Serotonin vs anticholinergic vs NMS



 
Serotonin Syndrome Anti-cholinergic Syndrome Neuroleptic malignant syndrome (NMS)
Temp, HR, BP, Tachypnea Temp, HR, BP, Tachypnea Temp, HR, BP, Tachypnea
Pupils: Dilated Pupils: Dilated Pupils: Normal
Skin: Diaphoretic Skin: flushed Skin: Diaphoretic
Mucous Membrane: Drooling/ Salivation Mucous Membrane: Dry Mucous Membrane: Drooling/ Salivation
Tone in extremities, w/ hyper-reflexia & clonus Normal muscle tone  reflexes "lead-pipe" rigidity & reflexes
Treatment Treatment Treatment
Emergency/Severe:
- Midazolam 1-5mg/hr IV infusion and Morphine sulfate 1-5mg/hr IV infusion

Moderate:
- Diazepam 5-10 mg po x1, may repeat in 30-60 min
OR
- Cyproheptadine 12 mg PO x1, may repeat x1.

PLUS
Chlorpromazine 12.5-50mg IV ove 30-60 min. May repeat 4-8 hr according to response.
PLUS/Minus
Muscle paralysis (if rhabdo present)
GI symptoms:
 - Zofran + Bismuth, +/- IV Fluids

Tachycardia:
 - Lorazepam

Bradycardia:
- Atropine 0.5 mg IM/IV

Seizure:
- Lorazepam




 
Acute:
- Stop anti-psychotic meds
- IV Fluids
- Hyperthermia: Physical measures. (Tylenol, IBU do not work)
- Dysphasia: NG Tube.

Pharmacologic Therapy:
- Lorazepam 1-4 mg PO/IV x1
- Dandroline:
 Load: 2.5mg/kg IV Bolus, repeat PRN.
 Maintenance: 0.25mg/kg/hr IV infusion x36 hr.