1/6. Concomitant neuroleptic malignant syndrome and lithium intoxication in a patient with bipolar I disorder: case report.The purpose of this report is to remind clinicians of the risk of the simultaneous occurrence of neuroleptic malignant syndrome (NMS) and lithium intoxication. A 39-year-old female with bipolar I disorder was admitted to our psychiatric ward due to relapse of a manic episode and a suicide attempt in which she had ingested 20 to 30 tablets of lithium (300 mg/tablet) 12 hours before admission. Except for intramuscular injection of 5 mg of haloperidol 30 minutes after admission, the patient received no antipsychotic drugs during her hospitalization. Six hours after admission, she began to show symptoms of NMS. lithium intoxication was also found. Within a week, her condition had stabilized with no neurological complications or cognitive deficits noted during the following 4 months. Discussed in this case report are the risk factors of NMS found in this patient, drug interactions of lithium and antipsychotic agents as related to NMS, and problems in clinical management.- - - - - - - - - - ranking = 1keywords = intoxication (Clic here for more details about this article) |
2/6. Acute lithium intoxication and neuroleptic malignant syndrome.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.- - - - - - - - - - ranking = 0.66666666666667keywords = intoxication (Clic here for more details about this article) |
3/6. Multiple complications and withdrawal syndrome associated with quetiapine/venlafaxine intoxication.OBJECTIVE: To report a case of quetiapine/venlafaxine intoxication associated with multiple complications and to review their possible relationship with these 2 drugs. CASE SUMMARY: A 53-year-old white man was admitted to the hospital for loss of consciousness secondary to voluntary intoxication with venlafaxine and quetiapine. Several complications were attributable to this intoxication including seizures, prolonged coma, respiratory depression, neuroleptic malignant syndrome, prolonged QRS and QTc intervals, and a possible venlafaxine withdrawal syndrome. DISCUSSION: Quetiapine could be responsible for the neuroleptic malignant syndrome presented in this case. Moreover, venlafaxine intoxication, fever, autonomic instability, and myoclonus presented serotonin syndrome as a differential diagnosis. Potential causes of seizures and prolongation of the QRS and QTc intervals are reviewed. Finally, prolonged coma and late venlafaxine withdrawal are discussed with regard to the pharmacodynamics and pharmacokinetics of drug elimination in the context of intoxication. CONCLUSIONS: Clinicians should be aware of possible complications following intoxication with atypical antipsychotics and anti-depressants, including protracted altered mental status.- - - - - - - - - - ranking = 1.6666666666667keywords = intoxication (Clic here for more details about this article) |
4/6. Treatment of neuroleptic malignant syndrome with direct hemoperfusion.neuroleptic malignant syndrome (NMS) is an uncommon but serious and fatal idiosyncratic reaction to neuroleptics. It is difficult to correct this abnormalities successfully. There has been several reports on the treatment of NMS with dantrolene and/or bromocriptine. But these therapy are not effective in every cases. We have experienced ten cases of NMS. Six of them were presented with respiratory distress. Seven patients were treated with direct hemoperfusion and the remainder were managed by dantrolene, bromocriptine and other drugs. patients treated with direct hemoperfusion two to four times could got a good improvement within several days and recovered. As to the patients treated by drugs. One of them who was not serious recovered with bromocriptine after twenty days. Two patients needed hemodialysis. NMS is occur not only by the use of neuroleptics but also by the break of them. So, this syndrome is do not develop by the high concentration of neuroleptics merely. NMS differed from ordinary drug intoxication. The etiology of NMS has unknown. But two major theories are present. One is dopaminergic blockade theory the other is direct toxic effect on skeltal muscles. We speculate that direct hemoperfusion remove metabolites of neuroleptics or normalize the alteration in the central nervous system.- - - - - - - - - - ranking = 0.16666666666667keywords = intoxication (Clic here for more details about this article) |
5/6. An autopsy case of cerebellar degeneration following lithium intoxication with neuroleptic malignant syndrome.We report a rare case of cerebellar degeneration that was diagnosed at autopsy in a patient who developed lithium intoxication accompanied by neuroleptic malignant syndrome. This 63 year old female, who suffered from manic depressive psychosis, had received lithium bicarbonate at a daily dose of about 1000 mg for 4 years. She developed a high fever and extrapyramidal symptoms resembling a neuroleptic type of malignant syndrome and died 1 month later. autopsy revealed an almost complete loss of purkinje cells with a mild reduction of granule cells in most areas of the cerebellar hemisphere and vermis, except for the tonsil and flocculus, and mild gliosis in the dentate nucleus. In cases of suspected lithium intoxication, one must be alert to the possibility of neuroleptic malignant syndrome and to prevent cerebellar degeneration.- - - - - - - - - - ranking = 1keywords = intoxication (Clic here for more details about this article) |
6/6. Ecstasy intoxication: an overlap between serotonin syndrome and neuroleptic malignant syndrome.3,4-Methylenedioxymethamphetamine (MDMA), also known as "ecstasy" is a popular recreational drug with potential for abuse. Although its neurotoxic effects have been established in animal studies, the acute and long-term effects of this serotonergic agent in humans are still unknown. We describe a 19-year-old woman with overlapping symptoms of neuroleptic malignant syndrome and serotonin syndrome after a single exposure to MDMA. We also review 15 other cases reported in the literature to draw attention to the serious neurotoxicity, including fatal outcomes, caused by the use of this increasingly popular, illicit drug.- - - - - - - - - - ranking = 0.66666666666667keywords = intoxication (Clic here for more details about this article) |