Distinguishing (N)neuroleptic malignant syndrome from (S) serotonin syndrome
(1. defining features, 2. neuromuscular abnormalities, 3. onset, 4. med hx, 5. typical blood results, 6. general treatment for all, 7. specific tx, 8. mortality)
- 1. both conditions characterized by triad of
- - neuromuscular abnormalities
- - altered consciousness level
- - autonomic dysfunction (hyperthermia, sweating, tachycardia,unstable blood pressure)
- 2. (N) reduced activity
- Severe rigidity (‘lead pipe’); stiff pharyngealand thoracic muscles may lead to dysphagiaand dyspnoea; bradyreflexia
- (S) increased activity
- Myoclonus or clonus, hyperreflexia,tremor, muscular rigidity (less severe thanneuroleptic malignant syndrome)
- 3. (N) insidious
- (S) acute
- 4. (N) 4-11 days of initiation or dose increase of dopamine antagonist (any antipsychotic, metoclopramide)
- (S) after 1 or 2 dose of new serotenergic medication. Most common cause is concurrent SSRI and MAOI
5. Elevated creatinine kinase, white cell count and hepatic transaminases; metabolic acidosis
- 6. Discontinue offending drugs.
- Cool the patient.
- Monitor and manage hydration and haemodynamics (e.g. intravenous fluids).
- Consider ITU for monitoring and/or ventilation.
- Monitor for complications (e.g. pneumonia, renal failure).
- Use benzodiazepines for sedation if agitated
- 7. (N) Bromocriptine (to reverse dopamine blockade)Dantrolene (to reduce muscle spasm)ECT
- (S) Cyproheptadine (5HT - 2A antagonist)
- 8. (N) 20% untreated
- (S) Low