A rapidly progressing lethal case of neuroleptic malignant syndrome

Lenler-Petersen, P; Hansen, Bernie; Hasselstrøm, L

doi:10.1007/bf01705164

Cited by 18 publications

(14 citation statements)

References 12 publications

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“…To our knowledge, a few cases died from cardiac complications in NMS in the literature (Lenler-Petersen et al 1990;Benaissa et al 1998;Patrick et al 2003). In one of these reports, cardiac and skeletal muscles showed similar changes, suggesting a common disease process on post mortem investigation (Patrick et al 2003).…”

Section: Discussionmentioning

confidence: 94%

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Zuclopenthixol-induced neuroleptic malignant syndrome presenting as fever of unknown origin, hyperglycaemia and acute myocardial infarction in a 60-year-old man

Varoğlu¹,

Ateş²,

Gündoğdu³

et al. 2009

The World Journal of Biological Psychiatry

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Neuroleptic malignant syndrome (NMS) is a rare clinical condition and potentially life-threatening complication of antipsychotic medications. We report a patient with an atypical presentation of NMS. A 60-year-old man with schizophrenia was admitted to our hospital with disturbed consciousness, fever and marked extrapyramidal rigidity both in the upper and lower extremities. He had been given i.m. zuclopenthixol 200 mg/month but had not taken the last dose. Laboratory investigations showed that creatinine phosphokinase 428 IU/l (normal up to 130), lactate dehydrogenase 772 IU/l (normal up to 450), blood glucose 256 mg/dl (65-110). Urine analyses revealed ketonuria. White blood cell (WBC) count was 6100 cells/mm(3). Therefore, the patient was diagnosed as having NMS and antipsychotic medications were stopped. Adequate hydration was provided and bromocryptine 5 mg was started three times a day. Despite treatment, the patient died due to acute myocardial infarction after 3 days of hospitalization.

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Section: Discussionmentioning

confidence: 94%

“…Risk factors are dehydration, use of multiple antipsychotic medications, agitation, previous episodes, rate and route of neuroleptic administration (Aruna and Murungi 2005). The rapidly fatal course is an uncommon event (Lenler-Petersen et al 1990). The mortality rate of NMS in the literature is 10Á20%.…”

Section: Introductionmentioning

confidence: 99%

Zuclopenthixol-induced neuroleptic malignant syndrome presenting as fever of unknown origin, hyperglycaemia and acute myocardial infarction in a 60-year-old man

Varoğlu¹,

Ateş²,

Gündoğdu³

et al. 2009

The World Journal of Biological Psychiatry

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“…Benzodiazepines, for example, lorazepam 1-2 mg, may be substituted to manage agitation, and good fluid intake should be assured. The notion that benzodiazepines may prevent NMS from occurring, or may treat mild NMS, has been suggested by some investigators [94], although controlled studies of risk factors have not consistently supported this hypothesis [64]. Discontinuation of lithium is also generally recommended.…”

Section: Early/mild Nmsmentioning

confidence: 98%

“…In addition, altered mental status may increase the risk for aspiration pneumonia in about 20 % of patients [93]. Autonomic dysfunction can also predispose to cardiac arrhythmias and myocardial ischemia that might be lethal [94].…”

Section: Complications and Residual Symptomsmentioning

confidence: 99%

Neuroleptic Malignant Syndrome

Mehndiratta

Spolter

Igboeli

et al. 2013

Neuromuscular Disorders in Clinical Practice

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“…The onset of symptoms occurs from hours to months after drug exposure. The fulminant course in our patient is infrequent, but has been reported previously [4]. The mortality rate in NMS cited in the literature is between 15 and 22 % [1, 2, 3].…”

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confidence: 88%

Acute cardiac failure in a case of rapidly lethal neuroleptic malignant syndrome

1998

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Sir: A 40-year-old previously healthy woman, without psychiatric history, was admitted to the Psychiatric Department for behavioral disturbances. She received neuroleptic treatment including chlorpromazine (Largactil) then loxapine (Loxapac) per os. Because of the onset of fever 2 weeks later, treatment was stopped and the patient was transferred to the internal medicine service for investigations. Cerebral CT scan and bacteriological screening examinations (blood and CSF cultures, thick smear, HIV) were negative. Only a culture of urine was positive for gram-negative bacilli. Amoxicillin (Clamoxyl) and netilmicin (Netromicine) were prescribed. The patient remained febrile at 41.2°C. She was then transferred to our Toxicological ICU with suspicion of neuroleptic malignant syndrome (NMS). On arrival, the patient was unconscious, with global hypertonicity, intermediately reactive pupils and a respiratory rate of 34/min. She was intubated and mechanically ventilated. The rectal temperature was 41°C. Her systolic blood pressure was 120 mm Hg, heart rate 148/min. QRS duration was 0.06 s and QT/QTc 0.28/0.26 s were noted on the ECG. Pertinent laboratory data were: CPK: 813 IU/ml (N < 230), plasma lactate: 2.2 mmol/l, white blood cell count 11.8´10 9 /l. The admission blood, CSF and urine cultures were negative. Blood toxicology screening was negative for alcohol, benzodiazepines, tricyclic antidepressants, barbiturates, carbamates, paracetamol and salicylates. Serial hemodynamic measurements were obtained using a Swan-Ganz catheter (Table). Therapy included cooling, fluid repletion, pancuronuim infusion and dantrolene sodium, resulting in a transitory decrease of the body temperature to 37.7°C (10 h). The body temperature then rose to 40.7°C at 31 h. The addition of bromocriptine did not produce any change of temperature. Coagulopathy without evidence of bleeding was noted. The patient died on day 3 (56 h) from refractory cardiogenic shock. Her temperature just before death was 41°C.NMS is an uncommon, life-threatening consequence of neuroleptic treatment. A temperature as high as 41°C, muscular rigidity, autonomic dysfunction, sinus tachycardia and fluctuating consciousness, as initially noted in our patient, appear characteristic of NMS [1, 2, 3]. The laboratory abnormalities, negative CT scan, blood, CSF and urine cultures also appear compatible with NMS. The onset of symptoms occurs from hours to months after drug exposure. The fulminant course in our patient is infrequent, but has been reported previously [4]. The mortality rate in NMS cited in the literature is between 15 and 22 % [1, 2, 3]. Deaths occurred 3±30 days after the onset of symptoms and resulted from respiratory or renal failure, cardiovascular collapse or arrhythmias [1, 2, 3]. Respiratory failure is presumed a secondary complication due to prolonged immobilization and fluctuating consciousness resulting in pulmonary emboli and aspiration. Renal failure seems to be related to dehydration associated with rhabdomyolysis. The mechanism of cardiovascular...

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A rapidly progressing lethal case of neuroleptic malignant syndrome

Cited by 18 publications

References 12 publications

Zuclopenthixol-induced neuroleptic malignant syndrome presenting as fever of unknown origin, hyperglycaemia and acute myocardial infarction in a 60-year-old man

Zuclopenthixol-induced neuroleptic malignant syndrome presenting as fever of unknown origin, hyperglycaemia and acute myocardial infarction in a 60-year-old man

Neuroleptic Malignant Syndrome

Acute cardiac failure in a case of rapidly lethal neuroleptic malignant syndrome

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