The Rigid Patient

​A 24-year-old man with a history of schizophrenia presented with altered mental status. His mother said he had become more catatonic and rigid over the previous two days. She reported that he was prescribed Abilify 5 mg by mouth daily for three years, but a long-acting depot of Abilify 400 mg had been administered two days before by court order. His vital signs include a heart rate of 120 bpm, blood pressure 140/90 mm Hg, temperature 38.5°C, respiratory rate is 14 bpm, and SPO2 is 98% on room air. The patient is alert and diaphoretic. Pupils are 3 mm. Cogwheeling, rigidity, and two beats of ankle clonus are also observed. Toxicology is consulted and asked about interventions and anticipated observation period. Differential Diagnosis< Neuroleptic malignant syndrome< Serotonin syndrome< Anticholinergic syndrome< Sympathomimetic< Malignant catatonia< Heat stroke< Infection< Psychogenic< Baclofen withdrawal< Extrapyramidal symptom (tardive dyskinesia)​NMSNeuroleptic malignant syndrome is a life-threatening idiosyncratic reaction associated with neuroleptic medication. It was first described in the 1960s in patients treated with haloperidol, but has been associated with virtually every antipsychotic. The incidence of NMS is reported to be 0.2-2.4 percent of patients receiving neuroleptic medications. The mechanism of NMS has not been completely elucidated, but the most accepted mechanism of action appears to be antagonism of the D2 rec...
Source: The Tox Cave - Category: Emergency Medicine Tags: Blog Posts Source Type: blogs