INTRODUCTION: Neuroleptic malignant syndrome (NMS) is a life threatening idiosyncratic reaction to neuroleptic medications. Quetiapine is considered a safe and common medication prescribed in patients with agitation and Lewy Body dementia (LBD). We present a case of NMS in a patient with LBD who is treated with quetiapine and rivastigmine. CASE PRESENTATION:A 66 year old man with a past medical history of LBD presents to the emergency department with a 5 day progression of altered mental status. At baseline, he is typically bed-bound but able to communicate verbally and feed independently. His LBD is managed with quetiapine and rivastigmine with recent up-titration of his quetiapine dose. His quetiapine was held 3 days prior to presentation due to concerns for sedation.

INTRODUCTION:Overdose has become a leading cause of injury-related death in the United States. Rapid recognition of a toxidrome is vital in determining management.CASE PRESENTATION: A young, unknown female was brought to the ED after being found agitated and combative. Evaluation was notable for tachycardia, mydriasis and diaphoresis. She received intramuscular diphenhydramine (DPH), haloperidol and lorazepam for agitation.She developed a wide QRS complex with polymorphic ventricular tachycardia (VT) concerning for Torsades de pointes, terminated by precordial thump. She was intubated for airway protection. Magnesium and sodium bicarbonate (NaHCO) pushes were administered for sustained monomorphic VT with return to sinus tachycardia. Electrocardiogram was significant for prolonged QTc of 607ms and QRS >150ms. Initial toxicology was negative for acetaminophen, salicylate and ethanol.NaHCO infusion with goal pH 7.5 to maintain a narrow QRS was started. She had persistently prolonged QT interval. Overdrive transcutaneous pacing was unsuccessful, so isoproterenol (IPN) infusion was started. NaHCO and IPN infusions were discontinued at 48 hours with no further arrhythmias. Extended toxicology screen was positive for DPH. On extubation, she endorsed consumption of >1.25g DPH.

No abstract

No abstract

No abstract