Neuroleptic malignant syndrome :
Diagnosis: tetrad of altered mental status, muscular rigidity & hyperthermia & autonomic dysfunction → ICU admission
Immediate measures
- Supplemental oxygen & assisted ventilation if needed.
- Hyperthermia → Submersion in an ice-water bath.
- Benzodiazepines
Drug therapy
- First line: Benzodiazepines.
- Second line: Dantrolene and Bromocriptine.
- Dantrolene: oral (50–100 mg/day) or by IV infusion (2–3 mg/kg/day or ≤10 mg/kg/day).
- Bromocriptine: orally or by NGT at doses of 2.5 to 10 mg /8h.
Alkalinization of the urine with NaHCO₃ reduces myoglobinuric renal failure in patients with high CPK.
Heparin prophylaxis for DVT.
NMS Electroconvulsive Therapy
Dramatically improves the manifestations of NMS by enhancing central dopaminergic transmission (3-4 sessions).
