may require bicarbonate therapy if there is documented severe acidosis that is unresponsive to specific treatmentĬhris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne.paralyse -> rigidity will respond to NDNMBS.cardiovascular support (may require cautious beta-blockade).airway assessment and securing if not patent (jaw trismus).(4) NMS frequently associated with multi-organ failure (3) NMS usually accompanied by hyperthermia, severe muscle rigidity and rhabdomyolysis (not mydriasis, diarrhoea, hyperreflexia, myoclonus) (2) NMS usually develops over days or weeks
(1) NMS is a idiosyncratic reaction after prolonged exposure to neuroleptics or after withdrawal of a dopamine receptor agonist. Important differences between serotonin syndrome and neuroleptic malignant syndrome: abrupt ceasing of neuroleptic or PD drugs.butyrophenones (droperidol, haloperidol).phenothiazines (chlorpromazine, promethazine).CVS – tachycardia, high BP, autonomic dysfunction.NEURO – dyskinesia, dysarthria, parkinsonianism, agitation, stupour, coma, GTC seizures, chorea, babinski, chorea, trismus.RESP – decreased chest wall compliance, tachypnoea, pulmonary infection.abnormal reaction of predisposed skeletal muscle (like MH).
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