Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0026837 (muscle rigidity)
 1,077 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Neuroleptic malignant syndrome (NMS) is associated with essentially all of the currently available antipsychotic agents. The signs and symptoms associated with the syndrome are hyperpyrexia, defined by body temperature greater than 38 degrees C; extreme muscle rigidity, with or without elevated creatine phosphokinase or hyperreflexia; and other symptoms such as altered level of consciousness and/or autonomic dysfunction as manifested by labile blood pressure, tachycardia, tachypnea, urinary or fecal incontinence, pallor, or diaphoresis. This potentially fatal syndrome complicates the treatment of patients with recurrent psychotic symptoms because of the possibility for recurrence of the NMS. A case of recurrent NMS is presented in which the patient was rechallenged with an antipsychotic agent. In addition, 41 reported cases of antipsychotic rechallenge after NMS are reviewed. The results of the review suggest that neuroleptic rechallenge following NMS is associated with an acceptable risk of recurrence in most patients. However, close monitoring for NMS and careful selection of patients for antipsychotic rechallenge is mandatory. A minimal time period of five days before rechallenge may also reduce the risk of recurrent NMS. Recurrence was not associated with patient age or gender, nor the antipsychotic agent used.
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PMID:Neuroleptic rechallenge after neuroleptic malignant syndrome: case report and literature review. 289 92

Heat stroke victims lack thermoregulatory control. Treatment includes immediate cooling, circulatory support and monitoring for secondary complications. Neuroleptic malignant syndrome is a complication of neuroleptic drug therapy; skeletal muscle hypertonicity helps distinguish this entity from heat stroke. Malignant hyperthermia should be considered in any patient who is under physiologic or anesthetic stress and develops hyperthermia plus skeletal muscle rigidity, tachypnea, hypoxia, tachycardia and hyperkalemia.
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PMID:Hyperthermic syndromes. 328 39

At least three myopathies have been associated with malignant hyperthemia (MH). The clinical manifestations of MH are variable and depend on the nature of the underlying myopathy and the anesthetic agents administered. Unless muscle relaxants are used, fever and muscle rigidity may be delayed at onset. Tachycardia and tachypnea are often the earliest manifestations and can occur immediately or several hours into a surgical procedure. Life-threatening cardiac arrhythmias may result from hyperkalemia and acidosis. A hyperthermic reaction developed in an 8-year-old boy with a family history of Duchenne's muscular dystrophy one hour after induction of anesthesia. Temperature elevation and muscle rigidity were minor components of the condition. Determination of arterial blood gas concentrations and the serum potassium level established the diagnosis and enabled the start of lifesaving therapy.
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PMID:Malignant hyperthermia. Current concepts. 706 79

The incidence, etiology, clinical manifestations, and management of malignant hyperthermia (MH) are reviewed. The syndrome of MH is recognized as one of the causes of anesthesia-related deaths. It is considered pharmacogenetic because both an abnormal gene and precipitating environmental factors are necessary to produce an acute reaction. Metabolic defects, involving a derangement of calcium dynamics, appear to be the common characteristic of susceptible individuals. Calcium release and uptake from the sarcoplasmic reticulum is altered when an individual with MH is exposed to certain anesthetic agents or triggering physical and emotional stresses. Muscle rigidity, tachycardia, tachypnea, and high fever can lead to other complications and death. Management of an acute reaction of MH includes cooling methods to lower body temperature, hyperventilation, sodium bicarbonate control of acidosis, maintenance of fluid and electrolyte balance, and the administration of dantrolene sodium. A thorough family history, baseline CPKs, caffeine-halothane contracture tests, and ultramicroscopic examination of muscle biopsy specimens are recommended as screening techniques. The early administration of dantrolene sodium in acute reaction of MH has been shown to rapidly alleviate the symptoms and ensuing severe complications. Individuals with a strong family history of MH or previous episodes may be treated with oral dantrolene sodium before surgery to effectively prevent a crisis, and after surgery to prevent recurrence.
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PMID:Malignant hyperthermia: current perspectives. 728 92

Severe adverse reactions to neuroleptic medications are not uncommon and include the neuroleptic malignant syndrome, rhabdomyolysis, and acute renal failure. The neuroleptic malignant syndrome consists of hyperthermia, diaphoresis, tachycardia, tachypnea, abnormal blood pressure, alteration of consciousness, and extrapyramidal rigidity. Rhabdomyolysis--which might be due to hyperthermia, muscle rigidity, and/or metabolic changes in skeletal muscle function--results in acute renal failure. We report a patient with rhabdomyolysis and acute renal failure that developed after large doses of haloperidol were given, but without muscle rigidity or hyperthermia. This patient's presentation illustrates that high-dose haloperidol therapy might cause rhabdomyolysis and acute renal failure without significant rigidity or hyperthermia.
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PMID:Rhabdomyolysis and acute renal failure during high-dose haloperidol therapy. 756 18

