eMedicine Specialties > Pediatrics: Cardiac Disease and Critical Care Medicine > Critical Care

Neuroleptic Malignant Syndrome: Follow-up

Author: Mary C Mancini, MD, PhD, Professor, Department of Surgery, Louisiana State University Health Sciences Center
Coauthor(s): Girish G Deshpande, MD, MBBS, FAAP, Assistant Professor, Department of Pediatrics, Division of Critical Care Medicine, Children's Hospital of Illinois at OSF St Francis Medical Center
Contributor Information and Disclosures

Updated: Dec 9, 2008

Follow-up

Deterrence/Prevention

  • Because neuroleptic malignant syndrome (NMS) usually develops while the dose is being increased, be alert to this possibility until a steady dose is achieved.
  • Know the risk factors and be vigilant for neuroleptic malignant syndrome development.

Complications

  • Respiratory failure
  • Aspiration pneumonia
  • Renal failure
  • Cardiovascular collapse and arrhythmias
  • Thromboembolism and disseminated intravascular coagulation (DIC)

Prognosis

  • Prognosis depends on how early patient is treated and on the presence of such associated complications as respiratory or renal failure.
  • The mortality rate once reported at 20-30% is now estimated at 5-11.6%.
  • The mortality rate rises to about 50% if neuroleptic malignant syndrome is complicated by renal failure.

Patient Education

  • Explain and educate the patient and caretakers about possible adverse effects of medications.

Miscellaneous

Medicolegal Pitfalls

  • Several other drugs in addition to neuroleptics can cause this potentially lethal condition.
  • Know the risk factors for neuroleptic malignant syndrome (NMS) if a patient must be started on neuroleptics.
  • Monitor the patient on close follow-up in the outpatient department while the dose of neuroleptics is being increased.
  • Explain this serious complication of the therapy to the patient and the patient's caregiver.
  • Explore the possibility of a recent neuroleptic administration in any patient who presents with the symptom complex of hyperthermia, rigidity, and altered mentation. Necessary investigations may be performed to rule out other treatable and potentially serious conditions that could cause similar symptomatology.
  • Treatment is mainly supportive; it is directed toward controlling the rigidity and hyperthermia and toward preventing other complications (eg, respiratory failure, renal failure). Remember that development of renal failure increases the mortality rate to 50%.
 


More on Neuroleptic Malignant Syndrome

Overview: Neuroleptic Malignant Syndrome
Differential Diagnoses & Workup: Neuroleptic Malignant Syndrome
Treatment & Medication: Neuroleptic Malignant Syndrome
Follow-up: Neuroleptic Malignant Syndrome
References
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Further Reading

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Keywords

neuroleptic malignant syndrome, NMS, neuroleptics, antidopaminergic activity, serotonin, schizophrenia, respiratory failure, cardiovascular collapse, renal failure, arrhythmias, thromboembolism, hypoxia, ischemic encephalopathy, urinary incontinence, diaphoresis, sialorrhea, hypertension, respiratory distress, dehydration, hypotension, butyrophenones, haloperidol, phenothiazines, thioxanthenes, long-acting neuroleptics, benzamines, tricyclic antidepressants, monoamine oxidase inhibitors, MAOIs, anticonvulsants, lithium, domatine antagonists

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Contributor Information and Disclosures

Author

Mary C Mancini, MD, PhD, Professor, Department of Surgery, Louisiana State University Health Sciences Center
Mary C Mancini, MD, PhD is a member of the following medical societies: American Heart Association, American Medical Association, American Thoracic Society, Association for Academic Surgery, Association for Surgical Education, International College of Surgeons, International Society for Heart and Lung Transplantation, New York Academy of Sciences, Phi Beta Kappa, and Southern Thoracic Surgical Association
Disclosure: Nothing to disclose.

Coauthor(s)

Girish G Deshpande, MD, MBBS, FAAP, Assistant Professor, Department of Pediatrics, Division of Critical Care Medicine, Children's Hospital of Illinois at OSF St Francis Medical Center
Girish G Deshpande, MD, MBBS, FAAP is a member of the following medical societies: American Academy of Pediatrics
Disclosure: Nothing to disclose.

Medical Editor

G Patricia Cantwell, MD, Associate Clinical Professor, Department of Pediatrics, University of Miami; Director of Pediatric Critical Care Medicine, Miller School of Medicine, Jackson Children's Hospital
G Patricia Cantwell, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Emergency Physicians, American Heart Association, American Trauma Society, National Association of EMS Physicians, Society of Critical Care Medicine, and Wilderness Medical Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from broker recommendation; Avanir Pharma Stock Investment from broker recommendation

Managing Editor

Barry J Evans, MD, Assistant Professor of Pediatrics, Temple University Medical School; Director of Pediatric Critical Care and Pulmonology, Associate Chair for Pediatric Education, Temple University Children's Medical Center
Barry J Evans, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Chest Physicians, American Thoracic Society, and Society of Critical Care Medicine
Disclosure: Nothing to disclose.

CME Editor

Mary E Cataletto, MD, Associate Director, Division of Pediatric Pulmonology, Winthrop University Hospital; Professor of Clinical Pediatrics, State University of New York at Stony Brook; Director of Children's Sleep Services, Winthrop University Hospital
Mary E Cataletto, MD is a member of the following medical societies: American Academy of Pediatrics and American College of Chest Physicians
Disclosure: Shering Plough Pharmaceuticals Honoraria Consulting

Chief Editor

Timothy E Corden, MD, Associate Professor of Pediatrics, Co-Director, Policy Core, Injury Research Center, Medical College of Wisconsin; Associate Director, PICU, Children's Hospital of Wisconsin
Timothy E Corden, MD is a member of the following medical societies: American Academy of Pediatrics, Phi Beta Kappa, Society of Critical Care Medicine, and Wisconsin Medical Society
Disclosure: Nothing to disclose.

 
 
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