Key result
Meticulous fluid management and hyponatremia correction linked to coma resolution in severe cerebral edema.
Why the study?
The combination of neuroleptic malignant syndrome, water intoxication, syndrome of inappropriate antidiuretic hormone secretion, and rhabdomyolysis has been rarely reported and requires clinical attention.
Case Report (n=1)
Simultaneous occurrence of NMS, water intoxication, SIADH, and rhabdomyolysis can lead to coma, which can be successfully managed with meticulous fluid management and hyponatremia correction.
May support fluid management in NMS-related hyponatremia; hypothesis-generating and needs prospective validation.
Background: Water intoxication is typically caused by primary or psychogenic polydipsia that potentially may lead to fatal disturbance in brain functions. Neuroleptic malignant syndrome (NMS) is a serious complication induced by administration of antipsychotics and other psychotropic drugs. The combination of inappropriate secretion of antidiuretic hormone (SIDAH), NMS and rhabdomyolysis have been rarely reported. Our patient also developed severe water intoxication. Case presentation: Herein we report a comatose case of NMS complicated with water intoxication, syndrome of SIADH and rhabdomyolysis. This patient had severe cerebral edema and hyponatremia that were improved rapidly by the correction of hyponatremia within a couple of days. Conclusions: Malignant neuroleptic syndrome water intoxication, SIADH and rhabdomyolysis can occur simultaneously. Comatose conditions induced by cerebral edema and hyponatremia can be successfully treated by meticulous fluid management and the correction of hyponatremia.
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Takenouchi et al. (2022) conducted a case report in Neuroleptic Malignant Syndrome, Water Intoxication, Hyponatremia, Severe Cerebral Edema, Coma (n=1). Fluid management and correction of hyponatremia (glyceol, furosemide, methylprednisolone, dantrolene) was evaluated on Improvement of cerebral edema and coma. Comatose conditions induced by severe cerebral edema and hyponatremia associated with neuroleptic malignant syndrome, water intoxication, SIADH, and rhabdomyolysis were successfully treated by meticulous fluid management and correction of hyponatremia.
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