A 20 years old boy with known history of mental illness was brought to emergency room with aggressive behaviour and tendency to attack others physically. After psychiatric evaluation, he was prescribed some new drugs and dose of previous drugs changed. After 3 days, he presents to emergency room again with fever (1050C), stiff limbs, altered sensorium and elevated serum CPK levels. What is the immediate management for this condition?
(Refer: Kaplan & Sadock's CTP, 10th Ed Chap 34.17  P.7849)
Neuroleptic malignant syndrome

A rare but extremely serious complication of neuroleptic treatment especially with high potency compounds. Evolve over 24-72 hours untreated last for 10 to 14 days , even fatal
Clinical features
	
Hyperthermia
Muscular rigidity – Increased muscle tone, dysphagia, dysponea
Autonomic disturbance – Elevated BP, HR, salivation, incontinence of urine


Raised WBC and creatinine phosphokinase
Management
	
Discontinuation of all medications
Hyperventilate with 100% oxygen
Administer sodium bicarbonate 1 – 2 mEq/kg IV and dantrolene sodium 2.5 mg/kg IV
Administer inotropes, anti-arrhythmic agents
Monitor urinary output, K+, Ca2+, blood gases, end tidal carbon dioxide
Consider invasive monitoring of arterial blood pressure and central venous pressure
Correction of acidosis and control of temperature.
Succinyl choline
Dantrolene
Edrophonium
Neostigmine