Forced Diuresis and Expedient Blood Pressure Control in the Management of Quetiapine Induced Neuroleptic Malignant Syndrome: A Case Report
Keywords:Computed Tomography, Children, Brain, Tropical Region, Cerebral Atrophy
BACKGROUND: This case report intends to highlight the importance of safeguarding renal function from rhabdomyolysis in neuroleptic malignant syndrome (NMS) by concomitant administration of parenteral fluids at a high rate together with high doses of parenteral loop diuretics (we utilised 6 mg bumetanide daily) and tailed over a few days, in order to preserve glomerular/renal medullary perfusion and nephron function.
CASE REPORT: This case describes an elderly lady previously diagnosed with Lewy body dementia who had been started on low dose quetiapine a few days previously and presented with an acute 24 â€“ 48 hour onset of fever, generalised stiffness, rapidly becoming uncommunicable and with high blood pressure. Haemoglobinuria was present prompting intravenous treatment with labetalol to address the BP, whereas rapid isotonic saline fluid infusions together with intravenous high dose bumetanide were instituted to safeguard the kidneys against damage due to nephron deposition, both from haemoglobinuria as well as possibly myoglobin from rhabdomyolysis. A working diagnosis of the neuroleptic malignant syndrome with secondary malignant hypertension was made, and the quetiapine withdrawn. Blood pressure was after that subsequently controlled on amlodipine, and the haemoglobinuria quickly settled within 24 hours, with large amounts of dilute urine being passed on account of the forced diuresis. The fact that renal function and creatinine kinase remained normal is testimony to how these expedient measures averted progression to both rhabdomyolysis and renal failure in this case, thereby ameliorating prognosis.CONCLUSION: The patient was kept on infused fluids with maintenance bumetanide alone, achieving a full clinical recovery within the following 3 days.
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Khaldi S, Kornreich C, Choubani Z, Gourevitch R. Neuroleptic malignant syndrome and atypical antipsychotics: a brief review. Encephale. 2008; 34(6):618-24. https://doi.org/10.1016/j.encep.2007.11.007 PMid:19081460
Sarkar S, Gupta N. Atypical antipsychotics and neuroleptic malignant syndrome: nuances and pragmatics of the association. B J Psych Bull. 2017; 41(4):211â€“216.
Horacek J, Bubenikova-Valesova V, Kopecek M, et al. Mechanism of action of atypical antipsychotic drugs and the neurobiology of schizophrenia. CNS Drugs. 2006; 20:389â€“409. https://doi.org/10.2165/00023210-200620050-00004 PMid:16696579
Trollor JN, Chen X, Chitty K, Sachdev PS. Comparison of neuroleptic malignant syndrome induced by first- and second-generation antipsychotics. Br J Psychiatry. 2012; 201(1):52-6. https://doi.org/10.1192/bjp.bp.111.105189 PMid:22626633
Belvederi Murri M, Guaglianone A, Bugliani M, Calcagno P, Respino M, Serafini G, Innamorati M, Pompili M, Amore M. Second-generation antipsychotics and neuroleptic malignant syndrome: a systematic review and case report analysis. Drugs R D. 2015; 15(1):45-62. https://doi.org/10.1007/s40268-014-0078-0 PMid:25578944 PMCid:PMC4359181
Karagianis JL, Philips LC, Hogan KP, Le Drew KK. Clozapine-associated neuroleptic malignant syndrome: two new cases and a review of the literature. Ann Pharmacother. 1999; 33:623-30. https://doi.org/10.1345/aph.18286 PMid:10369628
Moltz DA, Coeytaux RR. Case report: possible neuroleptic malignant syndrome associated with olanzapine. J Clin Psychopharmacol. 1998; 18:485-6. https://doi.org/10.1097/00004714-199812000-00014
Gortney JS, Fagan A, Kissack JC. Neuroleptic malignant syndrome secondary to quetiapine. Ann Pharmacother. 2009; 43(4):785-91. https://doi.org/10.1345/aph.1L371 PMid:19299325
PrÃ©court A, Dunewicz M, GrÃ©goire G, Williamson DR. Multiple complications and withdrawal syndrome associated with quetiapine/venlafaxine intoxication. Ann Pharmacother. 2005; 39(1):153-6. https://doi.org/10.1345/aph.1E073 PMid:15562144
Woods G, Taggart C, Boggs R, Cadden I. Neuroleptic malignant syndrome associated with quetiapine and venlafaxine use: a case report and discussion. Ther Adv Psychopharmacol. 2013; 3(1):53â€“55. https://doi.org/10.1177/2045125312464386 PMid:23983992 PMCid:PMC3736958
Matsumoto R, Kitabayashi Y, Nakatomi Y, Tsuchida H, Fukui K. Neuroleptic Malignant Syndrome Induced by Quetiapine and Fluvoxamine. Am J Psychiatry. 2005; 162:4. https://doi.org/10.1176/appi.ajp.162.4.812 PMid:15800166
Stanley AK, Hunter J. Possible neuroleptic malignant syndrome with quetiapine. B J Psych. 2000; 176(5)497. https://doi.org/10.1192/bjp.176.5.497-a
Schattner A, Kitroser E, Cohen JD. Fatal Neuroleptic Malignant Syndrome Associated With Quetiapine. Am J Ther. 2016; 23(5):e1209-10. https://doi.org/10.1097/MJT.0000000000000274 PMid:26132604
Assion HJ, Heinemann F, Laux G. Neuroleptic malignant syndrome under treatment with antidepressants? A critical review. Eur Arch Psychiatry Clin Neurosci. 1998; 248:231â€“239. https://doi.org/10.1007/s004060050043 PMid:9840369
Uguz F, Sonmez EO. Neuroleptic malignant syndrome following combination of sertraline and paroxetine: a case report. Gen Hosp Psychiatry. 2013; 35:327. https://doi.org/10.1016/j.genhosppsych.2012.11.004 PMid:23312145
Ananth J, Parameswaran S, Gunatilake S, Burgoyne K, Sidhom T. Neuroleptic malignant syndrome and atypical antipsychotic drugs. J Clin Psychiatry. 2004; 65:464-70. https://doi.org/10.4088/JCP.v65n0403 PMid:15119907
Sing KJ, Ramaekers GM, Van Harten PN. Neuroleptic malignant syndrome and quetiapine. Am J Psychiatry. 2002; 159:149-50. https://doi.org/10.1176/appi.ajp.159.1.149 PMid:11772710
Al-Waneen R. Neuroleptic malignant syndrome associated with quetiapine. Can J Psychiatry. 2000; 45:764-65. PMid:11086565
Adnet P, Lestavel P, Krivosic-Horber R. Neuroleptic malignant syndrome. Br J Anaesth. 2000; 85:129-35. https://doi.org/10.1093/bja/85.1.129 PMid:10928001
Najib J. Neuroleptic malignant syndrome: a case report and review of the treatment. Hosp Pharm. 1997; 32:512-8.
Caroff SN, Mann SC, Campbell EC. Neuroleptic malignant syndrome. Adverse Drug React Bull. 2001; 209:799-802. https://doi.org/10.1097/00012995-200108000-00001
Ebadi M, Srinivasan SK. Pathogenesis, prevention, and treatment of neuroleptic- induced movement disorders. Pharmacological Rev. 1995; 47(4):575-9. PMid:8746555
Henry Woodford. Essential geriatrics 2nd Ed., 2010.
Baskys A. Lewy body dementia: the litmus test for neuroleptic sensitivity and extrapyramidal symptoms. J Clin Psychiatry. 2004; 65(Suppl 11):16-22. PMid:15264967
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