J.N., a 21-year-old woman with chronic paranoid schizophrenia, was admitted to the hospital with a diagnosis of pneumonia. She was brought to the ER by her mother, who said J.N. had been very lethargic, had a fever of 104°F, and had had muscular rigidity for 3 days. She took Haldol (haloperidol) and Cogentin (benztropine mesylate). Her mother stated that J.N.’s neuroleptic medication had been changed the week before by her psychiatrist. Her secondary diagnosis was stated as neuroleptic malignant syndrome, a rare and life-threatening disorder associated with the use of antipsychotic medications. This drug-induced condition is usually characterized by alterations in mental status, temperature regulation, and autonomic and extrapyramidal functions.
J.N. was monitored for potential hypotension, tachycardia, diaphoresis, dyspnea, dysphagia, and changes in her level of consciousness (LOC). Her medications were discontinued, she was hydrated with IV fluids, and her body temperature was monitored for fluctuations. She was treated with Bromocriptine, a dopamine antagonist, and Dantrolene, a muscle relaxant and antispasmodic.
After 5 days, J.N. was transferred to a mental health facility and restarted on low-dose neuroleptics. She was monitored to prevent a recurrence. Both J.N. and her family were educated about neuroleptic malignant syndrome in preparation for her discharge back home in 2 weeks.
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