GEMS for JEMPsychiatric Emergencies for Clinicians: Emergency Department Management of Neuroleptic Malignant Syndrome
Section snippets
Clinical Scenario
A 25-year-old man presents with a recent diagnosis of schizophrenia. He was discharged 1 week earlier from an inpatient psychiatric unit. His mother states that he has been acting “differently” for the past 2 days. He has not been “making any sense,” has felt warm to the touch, and today has been stiff and moving rigidly like a “robot.” The review of systems per his mother is negative for hallucinations since leaving the hospital and is also negative otherwise, including for symptoms of
Clinical Bottom Lines
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The hallmark of NMS is recent exposure to dopamine agonists or recent withdrawal of dopamine antagonists, fever, rigidity, and altered mental status.
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For patients with probable NMS, provide aggressive supportive care with cooling and intravenous fluids and benzodiazepines.
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Toxicology consultation is prudent. The patient should be admitted to the intensive care unit.
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Stop all dopaminergic medications and avoid use of other medications with dopaminergic activity, such as metoclopramide, if possible.
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2021, Journal of Emergency NursingCitation Excerpt :Musculoskeletal rigidity has been associated with muscle mitochondrial alterations, whereas disruption in the sympathetic nervous system has been associated with autonomic instability.26 The reported incidence of NMS for persons taking antipsychotic medications ranges from 0.02% to 3.23%.26,27 NMS occurs at all ages, but men experience NMS more often.
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