Haloperidol
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Neuroleptic malignant syndrome treated with lorazepam and diazepam: case report A 61-year-old man with bipolar I disorder developed neuroleptic malignant syndrome (NMS) with rhabdomyolysis following treatment with haloperidol; he was successfully treated with lorazepam and diazepam. The man was admitted with an irritable mood, inflated self esteem, flight of ideas, hypertalkativeness, decreased sleep requirement and delusion of persecution. He had received IM injections of haloperidol 5mg 12 hours prior; another IM injection of haloperidol 5mg was administered 12 hours post-admission for aggressive behaviour. He developed a fever, delirium, muscle rigidity, tachycardia, diaphoresis and an elevated BP 24 hours later. His levels of creatine phosphokinase (CPK), myoglobin and AST levels were 14 918 U/L, 7368 µg/L and 259 U/L, respectively. A diagnosis of NMS with rhabdomyolysis was made. Paracetamol [acetaminophen], hydration and sodium bicarbonate were administered. During the 5 days following NMS onset, the man received lorazepam 8mg daily (and required doses of IM lorazepam for agitation), and diazepam 30mg daily (10mg IV in normal sodium chloride every 8 hours). Biperiden was administered on day 5 for mild muscle rigidity. His fever and muscle rigidity improved markedly and his confusion subsided on day 6; diazepam was subsequently withdrawn. Lorazepam was maintained for 6 days and tapered to 3mg daily, and valproic acid was administered for manic symptoms. His score on the Francis-Yacoub NMS rating scale, which was 55 on day 1, was zero on day 26. His fever, muscle rigidity and autonomic dysfunction resolved on day 7, and he was alert. On day 8, his levels of CPK, myoglobin, and AST had markedly decreased, and on day 11 his levels were 564 U/L, 116 µg/L, and 59 U/L, respectively. Olanzapine was administered for worsened psychotic symptoms; no recurrence of NMS symptoms was evident. He was discharged in a stable condition on olanzapine, lorazepam, valproic acid and flurazepam. At 6 months’ follow-up, no NMS recurrence was noted. Tsai M-C, et al. Severe neuroleptic malignant syndrome: Successful treatment with high-dose lorazepam and diazepam: A case report. Chang Gung Medical Journal 803046455 33: 576-580, No. 5, Sep-Oct 2010 - Taiwan
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Reactions 8 Jan 2011 No. 1333
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