MedBugs: SAQ #65

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Case: Neuroleptic malignant syndrome

A 22-year-old male is brought in by ambulance after being found confused at the park. You note in his medical records that he has a background of bipolar disorder on lithium and olanzapine. Vital signs:

HR 136 bpm
BP 161/100
RR 24

94 % RA T 39.1 On examination, you find that the patient has lead-pipe rigidity. You are concerned that he has neuroleptic malignant syndrome.

1. List (5) differential diagnoses you would consider in this patient. 5 marks

2. What are (4) risk factors for developing neuroleptic malignant syndrome? 4 marks

3. Other than muscle rigidity, list (3) other criteria required to make a diagnosis of NMS? 3 marks

4. List (2) specific therapies that can be used to treat NMS 2 marks

5. Complete the table, listing (4) clinical features which would distinguish NMS from serotonin syndrome 4 marks

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