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Neuroleptic malignant risk Parkinson's — DGM MCQ

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HardMovement disordersNeuroleptic malignant risk Parkinson'sDGM

An 82-year-old man with Parkinson's disease becomes febrile and rigid after his levodopa was withheld for two days. He is confused, tachycardic and has raised creatine kinase. He was nil by mouth after surgery. Current medicines include co-careldopa. What is the most appropriate management?

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Correct answer: E — Urgent specialist review and reinstitution of dopaminergic therapy by safe route

Abrupt withdrawal of dopaminergic therapy can cause a neuroleptic malignant-like syndrome requiring urgent treatment and specialist advice. Continuing withdrawal, dismissing stiffness, haloperidol and early discharge are unsafe. Alternative routes for Parkinson's medicines should be planned when patients are nil by mouth.

Reference: NICE NG71; BNF