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Updated: Apr 9 2018


  • 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
    • 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
      • neuroleptic malignant syndrome (NMS)
        • medical emergency secondary to neuroleptic use (e.g., antipsychotics)
          • characterized by
            • hyperthermia
            • mental status change
            • rigidity
            • autonomic dysfunction
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