A Case of Myoglobinuric Acute Kidney Injury due to Rhabdomyolysis Associated with Neuroleptic Malignant Syndrome.
- Author:
Jung Nam CHO
1
;
In Hee LEE
Author Information
1. Department of Internal Medicine, Catholic University of Daegu School of Medicine, Daegu, Korea. ihlee@cu.ac.kr
- Publication Type:Case Report
- Keywords:
Neuroleptic malignant syndrome;
Rhabdomyolysis;
Urinalysis;
Kidney failure;
Acute
- MeSH:
Acute Kidney Injury;
Adult;
Antipsychotic Agents;
Benzodiazepines;
Blood Urea Nitrogen;
Consciousness;
Creatine Kinase;
Creatinine;
Dantrolene;
Dibenzothiazepines;
Female;
Fever;
Fluid Therapy;
Haloperidol;
Humans;
Hydrogen-Ion Concentration;
Muscle Rigidity;
Myoglobin;
Neuroleptic Malignant Syndrome;
Occult Blood;
Psychotic Disorders;
Renal Insufficiency;
Rhabdomyolysis;
Specific Gravity;
Urinalysis;
Quetiapine Fumarate
- From:Korean Journal of Nephrology
2011;30(1):87-93
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
Neuroleptic malignant syndrome (NMS) is a rare, adverse reaction associated with the use of neuroleptic medication, which is characterized by altered consciousness, muscle rigidity, autonomic instability, hyperthermia, and elevated serum creatine phosphokinase (CPK) levels. Myoglobinuric acute kidney injury (AKI) is considered as the most serious complication of NMS. We report here a 25-year-old female who developed NMS associated myoglobinuric AKI, and had previously received olanzapine, haloperidol, and quetiapine for the treatment of brief psychotic disorder. The peak level of blood urea nitrogen (BUN) was 53.5 mg/dL, serum creatinine (Cr) 2.2 mg/dL, serum myoglobin 36,745 ng/mL, and a serum CPK of >30,000 IU/L. She was treated supportively with combination therapy including withdrawal of neuroleptics, intravenous hydration, cooling, and oral dantrolene. She gradually improved with clearing of altered sensorium, decrease in rigidity and normalizing of the serum CPK level. Serum BUN and Cr also decreased to 8.0 mg/dL and 0.6 mg/dL, respectively. Early, aggressive volume repletion with alkalinized fluids, along with appropriate pharmacological therapy is needed to prevent myoglobinuric AKI in patients with NMS. Additionally, dipstick urinalysis including urine pH, specific gravity, and occult blood may be useful in monitoring changes in hydration status during periods of fluid therapy.
