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Neuroleptic Malignant Syndrome Secondary to Metoclopramide Use in an Elderly Gastroenterologic Surgery Patient
Richard Breeden1, Heath Ford, Carey Chrisman
1Richard Breeden, PharmD, BCPS, BCNSP, is Assistant Professor, South College School of Pharmacy, Critical Care Pharmacist, Methodist Medical Center of Oak Ridge, Knoxville, Tennessee. Heath Ford, PharmD, PhD, CGP, is Assistant Professor, South College School of Pharmacy, Knoxville, Tennessee. Carey Chrisman, PharmD, is Affiliate Assistant Professor, University of Tennessee College of Pharmacy, and Critical Care Pharmacist, Methodist Medical Center of Oak Ridge, Oak Ridge, Tennessee. Charles Mascioli, MD, MBA, FCCP, is Critical Care Physician, Methodist Medical Center of Oak Ridge, Oak Ridge, Tennessee.
Abstract:
An 84-year-old African American woman was admitted to the hospital secondary to severe abdominal pain accompanied by septic shock. She underwent exploratory laparotomy, which revealed extensive small bowel necrosis likely due to small bowel torsion. A small bowel resection was performed with primary anastomoses and the patient was subsequently transferred to the intensive care unit (ICU). She recovered from shock but had a persistent gastroparesis interfering with enteral feeding, for which metoclopramide was prescribed. She was then transferred to a general medical-surgical unit in a stable condition where she received a total of four 10-mg oral doses of metoclopramide administered every 8 hours. Approximately 32 hours after receiving the first dose of metoclopramide, the patient was subsequently transferred back to the ICU because of fever and inability to maintain respirations. Neuroleptic malignant syndrome was suspected, and the patient was intubated and received supportive care. After a week in the ICU, she was discharged back to the medical-surgical unit in a stable condition and recovered completely. The patient was later discharged home.