Neuroleptic Malignant Syndrome (NMS) after Treatment with Metoclopramide - A Rare Case Report

ABSTRACT

Neuroleptic Malignant Syndrome (NMS) is a medical emergency. It presents with mental status change, rigidity, fever, and autonomic dysfunction. It is caused by antipsychotics especially neuroleptic agents and certain antiemetic drugs like metoclopramide that block central dopamine pathways. We present a case of a 32-year-old male chronic alcoholic who presented to us with alcohol withdrawal symptoms and was given injection metoclopramide and developed neuroleptic malignant syndrome (NMS).Incidence rates for NMS range from 0.02 to 3 percent in patients treated with antipsychotic agents.1,2 Though it is commonly encountered in young adults, any age group can be affected.3,4 Males are two-fold more affected than females.4Metoclopramide, a commonly used anti-emetic agent has anti-dopaminergic properties and can give rise to development of NMS. The signs and symptoms of NMS include hyperthermia, altered mental status, muscular rigidity resembling extrapyramidal rigidity, autonomic instability, diaphoresis, hyper salivation, dysphagia, tachycardia, hypertension. NMS if left untreated, is usually fatal. So, early recognition and treatment is of great importance.