Neuroleptic Malignant Syndrome Workup

  • Author: Joseph Tonkonogy, MD, PhD; Chief Editor: Iqbal Ahmed, MBBS, FRCPsych (UK)   more...
 
Updated: Oct 18, 2011
 

Laboratory Studies

  • The rigidity and hyperthermia found in neuroleptic malignant syndrome contribute to muscle damage and necrosis. Elevated blood creatine kinase (CK), aminotransferases (aspartate aminotransferase [AST], alanine aminotransferase [ALT]), and lactate dehydrogenase (LDH) reflect damage and necrosis, which can progress quickly to rhabdomyolysis with hyperkalemia, hyperphosphatemia, hyperuricemia, and hypocalcemia. Elevated blood levels of myoglobin and myoglobinuria can be observed and ultimately can lead to renal failure.
  • Assessment of elevation of serum CK level is especially frequently used in psychiatric practice for diagnostic evaluation of NMS-related rhabdomyolysis. Other causes of CK elevation may include prescription drugs, alcohol, physical reason, acute coronary syndrome.
  • More general laboratory features in NMS include leukocytosis, thrombocytosis, and evidence of dehydration. Cerebrospinal fluid protein might be elevated.[22] Serum iron concentration might be decreased.
  • Investigate other causes for fever based on the clinical scenario.
  • Investigate symptoms and signs of urinary tract, respiratory, and CNS infections.
  • A summary of the laboratory abnormalities associated with neuroleptic malignant syndrome includes the following:
    • Increased LDH
    • Increased CK
    • Increased AST
    • Increased ALT
    • Increased alkaline phosphatase
    • Hyperuricemia
    • Hyperphosphatemia
    • Myoglobinemia
    • Leukocytosis
    • Thrombocytosis
    • Proteinuria
    • Decreased serum iron[23]
    • Increased cerebrospinal fluid (CSF) protein
    • Hypocalcemia
    • Myoglobinuria
Proceed to Treatment & Management
 
 
Contributor Information and Disclosures
Author

Joseph Tonkonogy, MD, PhD  Clinical Professor of Psychiatry, University of Massachusetts Medical School; Consulting Staff, Departments of Psychiatry, University of Massachusetts Medical School

Joseph Tonkonogy, MD, PhD is a member of the following medical societies: American Academy of Neurology, American Medical Association, American Neuropsychiatric Association, International Neuropsychological Society, Massachusetts Medical Society, Royal Society of Medicine, Society for Neuroscience, and United Council for Neurologic Subspecialties, Certification Behavioral Neurology and Neuropsychiatry

Disclosure: Nothing to disclose.

Coauthor(s)

Darius P Sholevar, MD  Fellow, Cardiovascular Disease, Albert Einstein Medical Center

Disclosure: Nothing to disclose.

Specialty Editor Board

Alan D Schmetzer, MD  Professor Emeritus, Interim Chairman, Vice-Chair for Education, Associate Residency Training Director in General Psychiatry, Fellowship Training Director in Addiction Psychiatry, Department of Psychiatry, Indiana University School of Medicine; Addiction Psychiatrist, Midtown Mental Health Cener at Wishard Health Services

Alan D Schmetzer, MD is a member of the following medical societies: American Academy of Addiction Psychiatry, American Academy of Clinical Psychiatrists, American Academy of Psychiatry and the Law, American College of Physician Executives, American Medical Association, American Neuropsychiatric Association, American Psychiatric Association, and Association for Convulsive Therapy

Disclosure: Eli Lilly & Co. Grant/research funds Other

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Harold H Harsch, MD  Program Director of Geropsychiatry, Department of Geriatrics/Gerontology, Associate Professor, Department of Psychiatry and Department of Medicine, Froedtert Hospital, Medical College of Wisconsin

Harold H Harsch, MD is a member of the following medical societies: American Psychiatric Association

Disclosure: lilly Honoraria Speaking and teaching; Forest Labs None None; Pfizer Grant/research funds Speaking and teaching; Northstar None None; Novartis Grant/research funds research; Pfizer Honoraria Speaking and teaching; Sunovion Speaking and teaching; Otsuke Grant/research funds reseach; GlaxoSmithKline Grant/research funds research; Merck Honoraria Speaking and teaching

Chief Editor

Iqbal Ahmed, MBBS, FRCPsych (UK)  Faculty, Department of Psychiatry, Tripler Army Medical Center; Clinical Professor of Psychiatry, Clinical Professor of Geriatric Medicine, University of Hawaii, John A Burns School of Medicine

Iqbal Ahmed, MBBS, FRCPsych (UK) is a member of the following medical societies: Academy of Psychosomatic Medicine, American Association for Geriatric Psychiatry, American Neuropsychiatric Association, American Psychiatric Association, American Society of Clinical Psychopharmacology, and Royal College of Psychiatrists

Disclosure: Nothing to disclose.

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