Korean J Nephrol.  2011 Jan;30(1):87-93.

A Case of Myoglobinuric Acute Kidney Injury due to Rhabdomyolysis Associated with Neuroleptic Malignant Syndrome

• Cho JN
• Lee IH

Abstract

Neuroleptic malignant syndrome (NMS) is a rare, adverse reaction associated with the use of neuroleptic medication, which is characterized by altered consciousness, muscle rigidity, autonomic instability, hyperthermia, and elevated serum creatine phosphokinase (CPK) levels. Myoglobinuric acute kidney injury (AKI) is considered as the most serious complication of NMS. We report here a 25-year-old female who developed NMS associated myoglobinuric AKI, and had previously received olanzapine, haloperidol, and quetiapine for the treatment of brief psychotic disorder. The peak level of blood urea nitrogen (BUN) was 53.5 mg/dL, serum creatinine (Cr) 2.2 mg/dL, serum myoglobin 36,745 ng/mL, and a serum CPK of >30,000 IU/L. She was treated supportively with combination therapy including withdrawal of neuroleptics, intravenous hydration, cooling, and oral dantrolene. She gradually improved with clearing of altered sensorium, decrease in rigidity and normalizing of the serum CPK level. Serum BUN and Cr also decreased to 8.0 mg/dL and 0.6 mg/dL, respectively. Early, aggressive volume repletion with alkalinized fluids, along with appropriate pharmacological therapy is needed to prevent myoglobinuric AKI in patients with NMS. Additionally, dipstick urinalysis including urine pH, specific gravity, and occult blood may be useful in monitoring changes in hydration status during periods of fluid therapy.

Keyword

Neuroleptic malignant syndrome; Rhabdomyolysis; Urinalysis; Kidney failure; Acute

MeSH Terms

Acute Kidney Injury
Adult
Antipsychotic Agents
Benzodiazepines
Blood Urea Nitrogen
Consciousness
Creatine Kinase
Creatinine
Dantrolene
Dibenzothiazepines
Female
Fever
Fluid Therapy
Haloperidol
Humans
Hydrogen-Ion Concentration
Muscle Rigidity
Myoglobin
Neuroleptic Malignant Syndrome
Occult Blood
Psychotic Disorders
Renal Insufficiency
Rhabdomyolysis
Specific Gravity
Urinalysis
Quetiapine Fumarate
Antipsychotic Agents
Benzodiazepines
Creatine Kinase
Creatinine
Dantrolene
Dibenzothiazepines
Haloperidol
Myoglobin