The evaluation and management of patients with neuroleptic malignant syndrome

Bhanushali, Minal; Tuite, Paul J.

doi:10.1016/j.ncl.2003.12.006

Cited by 115 publications

(115 citation statements)

References 68 publications

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“…El síndrome neuroléptico maligno es una complicación de aparición tardía (2 a 10 días) y se caracteriza por presentar alteración del estado mental, rigidez muscular, hipertermia e inestabilidad autonómi-ca (fluctuaciones en la frecuencia cardiaca y la tensión arterial). 35 El diagnóstico se basa en los hallazgos clíni-cos. El tratamiento consiste en administrar las medidas de sostén. Así mismo, al igual que en los antidepresivos cíclicos, debe monitorizarse la longitud del complejo QRS y de encontrarse mayor a 100 ms iniciar terapia con bicarbonato de sodio.…”

Section: Antipsicóticosunclassified

CHAMACON: exposiciones potencialmente letales en pediatría

Bazán-Godínez

Pérez-Tuñon

2016

Acta Pediatr Mex

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Accidental exposure to potentially toxic substances is a common problem in children. This condition could be catastrophic, depending on factors associated with the patient, their environment and the substance involved. In this sense, there is a group of commonly used substances that when ingested by an infant, even in small amounts (one tablet, sip or spoonful), may cause death, either because they are highly toxic or simply because they are in a high concentration. When a child ingests any of these substances, it should be recognized as "a potentially lethal exposure". We propose the mnemonics CHAMA-CON to identify those substances and subsequently, we mentioned key aspects for the initial treatment in this exposures. KEYWORDS: poisoning in children; lethal exposures in pediatricsActa Pediatr Mex. 2016 jul;37(4):228-240. CHAMACON: exposiciones potencialmente letales en pediatría ResumenLa exposición accidental a sustancias potencialmente tóxicas es un problema frecuente en pediatría. Esta condición puede ser catastrófica dependiendo de factores propios del paciente, su entorno y de la propia sustancia a la que fue expuesto. En este sentido, existe un grupo de sustancias de uso común que al ser ingeridas por un lactante, aun en cantidades mínimas (una tableta, un sorbo o una cucharada), pueden causarle la muerte, ya sea porque son altamente tóxicas o simplemente porque se encuentran en una gran concentración. Cuando un niño ingiere cualquier sustancia de este grupo debe reconocerse como una "exposición potencialmente letal en pediatría". En el presente trabajo se propone la nemotecnia CHAMACON para lograr un sencillo reconocimiento de dichas sustancias y posteriormente se abordan aspectos clave en el abordaje inicial del paciente que ha presentado una exposición de esta índole.PALABRAS CLAVE: intoxicaciones en niños, exposiciones letales en pediatría.

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Section: Antipsicóticosunclassified

CHAMACON: exposiciones potencialmente letales en pediatría

Bazán-Godínez

Pérez-Tuñon

2016

Acta Pediatr Mex

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“…Intubation and paralysis may be required in the patient with intractable hyperthermia. Patients who succumb from NMS typically die from complications of extreme hyperthermia including rhabdomyolysis, acute tubular necrosis, and complications of renal failure, dysrhythmias, and cardiovascular collapse secondary to intractable metabolic acidosis [36][37][38]. Renal failure has been associated with a mortality rate of 50% [38].…”

Section: How Should Amantadine Withdrawal or Nms Be Treated?mentioning

confidence: 99%

“…Administration has been recommended at 1-2.5 mg/kg intravenously; if symptoms improve, the patient can receive 1 mg/kg every 6-12 hours for an additional 48 hours, followed by 1 mg/kg per day for 8 days [41,42]. Milder symptoms may be treated with an oral regimen of 50-200 mg daily [36]. Dosing should not exceed 10 mg/kg per day in order to avoid hepatotoxicity [36].…”

Section: What Drugs and Other Therapies Are Used To Treat Nms?mentioning

confidence: 99%

“…Milder symptoms may be treated with an oral regimen of 50-200 mg daily [36]. Dosing should not exceed 10 mg/kg per day in order to avoid hepatotoxicity [36]. While dantrolene has been demonstrated to be effective in the treatment of NMS, it is not specifically targeted at the proposed etiology for development of NMS.…”

Section: What Drugs and Other Therapies Are Used To Treat Nms?mentioning

confidence: 99%

“…Bromocriptine is given at doses of 2.5-10 mg orally every 6 hours and may be titrated up to a total dose of 40 mg/day [36]. Amantadine is usually given at 100-200 mg/day orally, but may be titrated up to 200 mg every 12 hours [37].…”

Section: What Drugs and Other Therapies Are Used To Treat Nms?mentioning

confidence: 99%

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Case files of the Program in Medical Toxicology at Brown University: Amantadine withdrawal and the neuroleptic malignant syndrome

Brantley¹,

Cohn²,

Babu³

2009

J. Med. Toxicol.

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A sixty-one-year old woman with a history of depression and idiopathic dystonia presented to the emergency department (ED) with fever, nausea, muscle rigidity, and redness in her extremities. The patient had seen various specialists for her dystonia during the preceding year and had tried multiple medication regimens, including benztropine and tizanidine. The patient described her home medications as tizanidine 2 mg three times daily, diazepam 2.5 mg daily, escitalopram 100 mg daily, rosuvastatin 10 mg daily and bupropion 300 mg nightly.At ED presentation her vital signs were: temperature 37.5°C (99.5F), blood pressure 157/76 mmHg, heart rate 105 beats per minute, respirations 24 per minute, and oxygen saturation of 100% on room air. Her physical examination was significant for diaphoresis, tachycardia, diffuse flushing, tremors in her upper and lower extremities, muscle rigidity, and hyperreflexia in the upper and lower extremities. The tremors were low amplitude and worse with intention, while the rigidity had cogwheeling features and was more notable in her lower extremities. Initial laboratory evaluation was significant for a creatine phosphokinase (CPK) of 1146 IU/L. Her electrocardiogram showed sinus tachycardia with normal QRS and QT intervals, and no evidence of acute ischemia.Two months earlier, the patient's neurologist had started her on amantadine 100 mg twice daily for dystonia. Three days prior to ED presentation, the patient abruptly stopped taking her amantadine on the advice of a pharmacist, secondary to bilateral lowerextremity edema. The following day, the patient presented to her primary care physician complaining of nausea, tremors, and diffuse flushing. The physician treated her for an allergic reaction with oral steroids and diphenhydramine. The patient's symptoms worsened over the next day with increasing tremors and rigidity, low-grade fever, nausea, and flushing, which prompted her presentation to the ED.

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