Neuroleptic Malignant Syndrome Secondary to Metoclopramide Use in an Elderly Gastroenterologic Surgery Patient

Abstract

An 84-year-old African American woman was admitted to the hospital secondary to severe abdominal pain accompanied by septic shock. She underwent exploratory laparotomy, which revealed extensive small bowel necrosis likely due to small bowel torsion. A small bowel resection was performed with primary anastomoses and the patient was subsequently transferred to the intensive care unit (ICU). She recovered from shock but had a persistent gastroparesis interfering with enteral feeding, for which metoclopramide was prescribed. She was then transferred to a general medical-surgical unit in a stable condition where she received a total of four 10-mg oral doses of metoclopramide administered every 8 hours. Approximately 32 hours after receiving the first dose of metoclopramide, the patient was subsequently transferred back to the ICU because of fever and inability to maintain respirations. Neuroleptic malignant syndrome was suspected, and the patient was intubated and received supportive care. After a week in the ICU, she was discharged back to the medical-surgical unit in a stable condition and recovered completely. The patient was later discharged home.

Neuroleptic malignant syndrome with abnormally elevated cardiac troponin I: a case report

“…In addition to these four principal symptoms, a considerable amount of literature has described various other symptoms, including elevated heart rate, labile blood pressure, mutism, elevated respiration rate, excessive sweating, difficulty swallowing, elevated white blood cell count, tremor, incontinence, metabolic acidosis, myoglobinuria, and dystonic reactions. 4 Of these symptoms, the heart-related indicators are elevated CK concentrations, heart rate, and blood pressure. Elevated TNI or troponin T (TNT) have not been previously reported in NMS patients.…”

“…[1][2][3] In addition, patients exhibit elevated serum creatine kinase (CK) and leukocytosis, among other symptoms. 3,4 In contrast, abnormally elevated cardiac troponin I (TNI) levels are rare in this syndrome.…”

Neuroleptic malignant syndrome in fields other than psychiatry

“…We performed a review of NMS case reports from clinicians other than psychiatrists in English and Japanese literature. They could be classified into two groups: (1) cases in which NMS onset was triggered by administering causative drugs 17–19,22–89 and (2) cases in which NMS developed from disruption of regular medication (Tables 7 and 8). 8,16,90–114 An example of the former is a case in which antipsychotic drugs were administered for postoperative delirium; an example of the latter is a case in which regular medication (i.e., antipsychotic drugs) to treat schizophrenia was discontinued temporarily because of general anesthesia.…”

“…Primary conditions in the first group ranged, widely, including trauma, 19,26,27,29,32,34,[40][41][42]52,57,58,64,75,81,83,86,88,89 digestive disease, 25,30,36,37,43,45,46,54,59,60,65,66,77,80,87 malignant tumor, 18,23,24,31,33,35,38,47,51,61,63 and cardiovascular disease 28,39,44,50,53,55,56,…”

Extrapiramidalismo por antieméticos

“…La metoclopramida puede causar síntomas extrapiramidales como acatisia, síndrome serotoninérgico, disquinesia tardía y síndrome neuroléptico maligno [snm] (15)(16)(17)(18)(19)(20). La incidencia de síntomas extrapiramidales con metoclopramida ha sido reportada en 0,2 % de los casos, pero en edades extremas puede incrementarse a 25 % (1,13).…”