Neuroleptic malignant syndrome is a rare but potentially lethal, rare reaction to
neuroleptics which is characterized by altered levels of consciousness, extrapyramidal
effects, autonomic instability,
hyperthermia, and elevated serum
creatine phosphokinase levels. The most serious complication of
neuroleptic malignant syndrome is
acute renal failure. We investigated six cases of
neuroleptic malignant syndrome associated with myoglobulinemic
acute renal failure due to
rhabdomyolysis and effect of
hemodialysis or
hemodiafiltration. The patients were five males and one female with a mean age of 43.5 yr. All of the patients, who developed
acute renal failure induced from
rhabdomyolysis, had previously received butyrophenone (
haloperidol),
phenothiazine,
benzamide, iminomide, benzisoxazole,
antidepressants, and
hypnotics (
benzodiazepine and
barbiturate) for the treatment of
schizophrenia. The clinical manifestations of
neuroleptic malignant syndrome were characterized by altered consciousness,
muscle rigidity and weakness,
fever, and excessive perspiration. The peak laboratory data were blood
urea nitrogen 102 +/- 26 (mean +/- SD) mg/dL, serum
creatinine 9.1 +/- 2.1 mg/dL, serum
creatine phosphokinase 229,720 +/- 289,940 IU/L, and all of them developed oliguric
acute renal failure.
Dantrolene sodium administration was given to five cases and
hemodialysis or
hemodiafiltration was performed in all of them. The serum
creatinine level after
hemodialysis or
hemodiafiltration was 1.4 +/- 1.0 mg/dL. All patients were successfully cured of
acute renal failure by
hemodialysis or
hemodiafiltration. As a result, myoglobulinemic
acute renal failure associated with
neuroleptic malignant syndrome was successfully treated by
hemodialysis or
hemodiafiltration.