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[Neuroleptic malignant syndrome. A case report]
A Guadagnucci1, D Tornaboni, G Vignali
1U.O. Anestesia e Rianimazione, Ospedale SS. Giacomo e Cristoforo-Massa.
Minerva Medica
|July 1, 1995
Summary
Neuroleptic Malignant Syndrome (NMS) is a rare, life-threatening reaction to antipsychotic medications. This case highlights a fatal NMS event in a bipolar disorder patient treated with haloperidol, emphasizing the critical need for vigilant monitoring and prompt intervention.
Area of Science:
- Pharmacology and Toxicology
- Neuroscience
- Critical Care Medicine
Background:
- A 42-year-old woman with bipolar disorder experienced a relapse requiring increased haloperidol dosage and perphenazine administration.
- The patient's medical history included multiple psychiatric hospitalizations.
- The relapse occurred during a period of extreme heat, potentially exacerbating physiological stress.
Observation:
- Initial symptoms included hallucinations and abdominal pain, with elevated CPK and urea.
- The patient developed coma, hyperthermia, diaphoresis, polyuria, leukocytosis, and severe electrolyte imbalances (hyponatremia, hypokalemia), initially suggesting water intoxication.
- Despite initial improvement, recurrence of hyperthermia, torpor, coma, muscular rigidity, and myoclonus indicated a severe adverse drug reaction.
Findings:
- Rapidly escalating creatine phosphokinase (CPK) and serum myoglobin levels indicated severe muscle breakdown (rhabdomyolysis).
- The patient experienced multi-organ failure, including renal, cardiac, and respiratory insufficiency.
- Autopsy revealed widespread rhabdomyolysis, shock, and acute tubular necrosis secondary to myoglobinuria.
Implications:
- This case underscores the potentially fatal neuroleptic malignant syndrome (NMS) associated with antipsychotic use, particularly haloperidol.
- The findings emphasize the importance of early recognition, differential diagnosis (including water intoxication), and aggressive management of NMS.
- Vigilant monitoring for NMS symptoms is crucial, especially in patients with predisposing factors like psychiatric illness and exposure to high environmental temperatures.