GuidelinesPrimary Care STG
Neuroleptic Malignant Syndrome
Description General measures Referral ICD-10 code: G21.0 + (T43.0-6/T43.8-9) Description Neuroleptic malignant syndrome (NMS) is a rare but potentially fatal syndrome characterised by a tetrad of fever, muscle rigidity, altered mental state, and autonomic dysfunction. An altered mental state with confusion, delirium, or stupor may precede other clinical signs of NMS. Suspect if there is a history
ICD-10 code: G21.0 + (T43.0-6/T43.8-9)
Description
- Neuroleptic malignant syndrome (NMS) is a rare but potentially fatal syndrome characterised by a tetrad of fever, muscle rigidity, altered mental state, and autonomic dysfunction.
- An altered mental state with confusion, delirium, or stupor may precede other clinical signs of NMS.
- Suspect if there is a history of exposure to an antipsychotic, fever and sweating, muscle rigidity, and elevated or fluctuating blood pressure.
- Most common after initiation or increase in dose of haloperidol, risperidone, or injectable antipsychotic, but may occur with any antipsychotic at any dose.
- Combinations of antipsychotics with SSRIs or lithium may increase the risk.
- Agitation, dehydration, exhaustion, and iron deficiency increase the risk of NMS.
- Other causes of fever must be investigated and treated.
General Measures
- Stop all antipsychotics.
- Cool patient and hydrate adequately.
Referral
- All patients for urgent medical admission and psychiatric review
Standard Treatment Guidelines and Essential Medicines List for South Africa Primary Healthcare Level_Chapter 16: Mental Health Conditions_NEMLC Recommendations for Medicine Amendments 2020_2023
Drugs mentioned
ICD-10 codes
- G21.0Malignant neuroleptic syndrome
- T43.0Poisoning, tricyclic and tetracyclic antidepressants
- T43.1Poisoning, monoamine-oxidase-inhibitor antidepressants
- T43.2Poisoning, other and unspecified antidepressants
- T43.3Poisoning, phenothiazine antipsychotics and neuroleptics
- T43.4Poisoning, butyrophenone and thioxanthene neuroleptics
- T43.5Poisoning, other and unspecified antipsychotics and neuroleptics
- T43.6Poisoning, psychostimulants with abuse potential
- T43.8Poisoning, other psychotropic drugs, not elsewhere classified
- T43.9Poisoning, psychotropic drug, unspecified