<prompt> A 20 years old boy with known history of mental illness was brought to emergency room with aggressive behaviour and tendency to attack others physically. After psychiatric evaluation, he was prescribed some new drugs and dose of previous drugs changed. After 3 days, he presents to emergency room again with fever 1050C, stiff limbs, altered sensorium and elevated serum CPK levels. What is the immediate management for this condition?Succinyl cholineDantroleneEdrophoniumNeostigmine  <response>: Refer: Kaplan Sadocks CTP, 10th Ed Chap 34.17 P.7849Neuroleptic malignant syndromeA rare but extremely serious complication of neuroleptic treatment especially with high potency compounds. Evolve over 24-72 hours untreated last for 10 to 14 days , even fatalClinical featuresHyperthermiaMuscular rigidity Increased muscle tone, dysphagia, dysponeaAutonomic disturbance Elevated BP, HR, salivation, incontinence of urineRaised WBC and creatinine phosphokinaseManagementDiscontinuation of all medicationsHyperventilate with 100 oxygenAdminister sodium bicarbonate 1 2 mEqkg IV and dantrolene sodium 2.5 mgkg IVAdminister inotropes, anti-arrhythmic agentsMonitor urinary output, K, Ca2, blood gases, end tidal carbon dioxideConsider invasive monitoring of arterial blood pressure and central venous pressureCorrection of acidosis and control of temperature. 