Emergency - Neuroleptic malignant syndrome

From CambridgeNotes

Affects 0.2% of patients on neuroleptics. Haloperidol most common culprit.

History and Examination

  • Hyperthermia
  • Muscle rigidity
  • Extra-pyramidal signs
  • Autonomic instability
  • Mutism
  • Confusion
  • Coma

Differential Diagnosis

  • Malignant hyperthermia
  • Heat stroke
  • Catatonia

Investigations

  • ↑WBC
  • ↑LFTs
  • ↑CPK, AST, LDH

Definitive Treatment

  • Stop drugs
  • Support with IV fluids
  • Cooling and ventilation
  • Give dantrolene (reduces muscle tone) and bromocriptine or amantadine (raises dopamine)
  • Complications: Rhabdomyolysis → acute renal failure, Thrombosis → pulmonary embolism
MediaWiki