Neuroleptic Malignant Syndrome Associated With Metoclopramide in a Burn Patient

Abstract

Neuroleptic malignant syndrome (NMS) is an uncommon, potentially fatal syndrome that occurs with the use of neuroleptic medications. In view of the rarity of this syndrome and the overlap with the pathophysiologic manifestations of a burn, the burn surgeon may not readily recognize NMS on presentation. We describe the case of a 27-year-old man with 15% TBSA burns who developed NMS as a result of metoclopramide use. Recognition and treatment resulted in a prompt resolution of symptoms. Initial treatment should include immediate withdrawal of all neuroleptic agents, measures aimed at decreasing body temperature, supportive care, and restoration of dopamine balance. Various authors have advocated treatment with various medications, including benzodiazepines, dantrolene, and dopaminergic agents. It is important for burn unit personnel to be aware of this syndrome because the early institution of therapy can be life saving.

Psychiatric Emergencies

“…Use of metaclopromide alone has resulted in cases of NMS (Nachreiner et al 2006). Close attention must be paid when these agents are used with other dopamine agonists or antagonists.…”

Neuroleptic malignant syndrome in trauma patient

“…It was also described elevation of amylase and lipase in the setting of this syndrome [5]. Robb et al [8] have described elevation of creatinine phosphokinase levels [7] (CPK) and white blood cells (WBC), electrolyte abnormalities and myoglobinuria.…”

“…Prager et al [20] and Lavie et al [21] reported the difficulty of diagnosing NMS [5,20,21]. Symptoms and signs can vary depending on the patient condition and the drug used.…”

“…It is important that other general medical conditions, as well as psychiatric disorders such as catatonia, must have been excluded prior to making the diagnosis of NMS. The rarity of this entity in the burn unit is reflected by the sparse literature regarding NMS and the burned patient [5].…”

“…Followed a neuroleptic drug administration, death can occur as a result of complications such as rhabdomyolysis or cardiovascular collapse [5], aspiration pneumonia, pulmonary embolus, or disseminated intravascular coagulation [3] that determine an estimated mortality rate about 10% [6].…”