Snapshot
- A 31-year-old woman with a medical history of schizophrenia is brought to the emergency department by her husband due to agitation, confusion, and delirium. Her temperature is 104°F (40°C), blood pressure is 162/108 mmHg, pulse is 110/min, and respirations are 31/min. On physical examination, she is diaphoretic, with generalized muscular rigidity. Laboratory testing is significant for a creatine kinase level of 4,680 IU/L. Her antipsychotic is removed, and supportive care is initiated. She is started on dantrolene for management of neuroleptic malignant syndrome.
Introduction
- Mechanism of action
- blocks ryanodine receptors
- decreases excitation-contraction coupling
- decreases Ca2+ release from the sarcoplasmic reticulum in skeletal muscle
- blocks ryanodine receptors
- Clinical use
- malignant hyperthermia
- hypermetabolic crisis secondary to inhaled anesthetic use (e.g., halothane) or succinylcholine
- patients have a genetic abnormality in ryanodine or dihydropyridine receptors, a skeletal muscle protein
- results in excessive Ca2+ release from the sarcoplasmic reticulum
- patients have a genetic abnormality in ryanodine or dihydropyridine receptors, a skeletal muscle protein
- hypermetabolic crisis secondary to inhaled anesthetic use (e.g., halothane) or succinylcholine
- neuroleptic malignant syndrome (NMS)
- medical emergency secondary to neuroleptic use (e.g., antipsychotics)
- characterized by
- hyperthermia
- mental status change
- rigidity
- autonomic dysfunction
- characterized by
- medical emergency secondary to neuroleptic use (e.g., antipsychotics)
- malignant hyperthermia