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PD – Hospitalisation Medication Omission Emergency — SCE Neurology MCQ

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HardMovement DisordersPD – Hospitalisation Medication Omission EmergencySCE Neurology

A man with advanced Parkinson disease is kept nil by mouth during treatment for aspiration pneumonia. Co-careldopa and ropinirole have been omitted for 36 hours. He becomes febrile and rigid with reduced consciousness, autonomic lability and raised creatine kinase. What is the priority intervention?

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Correct answer: D — Restore dopaminergic treatment through an enteral or transdermal route

Abrupt omission of dopaminergic therapy can precipitate parkinsonism–hyperpyrexia syndrome. The priority is urgent specialist-supported restoration of dopaminergic delivery, for example dispersible levodopa via enteral tube or a calculated rotigotine bridge, alongside fluids, cooling and complication management. Intravenous levodopa is not routine; bromocriptine must not be deferred until creatine kinase normalises. Broad-spectrum antibiotics may treat the pneumonia but do not correct dopamine withdrawal, and dantrolene does not replace dopamine restoration.

Reference: NICE NG71 Parkinson disease in adults: recommendations (Current NICE recommendations, accessed July 2026): https://www.nice.org.uk/guidance/ng71/chapter/Recommendations