A 6-year old female child received succinylcholine (1 mg.kg-1) and isoflurane (concentrations of 1.5-2 percent) and developed at the end of surgery a hypermetabolic syndrome suggestive of malignant hyperthermia (MH) with masseter muscle spasm, muscle rigidity, tachypnea, systolic hypertension (140 mm Hg), tachycardia (205 beats.min-1), hypercarbia (end expiratory CO2 71 mmHg), and an increase in body temperature (39.2 degrees C). The child responded well to therapy which included cooling, hyperventilation with pure oxygen and dantrolene administration. However, blood creatine kinase and myoglobin elevations were moderate (respectively 375 IU.L-1 and 114 micrograms.L-1) and an in vitro halothane and caffeine contracture test was negative. Differential diagnostic proposals are discussed and compared to the clinical incident.
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PMID:Malignant hyperthermia suggestive hypermetabolic syndrome at emergence from anesthesia. 871 51

Malignant hyperthermia (MH) is a medical emergency that all perioperative nurses should be prepared to handle. Patients with the inherited MH trait have a rare skeletal muscle disease that causes them to develop life-threatening hyperthermia (ie, body temperatures of 43.3 degrees C [110.0 degrees F] or higher) at the time MH-triggering agents are administered to induce general anesthesia or shortly thereafter. The incidence of MH episodes is reported to be 1 in every 12,000 pediatric anesthetic procedures and 1 in every 40,000 adult anesthetic procedures. The MH syndrome also is characterized by continuous skeletal muscle rigidity, hypermetabolism, hypercapnia, tachypnea, and tachycardia that result in cardiac arrest and death if left untreated. Perioperative staff members' knowledge of MH, the care of MH-susceptible patients, and adequate preparation for MH crises are the cornerstones of successful patient outcomes to this life-threatening syndrome.
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PMID:Malignant hyperthermia. 909 38

A 42-year-old man came to our emergency room hyperthermic (oral temperature, 42.4 degrees C), diaphoretic, and delirious. Other findings included labile blood pressure, sinus tachycardia (heart rate, 138/min), tachypnea (respiratory rate 34/min), muscle rigidity, and incontinence. Two days earlier, he had gone to a local clinic with complaints of abdominal pain, nausea, and vomiting. Promethazine was prescribed, and this was the patient's only medication on admission. Laboratory studies showed leukocytosis, hypernatremia, metabolic acidosis, elevated creatinine phosphokinase level, elevated transaminase levels, azotemia, hyperkalemia, hyperphosphatemia, hypocalcemia, and myoglobulinuria. The clinical and laboratory findings were characteristic of the neuroleptic malignant syndrome, with promethazine as the offending agent.
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PMID:Neuroleptic malignant syndrome due to promethazine. 1054 78

Neuroleptic malignant syndrome (NMS) is a rare and potentially fatal complication precipitated by the use of antipsychotic medications, most notably haloperidol. Criteria previously described include: exposure to the neuroleptic class of medications; hyperthermia; muscle rigidity; a cluster of laboratory and physical findings that may include mental status changes, autonomic instability, creatine phosphokinase elevation and leukocytosis, and exclusion of other causes for the patient's condition. A prodrome of mental status changes, autonomic instability, tremors, diaphoresis, excess salivation, and extrapyramidal signs may precede NMS. Prior reports of NMS linked to olanzapine have been in patients who had been previously treated with other neuroleptic agents or in patients who had previous episodes of NMS precipitated by other neuroleptics. Several cases included patients treated with olanzapine in addition to another neuroleptic. This report describes a case of NMS associated with olanzapine in a patient who had not previously been exposed to the neuroleptic drug class. At the time this patient presented, there were no reports in the literature of NMS associated with olanzapine alone. Treatment of NMS includes: immediate withdrawal of all neuroleptics; supportive care; fever control; management of autonomic instability (tachycardia, tachypnea, blood pressure fluctuations); and pharmacologic management with dantrolene and bromocriptine.
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PMID:Neuroleptic malignant syndrome due to olanzapine. 1239 78

A 45-year-old man was admitted to our hospital after taking an intentional overdose of 90 sustained-released lithium tablets (450 mg each). The patient was stabilized with three sessions of hemodialysis. On day 7 of his hospital stay, his serum lithium level was 0.5 mEq/L. On day 10, he developed high fever, tachypnea, muscle rigidity, rhabdomyolysis, acute renal insufficiency, mental confusion, and obtundation. His creatine kinase level was 698 IU/L, serum creatinine 3.5 mg/dl. Late-onset neuroleptic malignant syndrome (NMS) was diagnosed. The patient died after developing acute renal failure and acute respiratory distress syndrome. Clinicians should be aware that lithium may cause NMS independent of other neuroleptic agents.
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PMID:Acute lithium intoxication and neuroleptic malignant syndrome. 1282 Aug 23


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