Neuroleptic Malignant Syndrome

Totally Confused

Step 1: View clinicals

A 34 year old man presents with fever and confusion for 4 days. No other symptoms were seen. He was diagnosed with schizophrenia a month ago, and started on olanzapine soon afterwards. His medical and surgical histories are otherwise unremarkable. A complete blood count is significant for a WBC of 12,000/mm3 (normal: < 11,000), with 65% neutrophils and 34% lymphocytes. A random capillary glucose and liver profile are within normal parameters.


Step 2: Order all relevant investigations

Renal Functions + Electrolytes

Na+: 142 mEq/L (135-145) K+: 5.5 mEq/L (3.5-5.5) Cl-: 101 mEq/L (97-105) Total Ca++: 8.8 mg/dL (8.5-10.9) Blood Urea: 35 mg/dL (10-50) S. Creatinine: 0.7 mg/dL (0.5-1.5)

Creatine Phosphokinase (CPK)

Creatine Phosphokinase (CPK): 23,000 U/L (22-198)

Toxicology Screen

The Toxicology Screen is negative.

CT Brain + Lumbar Puncture

The CT scan of the brain and CSF analysis are completely normal.


Step 3: Select appropriate management

Antibiotics
Antipyretics
Stop Olanzapine
ICU Care


Score: ★★☆