The specific laboratory finding often reflect the clinical manifestations of Neuroleptic Malignant Syndrome (NMS) is
(A) Elevated Creatine kinase # Laboratory abnormalities of NMS:> Elevated serum CK -- Laboratory findings often reflect the clinical manifestations of NMS with more severe rigidity leading to more profound creatine kinase (CK) elevation.> In NMS, CK is typically more than 1000 IU/L and can be as high as 100,000 IU/L.> Normal CK can be seen if rigidity is not clearly well developed, particularly early in the onset of the syndrome.> Elevated CK, particularly in the mild to moderate range, is not specific for NMS and is often seen in patients with acute and chronic psychosis due to intramuscular injections and physical restraints, and sometimes without specific explanation.> CK levels greater than 1000 IU/L, however, are probably more specific for NMS, and the degree of CK elevation correlates with disease severity and prognosis.> Other-- Other laboratory abnormalities are common but nonspecific.> A consistent laboratory finding is leukocytosis, with a white blood cell count typically 10,000 to 40,000/mm3 . A left shift may be present.> Mild elevations of lactate dehydrogenase, alkaline phosphatase, & liver transaminases are common.> Electrolyte abnormalities - Hypocalcemia, Hypomagnesemia, Hypo & Hypernatremia, Hyperkalemia, & Metabolic Acidosis are frequently observed.> Myoglobinuric acute renal failure can result from rhabdomyolysis.> Low serum iron concentration (mean 5.71 pmol/L; normal 11 to 32 pmol/L) is commonly seen in NMS patients and is a sensitive (92 to 100 percent) but not specific marker for NMS among acutely ill psychiatric patients> Investigations FBC often shows leukocytosis. U&Es may show metabolic disturbance due to acidosis or renal failure. Hypocalcaemia is a frequent association. Arterial blood sample to assess acid-base balance. LFTs may show elevated transaminases and lactate dehydrogenase (LDH) of muscle origin. CK is usually elevated. Urine myoglobin should be checked. Coagulation studies (particularly prothrombin time, activated partial thromboplastin time and international normalised ratio (INR)) should be checked (to detect coagulopathy). A urinary drug screen should be performed (particularly for salicylates, cocaine and amfetamines). If sepsis is suspected then blood and other relevant cultures should be taken.> Imaging may be indicated: CXR should be considered if sepsis is suspected. CT scan of the head, in order to exclude other diagnoses. Lumbar puncture may be required to exclude other diagnoses (particularly where there is fever and altered mental status). There are no significant cerebrospinal fluid (CSF) findings in neuroleptic malignant syndrome (NMS) other than raised protein.
Elevated Creatine kinase
Hypocalcemia
Increased Alkaline phosphatase
Leukocytosis
Miscellaneous