Pe

Labs

Imaging Gross Pathology Micro Pathology Treatment

Discussion

A 27-year-old female Is brought to the emergency room by her mother because of a high fever and muscle rigidity.

'l'he patient's mother reports that her daughter is being treated with antipsychotics for schizophrenia but is otherwise in good health.

VS: tachycardia (HR 165); hypotension (BP 100/50); fever. PF.: confused with an altered level of consciousness; pallor; diaphoresis (due to autonomic instability); marked rigidity of all muscle groups.

CBC: leukocytosis. Increased CK (indicates muscle damage). ABGs: metabolic acidosis.

Treat muscle rigidity with diazepam and initiate rapid cooling to prevent brain damage (fever may reach dangerous levels). Dantrolene, dopamine agonists (bromocriptine). Respiratory support.

Neuroleptic malignant syndrome is a life-threatening complication characterized by generalized rigidity and high fever that occur in certain patients with idiosyncrasy to antipsychotics, mainly haloperidol. The onset of symptoms is usually within a couple of weeks after the drug is started; diminished iron reserves and dehydration are predisposing factors. p.277

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