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Neuroleptic Malignant Syndrome

Reviewed 06/2019
 


BASICS

DESCRIPTION

  • Neuroleptic malignant syndrome (NMS) is a life-threatening condition that may develop during treatment with neuroleptic medications; 2/3 of cases develop within the first 2 weeks of ...

DIAGNOSIS

HISTORY

  • Neuroleptic use or an increase in dose

  • Discontinuation of antiparkinsonian drug

  • Mental status changes common

PHYSICAL EXAM

  • Extrapyramidal symptoms: dysphagia, short shuffling gait, restin...

TREATMENT

  • NMS is a medical emergency. Discontinue offending agent immediately (3)[B].

  • Treat hyperthermia aggressively with cooling baths or ice packs.

  • Provide supportive care (3)[C].

    • Hydration

    • Maintain ...

ONGOING CARE

FOLLOW-UP RECOMMENDATIONS

  • Allow at least 15 days after recovery before considering a rechallenge neuroleptic; rechallenge should not be with the medication implicated in the original NMS e...

REFERENCES

1
Modi S, Dharaiya D, Schultz L, et al. Neuroleptic malignant syndrome: complications, outcomes, and mortality. Neurocrit Care.  2016;24(1):97–103. [View Abstract on OvidMedline]
2
Belved...

ADDITIONAL READING

  • Berman BD. Neuroleptic malignant syndrome: a review for neurohospitalists. Neurohospitalist.  2011;1(1):41–47. [View Abstract on OvidMedline]

  • Neuhut R, Lindenmayer JP, Silva R. ...

SEE ALSO

Algorithms: Coma; Delirium 

CODES

ICD10

G21.0 Malignant neuroleptic syndrome 

ICD9

333.92 Neuroleptic malignant syndrome 

SNOMED

15244003 Neuroleptic malignant syndrome (disorder) 

CLINICAL PEARLS

  • NMS is a medical emergency that normally requires critical care for management.

  • 2/3 of NMS cases occur within the first 2 weeks of starting a neuroleptic therapy.

  • Elevated serum creatini...

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