Treatment of Neuroleptic Malignant Syndrome: Structured Critical Care Protocol

Neuroleptic malignant syndrome is a serious, potentially life-threatening reaction to dopamine-blocking agents — including first- and second-generation antipsychotics and certain antiemetics — that requires prompt recognition and a structured, tiered response in a critical care setting.

Treatment Approach

Treatment begins with withdrawal of the causative dopamine-blocking agent; structured supportive critical care then addresses the syndrome's principal features — including hyperthermia, rhabdomyolysis, and hemodynamic instability — though the complete tiered regimen and all clinical decision points are in the full protocol.

Key Clinical Goal

Maintain euvolemia with a target urine output of approximately 200 to 300 ml per hour.

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1056/NEJMra2404606

In addition to withdrawal of the offending agent when possible, treatment involves a tiered approach to the main features of the syndrome: blood-pressure instability, hyperthermia and rhabdomyolysis from severe rigidity, and the potential for respiratory compromise.
Substantial amounts of intravenous fluids may be needed to maintain euvolemia and to manage rhabdomyolysis, with a target urine output of approximately 200 to 300 ml per hour.

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