Neuroleptic malignant syndrome

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(Redirected from NMS)

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%