.9","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp.2007.128322"},{"key":"2025042703372751000_2016.jun22_1.bcr2016215554.10","doi-asserted-by":"publisher","DOI":"10.1016\/S0736-4679(98)00057-2"},{"key":"2025042703372751000_2016.jun22_1.bcr2016215554.11","doi-asserted-by":"publisher","DOI":"10.1007\/978-3-540-74806-9_16"},{"key":"2025042703372751000_2016.jun22_1.bcr2016215554.12","first-page":"1139","article-title":"Prevention, recognition, and management of serotonin syndrome","volume":"81","author":"Ables","year":"2010","journal-title":"Am Fam Physician"},{"key":"2025042703372751000_2016.jun22_1.bcr2016215554.13","unstructured":"Goldfrank LR , Flomenbaum N . 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