Key result
In a patient with neuroleptic malignant syndrome, severe hyponatremia was identified as cerebral salt-wasting syndrome, which improved with dantrolene sodium and fluid/sodium replacement.
Why the study?
Does dantrolene sodium and fluid/sodium replacement improve cerebral salt-wasting syndrome in a patient with neuroleptic malignant syndrome?
Case Report (n=1)
Does dantrolene sodium and fluid/sodium replacement improve cerebral salt-wasting syndrome in a patient with neuroleptic malignant syndrome?
Hyponatremia in neuroleptic malignant syndrome may be caused by cerebral salt-wasting syndrome rather than SIADH, and can be managed with dantrolene and fluid/sodium replacement.
May indicate cerebral salt-wasting in neuroleptic malignant syndrome hyponatremia; hypothesis-generating for dantrolene plus sodium replacement.
BACKGROUND: Hyponatremia associated with neuroleptic malignant syndrome has thus far been described as a syndrome of inappropriate secretion of antidiuretic hormone. OBJECTIVES: To ascertain and describe the role of cerebral salt-wasting syndrome as the cause of hyponatremia in a patient with neuroleptic malignant syndrome. PATIENT: A psychotic patient being treated with olanzapine presenting with sopor, muscle rigidity, polyuria, tachycardia, pyrexia, and severe hyponatremia. METHODS: Serial serological examinations of plasma tonicity (sodium level and osmolality), brain natriuretic peptide, and antidiuretic hormone were performed, and sodium excretion and urine osmolality were determined from 24-hour urine collection. In addition, markers for rhabdomyolysis were monitored. RESULTS: The patient shows clear symptoms of cerebral salt-wasting syndrome in association with neuroleptic malignant syndrome, characterized by severe hyponatremia, volume depletion, and elevated brain natriuretic peptide but normal antidiuretic hormone levels. Cerebral salt-wasting syndrome improved under dantrolene sodium treatment and concomitant fluid and sodium replacement. CONCLUSION: Hyponatremia in patients with neuroleptic malignant syndrome might more likely reflect cerebral salt-wasting syndrome than a syndrome of inappropriate secretion of antidiuretic hormone as an additional aspect of autonomic dysregulation caused by antidopaminergic drugs.
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Lenhard et al. (2007) conducted a case report in Neuroleptic malignant syndrome and severe hyponatremia (n=1). Dantrolene sodium and fluid/sodium replacement was evaluated on Improvement of cerebral salt-wasting syndrome symptoms. In a patient with neuroleptic malignant syndrome, severe hyponatremia was identified as cerebral salt-wasting syndrome, which improved with dantrolene sodium and fluid/sodium replacement.
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