Neuroleptic Malignant Syndrome

2 May


-Occurs with start of a new psychiatric medication or dose adjustment; it is NOT associated with overdoses (usually at therapeutic level when levels checked)

-All of the atypical antipsychotics have been associated with NMS



-Tetrad of fever, muscular rigidity, autonomic dysfunction, and altered mental status

-Rigidity usually cogwheel or lead-pipe rigidity


-Abnormal blood pressures (either high or low)


Labwork Findings:

-Elevated CK level



Common Complications:

-Renal failure secondary to rhabdomyolysis

-Respiratory failure from muscle rigidity and altered mental status



Supportive care and cessation of the antipsychotic medication is the primary treatment

-When intubating these patients, non-depolarizing agents such as rocuronium are preferred over depolarizing agents such as succinylcholine

-For sedation, benzodiazepines are the preferred medication treatment


Submitted by Joey Grover.


References: Tintinalli’s Emergency Medicine:  7th Edition; picture


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