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The differential diagnosis of NMS and lethal catatonia is especially difficult; sometimes they are even considered the same disease. However, lethal catatonia develops independently of the use of antipsychotics and begins with the onset of mood swings, affective disorders, and severe psychotic agitation, while the onset of hydrochlorothiazide pills is associated with antipsychotic therapy and is characterized by severe extrapyramidal symptoms, including muscle rigidity. Supportive (symptomatic) therapy.
In the state of dehydration observed in most patients, it is necessary to actively rehydrate the body. massive intravenous administration of appropriate solutions. Parenteral infusions are also useful in eliminating hypotension—in particular, intravenous drips of sodium nitroprusside. In addition, nitroprusside, being a peripheral vascular dilator, improves the patient's condition, enhances heat transfer and reduces fever. Therapy with short-term antihypertensive drugs is also useful. for example, nifedinine or oxygen.
The greatest difficulties in the differential diagnosis of NMS are caused by serotonin syndrome, malignant hyperthermia and lethal catatonia. hydration temperature reduction prevention of aspiration prevention of deep thrombosis nutritious nutrition.
If possible, cardiac monitoring should be provided. If signs of rhabdomyolysis appear, it is necessary, due to the risk of developing renal failure, to increase hydration and achieve alkalization of urine by intravenous administration of sodium bicarbonate solution. Installing an indwelling urinary catheter helps monitor urine output.
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In case of developed renal failure, hemodialysis is indicated, which, however, is ineffective for eliminating antipsychotics, since they are closely associated with blood proteins. Measures to combat fever are very important, since hyperthermia leads to buy microzide online and multiple organ failure. Physical methods (cold wraps, icing areas of large vessels, evaporative cooling) and the use of antipyretics help reduce the temperature. There is a point of view that heat generation in NMS is associated exclusively with muscle rigidity and cannot be corrected by conventional pharmacological agents, therefore, in order to combat fever, medications should be used to relieve muscle rigidity.
Prevention of aspiration must be of utmost importance. Muscle rigidity in NMS may cause loss of gag and cough reflexes. It is necessary to check the presence of reflexes more often, provide parenteral nutrition, and ensure that the patient is positioned in bed to prevent aspiration. Chest physical therapy, some movement exercises, and frequent turning or changing the patient's position should be used to relieve immobility and muscle stiffness. Due to the risk of aspiration in thoracic or esophageal dystonia, medications should not be administered orally but should be administered parenterally or through a nasogastric tube.
Pharmacotherapeutic recommendations for NMS are based only on uncontrolled pro- and retrospective studies, as well as on descriptions of individual cases of the disease - therefore, information about the effectiveness of drug treatment for this disorder may be illusory. However, an extensive review of the literature by P. Sakkas et al. shows that drugs such as bromocriptine, amantadine and dantrolene are most effective in treating the syndrome. Other researchers note that the use of these drugs almost halves the mortality rate from NMS and shortens the course of the disease.
To prevent deep thrombosis and pulmonary embolism, subcutaneous administration of heparin or small doses of Lovenox are used (English) Russian. , for the same purpose you can use special elastic antithrombotic stockings. Levodopa + carbidopa (English) Russian. effective in controlling fever in neuroleptic malignant syndrome.
- To increase peripheral vasodilation, which enhances heat transfer, massage is indicated.
- It is useful to use muscle relaxants that simulate the contractility of skeletal muscles both through their effect on neuromuscular junctions and by directly activating the muscles themselves, which leads to a decrease in metabolism and heat production in the muscles and a decrease in hyperthermia.
- In the West, dantrolene sodium is usually used from this group of microzide drugs (this drug is not registered in USA).
- Treatment with dantrolene is indicated only in cases of NMS that are accompanied by severe rigidity, high fever and, as a consequence, hypermetabolism.
Dantrolene and bromocriptine can be used in combination (the first - intravenously, the second - enterally) without undesirable specific effects; the combined use of dantrolene and bromocriptine significantly reduces the duration of clinical manifestations of NMS. This combination is recommended for the treatment of particularly severe, long-term or treatment-resistant cases of NMS.
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In a small proportion of patients who do not respond to the above-described therapy, the use of benzodiazepines is indicated, especially in cases of hydrochlorothiazide pills muscle rigidity and severe catatonia. The most commonly used drugs are intravenous diazepam and lorazepam.