Definition
- Adverse reaction to medication that blocks dopamine
Clinical Manifestations
- Current antipsychotic use
- Can occur at any time
- Especially common with first-generation antipsychotics like haloperidol
- FARM: fever, autonomic dysfunction, rigidity, mental status changes
- Hyperthermia
- Autonomic dysfunction
- Hypertension
- Tachycardia
- Tachypnea
- Sweating
- Rigidity
- Mental status changes
- Compared to serotonin syndrome, NMS is more likely to have:
- More severe rigidity and hyperthermia
- Bradyreflexia
- Less acute onset
- Normal bowel sounds and pupils
Investigations
- Labs
- CK will be elevated (rhabdomyolysis)
Management
- Discontinue offending medication
- Supportive therapy
- IV fluids
- Antipyretics
- Cooling blankets
- Dantrolene, sometimes
- D2 agonists like bromocriptine, maybe
- If myoglobinuria: alkaline diuresis
Prognosis
- Mortality is high at 10-20%
