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Parkinsonism-hyperpyrexia syndrome — SCE Geriatric Medicine MCQ

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HardMovement disordersParkinsonism-hyperpyrexia syndromeSCE Geriatric Medicine

An 80-year-old man with Parkinson disease is admitted with vomiting and is kept nil by mouth overnight. By morning he is rigid, febrile at 38.7°C, confused and has CK 1800 IU/L; his usual co-careldopa was omitted for 18 hours. There is no clear infective focus. What is the most appropriate management?

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Correct answer: C — Urgently reinstate dopaminergic therapy using an appropriate non-oral route and seek specialist advice

Abrupt withdrawal of dopaminergic treatment can cause parkinsonism-hyperpyrexia syndrome, a potentially life-threatening emergency resembling neuroleptic malignant syndrome. Dopaminergic therapy should be restored promptly, using dispersible/NG or transdermal strategies with specialist advice if oral intake is unsafe. Haloperidol would worsen parkinsonism. The teaching point is that time-critical Parkinson medicines should not be omitted during acute admissions.

Reference: NICE NG71; BNF; Parkinson's UK emergency guidance