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Neuroleptic malignant syndrome — RCPSC EM MCQ

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HardPsychiatric emergenciesNeuroleptic malignant syndromeRCPSC EM

A patient started on haloperidol 10 days ago develops fever, generalized lead-pipe rigidity, confusion, autonomic lability, CK 18,000 U/L and acute kidney injury. Which immediate package is most appropriate?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: E — Stop haloperidol, provide cooling and IV fluids, and support evolving organ dysfunction

Explanation lettering: E = shown as A · A = shown as B · D = shown as C · B = shown as D · C = shown as E

C is correct for neuroleptic malignant syndrome because removing the dopamine antagonist and treating hyperthermia, rhabdomyolysis and organ dysfunction are immediate priorities. D applies serotonin-toxicity treatment. E leaves the precipitant in place. A omits withdrawal of the causative drug. B may be appropriate if infection remains possible but does not treat the toxidrome.

Reference: Emergency Care BC, Neuroleptic Malignant Syndrome: https://emergencycarebc.ca/clinical_resource/clinical-summary/neuroleptic-malignant-syndrome/