Neuroleptic malignant syndrome

Neuroleptic malignant syndrome
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Hx:
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Exposure to antipsychotic medications,
Abrupt withdrawal of dopaminergic drugs, and
Structural brain abnormality.

Symp:
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Altered mental status (confusion, psychosis, delirium)
Muscle rigidity (lead pipe or generalized hypertonia)
Hypertension, hypotension, tachycardia
Diaphoresis, sialorrhoea, urinary incontinence
Fever

{mem tip
머리가 굳고 (altered mental status)
몸이 굳는다 (rigidity)
몸이 굳어 혈압 상승. 몸이 굳어 열이남.
여러군데서 물이 샘 (diaphresis - 땀, sialorrhea - 침, urinary continence - 오줌)
}

Test:
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elevated CK (>500 units/L)
Other metabolic panel often normal.

Rx:
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Stop antipsychotic, dopaminergic antagonist. Restart/continue dopamine agonist.
rhabdomyolysis - vigorous hydration with IV fluid
Hyperthemia - paracetamol / ibprofen

dantrolene(controversial, may prolong clinical recovery) 1mg/kg IVI once. (over 1 hr)