This case report intends to highlight the importance of safeguarding renal function from
rhabdomyolysis in
neuroleptic malignant syndrome (NMS) by concomitant administration of parenteral fluids at a high rate together with high doses of parenteral
loop diuretics (we utilised 6 mg
bumetanide daily) and tailed over a few days, in order to preserve glomerular/renal medullary perfusion and nephron function.
CASE REPORT: This case describes an elderly lady previously diagnosed with
Lewy body dementia who had been started on low dose
quetiapine a few days previously and presented with an acute 24 - 48 hour onset of
fever, generalised stiffness, rapidly becoming uncommunicable and with
high blood pressure. Haemoglobinuria was present prompting intravenous treatment with
labetalol to address the BP, whereas rapid isotonic saline fluid infusions together with intravenous high dose
bumetanide were instituted to safeguard the kidneys against damage due to nephron deposition, both from haemoglobinuria as well as possibly
myoglobin from
rhabdomyolysis. A working diagnosis of the
neuroleptic malignant syndrome with secondary
malignant hypertension was made, and the
quetiapine withdrawn. Blood pressure was after that subsequently controlled on
amlodipine, and the haemoglobinuria quickly settled within 24 hours, with large amounts of dilute urine being passed on account of the forced diuresis. The fact that renal function and
creatinine kinase remained normal is testimony to how these expedient measures averted progression to both
rhabdomyolysis and
renal failure in this case, thereby ameliorating prognosis.
CONCLUSION: The patient was kept on infused fluids with maintenance
bumetanide alone, achieving a full clinical recovery within the following 3 days.