The neuroleptic malignant syndrome and acute renal failure

Rhabdomyolysis is a clinical disorder arising from skeletal muscle injury. Many potentially fatal complications may develop after rhabdomyolysis, including hyperkalemia, disseminated intravascular coagulation, and acute renal failure. Both traumatic and nontraumatic causes of rhabdomyolysis are seen. Frequently, nontraumatic rhabdomyolysis is associated with the use of common drugs. We report such a case--a patient afflicted with the neuroleptic malignant syndrome (NMS). NMS is characterized by fever, muscle rigidity, and neurologic changes after treatment with neuroleptic agents such as haloperidol. These symptoms may progress to rhabdomyolysis and acute renal failure. Many similar disease entities, especially those that display hyperpyrexia, resemble NMS. Thus, the diagnosis should rest on pertinent history as well as the recognition of these relevant clinical signs. Treatment should be directed toward averting the systemic complications of drug-induced rhabdomyolysis and renal failure. Discontinuation of the neuroleptic medication is imperative. Aggressive iv hydration, systemic and urine alkalinization, and therapy for life-threatening electrolyte abnormalities are all appropriate additional therapeutic goals. The use of dantrolene or bromocriptine may hasten recovery from NMS. Although mortality from NMS alone is unusual, NMS with concomitant renal failure carries a worse prognosis. The treatments outlined here may avert progressive renal failure and reduce mortality in patients with NMS-induced rhabdomyolysis and renal failure.