Pediatric Neuroleptic Malignant Syndrome Workup

  • Author: Mary C Mancini, MD, PhD; Chief Editor: Timothy E Corden, MD   more...
 
Updated: Nov 21, 2011
 

Laboratory Studies

No laboratory test result is diagnostic for neuroleptic malignant syndrome (NMS).

  • Evidence of increased muscular activity
    • Elevated creatinine kinase (50-100% of cases)
    • Metabolic acidosis
    • Increased transaminases
    • Myoglobinuria
  • CBC count showing leukocytosis (70-98% of cases)
  • Electrolyte levels that indicate hyperkalemia, metabolic acidosis
  • Renal function tests indicating prerenal (dehydration) and renal (myoglobinuria) failure
  • Coagulation studies, such as platelet count, prothrombin time (PT), and activated partial thromboplastin time (aPTT), if thromboembolic phenomenon or diffuse intravascular coagulation (DIC) is suspected
  • Cultures from various sites to look for infections
  • Cerebrospinal fluid (CSF) analysis to rule out meningitic or encephalitic process
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Imaging Studies

  • Imaging studies (eg, CT scanning, MRI) of the brain may be performed to rule out other conditions such as intracranial hemorrhage (ICH) or trauma. They per se do not yield any diagnostic information for neuroleptic malignant syndrome.
  • Chest radiography is indicated for suspected aspiration pneumonia.
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Histologic Findings

  • Neuroleptic malignant syndrome has an associated increase of MM isoenzyme of creatine kinase.
  • Muscle biopsy reveals morphological and histoenzymological abnormalities in muscle fibers. These findings are nonspecific and are not diagnostic of neuroleptic malignant syndrome.
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Contributor Information and Disclosures
Author

Mary C Mancini, MD, PhD  Professor and Chief of Cardiothoracic Surgery, Department of Surgery, Louisiana State University School of Medicine in Shreveport

Mary C Mancini, MD, PhD is a member of the following medical societies: American Association for Thoracic Surgery, American College of Surgeons, American Surgical Association, Phi Beta Kappa, Society of Thoracic Surgeons, and Southern Surgical Association

Disclosure: Nothing to disclose.

Coauthor(s)

Girish G Deshpande, MD, MBBS, FAAP  Associate Professor of Pediatrics, Interim Director and Division Chief of Critical Care Medicine, Department of Pediatrics, University of Illinois College of Medicine at Peoria; Consulting Staff, 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.

Specialty Editor Board

G Patricia Cantwell, MD  FCCM, Professor of Clinical Pediatrics, Chief, Division of Pediatric Critical Care Medicine, University of Miami, Leonard M Miller School of Medicine; Medical Director, Palliative Care Team, Director, Pediatric Critical Care Transport, Holtz Children's Hospital, Jackson Memorial Medical Center; Medical Manager, FEMA, Urban Search and Rescue, South Florida, Task Force 2; Pediatric Medical Director, Tilli Kids – Pediatric Initiative, Division of Hospice Care Southeast Florida, Inc

G Patricia Cantwell, MD is a member of the following medical societies: American Academy of Hospice and Palliative Medicine, American Academy of Pediatrics, American Heart Association, American Trauma Society, National Association of EMS Physicians, Society of Critical Care Medicine, and Wilderness Medical Society

Disclosure: Nothing to disclose.

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

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.

Mary E Cataletto, MD  Director of Children's Sleep Services, Winthrop Sleep Disorders Center, Mineola, NY; Professor of Clinical Pediatrics, State University of New York at Stony Brook, Stony Brook, NY

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.

References

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