NMS (Neuroleptic  M alignant  Syndrome)

1. Any medication that antagonizes and / or depletes dopamine can cause NMS. The common ones are antipsychotics, antiemetics, antihistaminics, WD from anti-Parkinsonian medications. Peak incidence is 1-7^th day of treatment with
   neuroleptics.
    
2. S&S are Hyperthermia, Lead-pipe rigidity, AMS & autonomic dysfunction. Temperature is universal finding and about 50% of pts have T > 40°C. Rigidity is 2ry to muscular tension. Chest wall rigidity has been described. Mental state can vary  from mild confusion to "catatonia" (i.e. alert but not responding) and coma. Autonomic dysfunction  is manifested by constant changing in VS (tachycardia,­  and ¯ of BP,  sweating). ARDS, DIC, ARF/Rhabdo can develop. One must consider Serotonin syndrome in deferential when dealing with possible NMS.
    
3. Dx is suspected by clinical findings and certain lab abnormalities such as ­ LFT, ­CPK, ­ WBC, Met. Acidosis, Myoglobinuria. Major ( ­temp, rigidity, ­CK) and Minor criteria (autonomic dysfunction, AMS,  ­WBC) were developed to facilitate the diagnosis. When  2 major + 4 minor criterias exist in proper setting, diagnosis is made.
    
4. Treatment c/o cooling down the pt, IVF to flush out the myoglobin, cardiac and pulmonary support. Specific therapy is accomplished with Bromocriptine 5 mg  PO and is given to combat ­ temperature. Muscular rigidity is treated with Dantrolene 2 mg/kg IV. Benzodiazepines are also effective but will interfere with mental status  interpretation.

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