| Autor: |
Ficarino HM; Division of Trauma & Acute Care Surgery, Department of Surgery, University of South Alabama, Mobile, AL, USA., Caposole MZ; Division of Trauma & Acute Care Surgery, Department of Surgery, University of South Alabama, Mobile, AL, USA., Noelle Davis S; Division of Trauma & Acute Care Surgery, Department of Surgery, University of South Alabama, Mobile, AL, USA., N Krebsbach M; Division of Trauma & Acute Care Surgery, Department of Surgery, University of South Alabama, Mobile, AL, USA., McGowin EF; Division of Trauma & Acute Care Surgery, Department of Surgery, University of South Alabama, Mobile, AL, USA., Alexander KM; Division of Trauma & Acute Care Surgery, Department of Surgery, University of South Alabama, Mobile, AL, USA.; 1383Department of Pharmacy Practice, Auburn University Harrison School of Pharmacy, Mobile, AL, USA., Kinnard CM; Division of Trauma & Acute Care Surgery, Department of Surgery, University of South Alabama, Mobile, AL, USA., Simmons JD; Division of Trauma & Acute Care Surgery, Department of Surgery, University of South Alabama, Mobile, AL, USA. |
| Abstrakt: |
Neuroleptic malignant syndrome (NMS) is described in the medical literature but rarely seen among acutely ill trauma patients. A 44-year-old man with burns to the hands and back after a chemical explosion was transported to an outside facility where he received treatment for presumed acute coronary syndrome after developing ventricular tachycardia and elevated serum troponins after the exposure. His cardiac catheterization was unremarkable, but an echocardiogram revealed severe cardiomyopathy, and he was also in multisystem organ failure. He was transferred to our facility after hospital day 2 for treatment of his multisystem organ failure and 2% total body surface area burns. His laboratory results were remarkable for a creatine kinase of >100 000 units/L, and he required 14 g of intravenous calcium. Upon further investigation, the patient reported taking ziprasidone for his bipolar disorder, and he had a core temperature of 103.5 °F on his initial presentation to the outside facility. As he convalesced, the unifying diagnosis was NMS. NMS is a side effect of antipsychotic therapy and is manifested by hyperpyrexia, rigidity, autonomic instability, and altered consciousness. An elevated creatine kinase >100 000 units/L is almost pathognomonic for NMS. Patients can also present with leukocytosis, organ failure, and electrolyte disturbances including hypocalcemia. We hypothesized that dehydration, the warm environmental conditions at our patient's job, and immense stress resulting in a catecholamine surge following his trauma were inciting triggers to this event. This case highlights the importance of considering alternate diagnoses in patients whose clinical presentation does not fit the most "obvious cause." |
