Neuroleptic malignant syndrome: A diagnostic challenge

Ambulkar, Reshma; Patil, Vijaya; Moiyadi, Aliasgar

doi:10.4103/0970-9185.101946

Cited by 14 publications

(12 citation statements)

References 5 publications

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“…Recent literature suggests that both diagnosis and treatment of NMS remain challenging 11,18. While NMS is primarily recognized by hyperthermia and peripheral muscle rigidity, presentation can often vary.…”

Section: Discussionmentioning

confidence: 99%

Emergent Treatment of Neuroleptic Malignant Syndrome Induced by Antipsychotic Monotherapy Using Dantrolene

Ngo

Guerrero

Lanum

et al. 2019

Clinical Practice and Cases in Emergency Medicine

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Neuroleptic malignant syndrome (NMS) is a rare but potentially fatal complication resulting from neuroleptic drug therapy. Presentation of NMS can vary, and diagnosis relies primarily upon medical history and symptomatology. Due to the potential delay in diagnosis, emergency physicians should remain vigilant in recognizing the symptoms of NMS and be prepared to initiate immediate treatment following diagnosis. Dantrolene, which has been used for spasticity and malignant hyperthermia, has been reported as a potential treatment for NMS and led to off-label use for NMS. We report two cases of NMS induced by antipsychotic monotherapy for which dantrolene was administered.

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Section: Discussionmentioning

confidence: 99%

Emergent Treatment of Neuroleptic Malignant Syndrome Induced by Antipsychotic Monotherapy Using Dantrolene

Ngo

Guerrero

Lanum

et al. 2019

Clinical Practice and Cases in Emergency Medicine

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“…Puede ser fatal 62 y supone un reto clínico ya que el resultado del paciente depende del rápido reconocimiento y tratamiento de esta entidad. 65 Constituye un diagnóstico de exclusión.…”

Section: Síndrome Neuroléptico Malignounclassified

“…67,71 Manejo y tratamiento El tratamiento es el retiro de la medicación neuroléptica y la administración de dantroleno y bromocriptina. 65 Además, se recomienda monitorización cardiaca, respiratoria y renal, oxigenación e hidratación. Si es necesario se debe corregir y tratar las complicaciones como trastornos ácido-base, lesión renal, coagulopatía y convulsiones.…”

Section: Diagnósticounclassified

Reacciones adversas inmunitarias y no inmunitarias a fármacos de uso perioperatorio

González-Díaz

Arias-Cruz

Monge-Ortega

2019

RAM

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Las reacciones a medicamentos pueden ocurrir por mecanismos mediados o no por imunoglobulina E. La alergia a fármacos es un tipo de interacción adversa y comprende una gama de reacciones de hipersensibilidad mediadas por distintos mecanismos inmunológicos con diversas manifestaciones clínicas. Se estima una tasa anual de 3.2 casos fatales de anafilaxia asociados con los fármacos por cada 100 000 habitantes, que parece ser aproximadamente 10 veces mayor en los pacientes hospitalizados. La incidencia de reacciones anafilácticas perioperatorias se estima en uno de cada 10 000-20 000 procedimientos anestésicos. El diagnóstico se basa en una cuidadosa historia clínica y en el examen físico. En algunos casos pueden requerirse pruebas cutáneas, pruebas de retos progresivos y procedimientos de inducción de tolerancia al medicamento. En los pacientes hospitalizados y en el intervalo perioperatorio frecuentemente se emplean relajantes musculares, neurolépticos y morfinomiméticos, por lo que pueden presentarse respuestas adversas a estos fármacos. En esta revisión se hace énfasis en las reacciones alérgicas a los medicamentos y se abordan estrategias para su diagnóstico y manejo.

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“…7 Dopaminergic agents such as bromocriptine or amantadine may reverse the Parkinsonian symptoms of NMS. 34 Electroconvulsive therapy (ECT) can be used in refractory moderate to severe presentations. 35,36 Dantrolene is reserved for severe cases of hyperthermia and rigidity.…”

Section: Treatment Of Nmsmentioning

confidence: 99%

A Case Report of Probable Neuroleptic Malignant Syndrome

McCullough

Stroup

Brahm

2013

Journal of Pharmacy Technology

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Objective: To report a case of probable neuroleptic malignant syndrome (NMS) of unknown origin. Case Summary: A 32-year-old Caucasian man was found unconscious by emergency services. On presentation to the emergency department, he had a temperature of 107.5°F (41.9°C) and a Glasgow Coma Scale rating of 3 (range = 3-15). Fluids were administered and cooling blankets applied. He was admitted to the intensive care unit. Supportive measures decreased his temperature to 101.7°F (38.7°C). Arterial blood gas, comprehensive metabolic panel, complete blood count, and cardiac risk panel results were within normal limits; urinalysis and urine and serum drug screens were negative. He had been discharged on the following medications: benztropine, citalopram, chlorpromazine, divalproex, haloperidol, and hydroxyzine. Based on the medication discharge list and clinical presentation, the Naranjo Adverse Drug Reaction Probability Scale was applied. The criteria scoring indicated a probable relationship (8 of 12) between the medications prescribed and symptoms consistent with NMS. Discussion: NMS has been reported with antipsychotics (APs) and other medications with dopaminergic activity. The etiology is poorly understood. Risk factors (ie, recent initiation or dose increase of an AP, dehydration, or genetic susceptibility) may increase the potential. The differentiation between the diagnosis of NMS and other factors, such as serotonin syndrome or hyperthermia, includes laboratory and clinical presentation characteristics. The potential contributions of anticholinergic agents, psychiatric comorbidities, and other risk factors were identified for this patient. Conclusions: We report the case of a patient found unresponsive and comatose. A variety of assessment measures were used to identify potential causes. Based on evaluations, clinical presentation, the medication list, and criteria for an adverse drug event, a diagnosis of NMS was given. Health care providers may not be fully aware of the potential severity for this medication-related effect in patients with multiple risk factors.

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Neuroleptic malignant syndrome: A diagnostic challenge

Cited by 14 publications

References 5 publications

Emergent Treatment of Neuroleptic Malignant Syndrome Induced by Antipsychotic Monotherapy Using Dantrolene

Emergent Treatment of Neuroleptic Malignant Syndrome Induced by Antipsychotic Monotherapy Using Dantrolene

Reacciones adversas inmunitarias y no inmunitarias a fármacos de uso perioperatorio

A Case Report of Probable Neuroleptic Malignant Syndrome

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