Neuroleptic Malignant Syndrome

Question 1

What is a neuroleptic malignant syndrome (NMS)?

Answer 1

Life threatening reaction to neuroleptic or antipsychotic

Question 2

What is a neuroleptic?

Answer 2

Another name for antipsychotic

Question 3

What are some common symptoms of NMS?

Answer 3

1. High fever
2. Rigid muscles
3. Variable BP
4. Sweating
5. Tachycardia

Question 4

What are complication of NMS?

Answer 4

1. Rhabdomyolysis
2. Hyperkalaemia
3. Kidney Failure
4. Seizures

Question 5

What are the main causes of NMS?

Answer 5

1. Typical antipsychotics
2. Atypical antipsychotics
3. Phenothiazines - chlopromazine
4. Butyrophenones - haloperidol
5. Rapid decrease of L-dopa
6. dehydration while on neuroleptic

Question 6

What is the pathophysiology of NMS?

Answer 6

1. Blockage of D2 receptor
   2, induce rapid glutamate release
2. causes catatonia, neurotoxicity and myotoxicity
3. Blockage of D2 receptors in basal ganglia can cause parkinsonism

Question 7

What is the management of NMS?

Answer 7

1. stop offending medication
2. Agressive cooling blankets and ice packs
3. IV fluids to prevent renal failure from myoglobin
4. Use dantrolene, bromocriptine and diazipam

Question 8

What are risk factors for NMS?

Answer 8

1. Rapid dose
2. Long acting
3. Dehydration
4. Renal Failure

Question 9

What laboratory investigation can help differentiate between

Answer 9

1. Increased WBC

2. CK from rhabdomyolysis

Question 10

What is the DDx of NMS?

Answer 10

1. Heat stroke
2. Malignant Hyperthermia
3. Seretonin Syndrome
4. Drugs - cocaine, amphetamines
5. encephalitis