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  #1  
Old 10-28-2011
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Question Serotonin syndrome vs Neuroleptic Malignant Syndrome

A 23 yo male collapsed at the entrance of Emergency Department. He was agitation, confused (not able to communicate) with clonus, increased pulse, hypertensive, sweating, and hyperthermia. You think it is serotonin syndrome but your nurse questioned you that: "Dr, how do you know it is not a Neuroleptic Malignant Syndrome manifestation from using anti-psychotic drugs?". You were wondering what investigations you should do to diffentiate serotonin syndrome from neuroleptic magligant sydrome ?

Anyone knows the answer?
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i really dont know and i want to knowwwwww
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Here are what you should think & act (1) neuroleptic malignant syndrome shows bradykinesia and extrapyramidal "lead pipe" rigidity, whereas serotonin syndrome causes hyperkinesia and clonus (2) serotonin syndrome is fast onset whereas NMS is slow onset (3) Serototin syndrome can be treated with cyrpoheptadine, chlorpromazine. But If you still cannot decide whether the diagnosis is serotonin syndrome or neuroleptic malignant syndrome then presume it is serotonin syndrom first and give cyproheptadine (do NOT give Chlorpromazine as it will worsen the symptoms of neuroleptic malignant syndrome in case your first guess was wrong). If px response well to cyproheptadine, bingo ! If px does not response, then you know it is NMS which can be treated with bromocriptine.
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Old 11-13-2011
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Also you can test urine dopamine and serotonin metabolites to differentiate NMS from serotonin syndrome
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Old 11-14-2011
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Old 06-27-2013
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Its Myoclonus. That's the differentiating symptom. It is only seen in Serotonin Syndrome not NMS
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Old 07-05-2014
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Default NMS vs serotonin syndrome

Quote:
Originally Posted by Vince782121 View Post
Its Myoclonus. That's the differentiating symptom. It is only seen in Serotonin Syndrome not NMS
An addition to your point, Uworld mentions that NMS is distinguished clinically by an absence of myoclonus and presence of rigidity!

All the best...
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Old 10-17-2015
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why chlorpromazine (d2 blocker ) used in sertonin syndrome


and why diphenhydramine (h1 blocker,, anti musarinic) is used in neurolepticmalignant syndrome
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