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Parkinsonism-hyperpyrexia syndrome — DGM MCQ

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HardMovement disordersParkinsonism-hyperpyrexia syndromeDGM

An 84-year-old man with Parkinson's disease is admitted with pneumonia and is made nil by mouth due to dysphagia. He normally takes co-careldopa five times daily. By evening he is rigid, febrile and confused. What is the most appropriate management?

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Correct answer: E — Urgently maintain dopaminergic therapy via appropriate alternative route with specialist advice

Abrupt withdrawal or delay of dopaminergic therapy can cause severe rigidity and a neuroleptic malignant-like syndrome. Alternative routes and urgent specialist advice are needed if the patient cannot swallow. Hospital prescribing should prioritise time-critical Parkinson's medicines.

Reference: NICE NG71; BNF