Yang CJ, Chiu CT, Yeh YC, Chao A. Successful management of delirium with dexmedetomidine in a patient with haloperidol-induced neuroleptic malignant syndrome: A case report. World J Clin Cases 2022; 10(2): 625-630 [PMID: 35097088 DOI: 10.12998/wjcc.v10.i2.625]
Corresponding Author of This Article
Anne Chao, MD, Doctor, Department of Anesthesiology, National Taiwan University Hospital, National Taiwan University, No. 7 Chung Shan South Road, Taipei 100220, Taiwan. chaoanne123@gmail.com
Research Domain of This Article
Critical Care Medicine
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Cases. Jan 14, 2022; 10(2): 625-630 Published online Jan 14, 2022. doi: 10.12998/wjcc.v10.i2.625
Successful management of delirium with dexmedetomidine in a patient with haloperidol-induced neuroleptic malignant syndrome: A case report
Chi-Ju Yang, Ching-Tang Chiu, Yu-Chang Yeh, Anne Chao
Chi-Ju Yang, Department of Pharmacy, National Taiwan University Hospital, Taipei 100220, Taiwan
Ching-Tang Chiu, Yu-Chang Yeh, Anne Chao, Department of Anesthesiology, National Taiwan University Hospital, Taipei 100220, Taiwan
Author contributions: Yang CJ and Yeh YC wrote the manuscript; Chiu CT reviewed the literature; Chao A revised the manuscript; all authors were involved in writing the manuscript and approved the final manuscript.
Supported byNational Taiwan University Hospital Fund, No. MS 213.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest to disclose.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Anne Chao, MD, Doctor, Department of Anesthesiology, National Taiwan University Hospital, National Taiwan University, No. 7 Chung Shan South Road, Taipei 100220, Taiwan. chaoanne123@gmail.com
Received: March 24, 2021 Peer-review started: March 24, 2021 First decision: October 16, 2021 Revised: November 4, 2021 Accepted: December 7, 2021 Article in press: December 7, 2021 Published online: January 14, 2022
Abstract
BACKGROUND
We report a case of lorazepam-induced agitated delirium treated with haloperidol, which in turn triggered the onset of neuroleptic malignant syndrome (NMS). The latter condition, a medical emergency, was effectively treated with medical treatment and dexmedetomidine, a versatile and highly selective short-acting alpha-2 adrenergic agonist with sedative-hypnotic and anxiolytic effects.
CASE SUMMARY
A 65-year-old man with a history of bipolar disorder presented to the emergency department with severe abdominal discomfort after binge eating. During his hospital stay, he received intravenous lorazepam for insomnia. On the next day, he became delirious and was thus treated with seven doses (5 mg each) of haloperidol over a 48 h period. Signs of NMS (hyperthermia, rigidity, myoclonus of upper limbs, impaired consciousness, tachypnea, and dark urine) became apparent and haloperidol was immediately suspended and brisk diuresis was initiated. On intensive care unit admission, he was confused, disoriented, and markedly agitated. Dexmedetomidine infusion was started with the goal of achieving a Richmond Agitation-Sedation Scale score of -1 or 0. NMS was resolved gradually and the patient stabilized, permitting discontinuation of dexmedetomidine after 3 d.
CONCLUSION
Dexmedetomidine may be clinically helpful for the management of NMS, most likely because of its sympatholytic activity.
Core Tip: Neuroleptic malignant syndrome (NMS), a life-threatening condition characterized by hyperthermia, rigidity, altered mental status, and dysautonomia, can occur in 0.02%–3% of patients who receive haloperidol. Herein, we report a case of lorazepam-induced agitated delirium treated with haloperidol, which further triggered NMS. The NMS was effectively managed with medical therapy and dexmedetomidine, a versatile and highly selective short-acting alpha-2 adrenergic agonist with sedative-hypnotic and anxiolytic effects. Dexmedetomidine may be clinically helpful for the management of NMS because of its sympatholytic activity. In the presence of rapid shallow breathing, dexmedetomidine may provide better patient comfort with less respiratory depression than does propofol.
