A 28-year-old man on clozapine presents with fever 40°C, generalized rigidity, altered consciousness, and serum CPK of 8,000 U/L. His blood pressure is 160/100 mmHg. The most important immediate step in management after stopping the offending drug is:
- A Start oral bromocriptine 2.5 mg three times daily
- B Give IV lorazepam and monitor temperature
- C IV dantrolene sodium and supportive ICU care including hydration ✓
- D Restart a lower dose of the antipsychotic with temperature monitoring
Correct answer: C. IV dantrolene sodium and supportive ICU care including hydration
Explanation
Neuroleptic Malignant Syndrome (NMS) requires immediate discontinuation of the antipsychotic, aggressive supportive care in ICU (hydration, cooling, monitoring), and IV dantrolene (a muscle relaxant that decreases calcium release from sarcoplasmic reticulum, reducing rigidity and hyperthermia). Bromocriptine (dopamine agonist) is an adjunct but is oral and slower; IV dantrolene addresses the acute life-threatening hyperthermia and rigidity more rapidly. Restarting any antipsychotic is contraindicated in acute NMS.
Reference: Kaplan & Sadock's Synopsis of Psychiatry, 11th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.