Neuroleptic Malignant Syndrome – Part 2
The exact cause of NMS is unknown but it is believed to be related to the levels and action of dopamine in the brain – either by blockage of the dopamine receptors or by the anti-dopamine effect of the causative drug.
Signs and symptoms of NMS include an increased body temperature (hyperthermia), muscle rigidity, a fast heart rate (tachycardia), a fast rate of
breathing (tachypnea), sweating (diaphoresis), delirium, tremors, repetitive motions of the limbs (choreoathetosis), a low blood pressure (hypotension) and acid-base disturbances (anion gap metabolic acidosis).
Most experienced clinicans recommend that the first treatment is to stop the causative drug. In addition, patients with a temperature > 39.5 C should be cooled via evaopative cooling. This is done by spraying the naked patient patient with lukewarm water and having circulating fans aimed at the patient. Although no large-scale clinical trials exist most clinicians think the drug treatment for NMS is bromocriptine given by mouth every 8 hours which will increase dopamine levels and action in the brain and/or dantrolene intravenously every 6 hours. Finally, there are some scattered reports of resolution of NMS with the use of eclectoconvulsive therapy (ECT).
Copyright 2006 Insidesurgery.com