Successful Treatment of Six Patients with Neuroleptic Malignant Syndrome Associated with Myoglobulinemic Acute Renal Failure

Abstract

Neuroleptic malignant syndrome is a rare but potentially lethal, rare reaction to neuroleptics which is characterized by altered levels of consciousness, extrapyramidal effects, autonomic instability, hyperthermia, and elevated serum creatine phosphokinase levels. The most serious complication of neuroleptic malignant syndrome is acute renal failure. We investigated six cases of neuroleptic malignant syndrome associated with myoglobulinemic acute renal failure due to rhabdomyolysis and effect of hemodialysis or hemodiafiltration. The patients were five males and one female with a mean age of 43.5 yr. All of the patients, who developed acute renal failure induced from rhabdomyolysis, had previously received butyrophenone (haloperidol), phenothiazine, benzamide, iminomide, benzisoxazole, antidepressants, and hypnotics (benzodiazepine and barbiturate) for the treatment of schizophrenia. The clinical manifestations of neuroleptic malignant syndrome were characterized by altered consciousness, muscle rigidity and weakness, fever, and excessive perspiration. The peak laboratory data were blood urea nitrogen 102 +/- 26 (mean +/- SD) mg/dL, serum creatinine 9.1 +/- 2.1 mg/dL, serum creatine phosphokinase 229,720 +/- 289,940 IU/L, and all of them developed oliguric acute renal failure. Dantrolene sodium administration was given to five cases and hemodialysis or hemodiafiltration was performed in all of them. The serum creatinine level after hemodialysis or hemodiafiltration was 1.4 +/- 1.0 mg/dL. All patients were successfully cured of acute renal failure by hemodialysis or hemodiafiltration. As a result, myoglobulinemic acute renal failure associated with neuroleptic malignant syndrome was successfully treated by hemodialysis or hemodiafiltration.

Neuroleptic Malignant Syndrome: Complications, Outcomes, and Mortality

“…Melli et al demonstrated acute renal failure in 34 % of patients with rhabdomyolysis caused by NMS [8] and the serum creatinine level correlated positively with CPK in a linear fashion (R 2 = 0.12; p < 0.0001) [8]. In Japan, Sanai et al published a case series of six patients with rhabdomyolysis that caused myoglobinuria and AKI and they were treated successfully with hemodialysis and dantrolene [19]. In our study, 17.7 % patients had AKI that increased the odds of death by 2.3 times.…”

Does Haloperidol Have Side Effects on Histological and Stereological Structure of the Rat Kidneys?

“…Sanai et al reported that acute renal failure induced from rhabdomyolysis developed in patients who had previously received haloperidol. [27] Since the recent development of stereological quantification methods, a large amount of numerical data has been readily obtained. [28,29] In the histological step of our study, dilatation of glomerular capillaries and large blood vessels was seen.…”

Neuropsychiatric complications of commonly used palliative care drugs

“…NMS is characterised by altered levels of consciousness, extrapyramidal effects (rigidity and akinesia), autonomic instability, hyperthermia, sweating and tremors or rigors 74 – 76. Muscle rigidity is the cardinal feature of NMS and is often associated with myonecrosis, myoglobinuria, and elevated serum creatinine phosphokinase (CPK) levels 77.…”

“…This, combined with rhabdomyolysis, can lead to acute renal failure, one of the more serious complication of NMS 74. Death has been reported to occur in 20–40% of cases 75 80 81…”