Case 2

A 27-year old male is brought to the Emergency Department by his parents. They are concerned as he has become less responsive over the last two days and is “acting strange”. You have difficulty garnering further information from him as your questions are met with blank stares and minimal speech.

His past medical history includes:

  • Type 1 Diabetes Mellitus, for which he is on a basal-bolus insulin regimen.

  • Bipolar Affective Disorder, for which he is on lithium.

  • Schizophrenia, usually managed with olanzapine. Your review of the EPR reveals that the Psychiatry team added low-dose haloperidol to his medictaion regimen late last week.

 

From the end of the bed, you note he appears uncomfortably rigid in the bed.

  • HR 120

  • BP varies between 140/90 and 220/140

  • SpO2 97% on RA

  • RR 25

  • Temp 38.5

 

Pupils are 4mm and reactive bilaterally and he is staring into space. He is warm and slightly sweaty to touch, though very pale. Neurological examination reveals generalised lead-pipe rigidity. There is no clonus and you have difficulty eliciting any reflexes.

 
 

Question 1

What toxidrome is this patient most likely to be suffering from?

Question 2

What medications can be responsible for this condition?

Question 3

What would you expect to find on neurological exam?

Question 4

What is the treatment of this condition?