Neuroleptic Malignant Syndrome in Emergency Medicine Workup

  • Author: Theodore I Benzer, MD, PhD; Chief Editor: Asim Tarabar, MD   more...
 
Updated: Sep 1, 2010
 

Laboratory Studies

The following laboratory studies may be indicated:

  • Complete blood count (CBC)
  • Blood cultures
  • Liver function tests (LFTs)
  • Blood urea nitrogen (BUN) and creatinine levels
  • Calcium and phosphate levels
  • Creatine kinase level
  • Urine myoglobin level
  • Arterial blood gas (ABG) level
  • Prothrombin time (PT), activated partial thromboplastin time (aPTT), international normalized ratio (INR)
  • Serum and urine toxicologic screening (eg, salicylates, cocaine, amphetamines)
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Imaging Studies

  • Perform chest radiography, if aspiration pneumonia is a concern.
  • Perform a head CT to evaluate for a structural lesion or before a lumbar puncture (LP). No universal agreement exists on the absolute need for a CT scan before the LP in patients without clinical evidence of a structural lesion; the decision is left to the individual practitioner.
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Procedures

  • The LP is indicated to rule out meningitis in patients exhibiting fever and altered mental status.
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Contributor Information and Disclosures
Author

Theodore I Benzer, MD, PhD  Assistant Professor in Medicine, Harvard Medical School; Director of Clinical Operations, Director of Toxicology, Chair of Quality and Safety, Department of Emergency Medicine, Massachusetts General Hospital

Theodore I Benzer, MD, PhD is a member of the following medical societies: Alpha Omega Alpha and American College of Emergency Physicians

Disclosure: Nothing to disclose.

Specialty Editor Board

Mark S Slabinski, MD, FACEP, FAAEM  Vice President, EMP Medical Group

Mark S Slabinski, MD, FACEP, FAAEM is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, and Ohio State Medical Association

Disclosure: Nothing to disclose.

John T VanDeVoort, PharmD  Regional Director of Pharmacy, Sacred Heart and St Joseph's Hospitals

John T VanDeVoort, PharmD is a member of the following medical societies: American Society of Health-System Pharmacists

Disclosure: Nothing to disclose.

Michael J Burns, MD  Instructor, Department of Emergency Medicine, Harvard University Medical School, Beth Israel Deaconess Medical Center

Michael J Burns, MD is a member of the following medical societies: American Academy of Clinical Toxicology, American College of Emergency Physicians, American College of Medical Toxicology, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Asim Tarabar, MD  Assistant Professor, Director, Medical Toxicology, Department of Emergency Medicine, Yale University School of Medicine; Consulting Staff, Department of Emergency Medicine, Yale-New Haven Hospital

Disclosure: Nothing to disclose.

References

  1. Strawn JR, Keck PE Jr, Caroff SN. Neuroleptic malignant syndrome. Am J Psychiatry. Jun 2007;164(6):870-6. [Medline].

  2. Gurrera RJ. Sympathoadrenal hyperactivity and the etiology of neuroleptic malignant syndrome. Am J Psychiatry. Feb 1999;156(2):169-80. [Medline].

  3. Jauss M, Krack P, Franz M, Klett R, Bauer R, Gallhofer B, et al. Imaging of dopamine receptors with [123I]iodobenzamide single-photon emission-computed tomography in neuroleptic malignant syndrome. Mov Disord. Nov 1996;11(6):726-8. [Medline].

  4. Picard LS, Lindsay S, Strawn JR, Kaneria RM, Patel NC, Keck PE Jr. Atypical neuroleptic malignant syndrome: diagnostic controversies and considerations. Pharmacotherapy. Apr 2008;28(4):530-5. [Medline].

  5. Ozer F, Meral H, Aydin B, Hanoglu L, Aydemir T, Oral T. Electroconvulsive therapy in drug-induced psychiatric states and neuroleptic malignant syndrome. J ECT. Jun 2005;21(2):125-7. [Medline].

  6. Hermesh H, Aizenberg D, Weizman A. A successful electroconvulsive treatment of neuroleptic malignant syndrome. Acta Psychiatr Scand. Mar 1987;75(3):237-9. [Medline].

  7. Rosebush PI, Stewart T, Mazurek MF. The treatment of neuroleptic malignant syndrome. Are dantrolene and bromocriptine useful adjuncts to supportive care?. Br J Psychiatry. Nov 1991;159:709-12. [Medline].

  8. Sakkas P, Davis JM, Janicak PG, Wang ZY. Drug treatment of the neuroleptic malignant syndrome. Psychopharmacol Bull. 1991;27(3):381-4. [Medline].

  9. Schneider SM. Neuroleptic malignant syndrome: controversies in treatment. Am J Emerg Med. Jul 1991;9(4):360-2. [Medline].

  10. Adnet P, Lestavel P, Krivosic-Horber R. Neuroleptic malignant syndrome. Br J Anaesth. Jul 2000;85(1):129-35. [Medline].

  11. Bhanushali MJ, Tuite PJ. The evaluation and management of patients with neuroleptic malignant syndrome. Neurol Clin. May 2004;22(2):389-411. [Medline].

  12. Buckley PF, Hutchinson M. Neuroleptic malignant syndrome. J Neurol Neurosurg Psychiatry. Mar 1995;58(3):271-3. [Medline].

  13. Carbone JR. The neuroleptic malignant and serotonin syndromes. Emerg Med Clin North Am. May 2000;18(2):317-25, x. [Medline].

  14. Caroff SN, Mann SC. Neuroleptic malignant syndrome. Psychopharmacol Bull. 1988;24(1):25-9. [Medline].

  15. Caroff SN, Mann SC, Lazarus A. Neuroleptic malignant syndrome. Arch Gen Psychiatry. Sep 1987;44(9):838-40. [Medline].

  16. Colosimo C, Merello M, Albanese A. Clinical usefulness of apomorphine in movement disorders. Clin Neuropharmacol. Jun 1994;17(3):243-59. [Medline].

  17. Heiman-Patterson TD. Neuroleptic malignant syndrome and malignant hyperthermia. Important issues for the medical consultant. Med Clin North Am. Mar 1993;77(2):477-92. [Medline].

  18. Lazarus A, Mann SC, Caroff SN. The Neuroleptic Malignant Syndrome and Related Conditions. Washington, DC: American Psychiatric Press; 1989.

  19. Nierenberg D, Disch M, Manheimer E, Patterson J, Ross J, Silvestri G, et al. Facilitating prompt diagnosis and treatment of the neuroleptic malignant syndrome. Clin Pharmacol Ther. Nov 1991;50(5 Pt 1):580-6. [Medline].

  20. Reulbach U, Dütsch C, Biermann T, Sperling W, Thuerauf N, Kornhuber J, et al. Managing an effective treatment for neuroleptic malignant syndrome. Crit Care. 2007;11(1):R4. [Medline].

  21. Sachdev P, Mason C, Hadzi-Pavlovic D. Case-control study of neuroleptic malignant syndrome. Am J Psychiatry. Aug 1997;154(8):1156-8. [Medline].

  22. Shiloh R, Valevski A, Bodinger L, Misgav S, Aizenberg D, Dorfman-Etrog P, et al. Precautionary measures reduce risk of definite neuroleptic malignant syndrome in newly typical neuroleptic-treated schizophrenia inpatients. Int Clin Psychopharmacol. May 2003;18(3):147-9. [Medline].

 
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