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Acute Myoglobinuric Renal Failure: A Consequence of the Neuroleptic Malignant Syndrome

Acute Myoglobinuric Renal Failure: A Consequence of the Neuroleptic Malignant Syndrome Abstract • Neuroleptic malignant syndrome and acute myoglobinuric renal failure developed in three patients after they had received a combination of a major tranquilizer and a tricyclic antidepressant or after a large dose of haloperidol. Rhabdomyolysis was demonstrated by biochemical methods as well as by a muscle biopsy. Myoglobinuria was confirmed by radioimmunodiffusion and also was verified in a necropsy specimen. Dehydration and drug interaction with tricyclic antidepressants seemed to be predisposing factors. Renal function recovered when the patient survived the acute episode, but neurologic sequelae persisted. Recommendations that may avert further cases are made. (Arch Intern Med 1982;142:601-603) References 1. Ayd FJ: Fatal hyperpyrexia during chlorporomazine therapy. J Clin Exp Psychopathol Q Rev Psychiatr Neurol 1956;17:189-192. 2. Hollister LE: Adverse reactions to phenothiazine. JAMA 1964;189:143-145.Crossref 3. Greenblatt DJ, Gross PL, Harris J, et al: Fatal hyperthermia following therapy of sedative-hypnotic withdrawal. J Clin Psychiatry 1978;39:673-675. 4. Cohen WJ, Cohen NH: Lithium, haloperidol, and irreversible brain damage. JAMA 1974;230:1283-1287.Crossref 5. Geller B, Greydamus DE: Haloperidol-induced comatose state with hyperthermia and rigidity in adolescence. J Clin Psychiatry 1979;49:102-103. 6. Caroff SN: The neuroleptic malignant syndrome. J Clin Psychol 1980;41:79-82. 7. Ouchterlony 0: Diffusion-in-gel methods of immunological analysis. Prog Allergy 1958;5:1-11. 8. Mann SC, Boger MR: Psychotropic drugs, summer heat, humidity and hyperpyrexia: A danger restated. Am J Psychol 1978;135:1097-1102. 9. Westlake RJ, Rastegar A: Hyperpyrexia from drug combinations. JAMA 1973;225:1250.Crossref 10. Meltzer HY: Rigidity, hyperpyrexia and coma following fluphenazine enanthate. Psychopharmacologia 1973;29:337-346.Crossref 11. Knochel JP: Environmental heat illness. Arch Intern Med 1974;133:841-864.Crossref 12. Henderson VW, Wooten GF: Neuroleptic malignant syndrome: A pathogenetic role for dopamine receptor blockade? Neurology 1981;31:132-137.Crossref 13. Lin MT: Effects of dopaminergic antagonist and agonist on thermoregulation in rabbits. J Physiol 1979;293:217-228. 14. Gram LF, Overo KF: Drug interactions: Inhibitory effects of neuroleptics on metabolism of tricyclic antidepressants in man. Br Med J 1972;1:463-465.Crossref 15. Jansen PA: The pharmacology of haloperidol. Int J Neuropsychiatry 1967;3:510-518. 16. Kennedy MS, Burks TF: Dopamine receptors in the central thermoregulatory mechanism of the cat. Neuropharmacology 1974;13:119-128.Crossref 17. Kruk ZL: The effect of drugs acting on dopamine receptors on the body temperature of the rat. Life Sci 1972;13:119-128. 18. Axelrod J: Noradrenaline: Fate and control of its biosynthesis. Science 1971;173:598-606.Crossref 19. Myers RD: Temperature regulation: Neurochemical systems in the hypothalamus , in Haymarket W, Anderson E (eds): The Hypothalamus: Anatomical, Functional and Clinical Aspects . Springfield, Ill, Charles C Thomas Publisher, 1969, p 507. 20. Tangrik K, Bhargava AK, Bhargava KP: Interrelation between monoaminergic and cholinergic mechanisms in the hypothalamus thermoregulatory centre of rabbits. Neuropharmacology 1974;13:333-346.Crossref 21. Loveless AH, Maxwell DR: A comparison of effects of imipramine, trimpramine and some other drugs in rabbits treated with a monoamine oxidase inhibitor. Br J Pharmacol 1965;25:158-170. 22. Gatz EE, Jones JR: Haloperidol antagonism to the hyperpyrexia and lethal effects of 2,4-dinitrophenol in rats. Anesth Analg 1970;49:773-880.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

Acute Myoglobinuric Renal Failure: A Consequence of the Neuroleptic Malignant Syndrome

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Publisher
American Medical Association
Copyright
Copyright © 1982 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1982.00340160181031
Publisher site
See Article on Publisher Site

Abstract

Abstract • Neuroleptic malignant syndrome and acute myoglobinuric renal failure developed in three patients after they had received a combination of a major tranquilizer and a tricyclic antidepressant or after a large dose of haloperidol. Rhabdomyolysis was demonstrated by biochemical methods as well as by a muscle biopsy. Myoglobinuria was confirmed by radioimmunodiffusion and also was verified in a necropsy specimen. Dehydration and drug interaction with tricyclic antidepressants seemed to be predisposing factors. Renal function recovered when the patient survived the acute episode, but neurologic sequelae persisted. Recommendations that may avert further cases are made. (Arch Intern Med 1982;142:601-603) References 1. Ayd FJ: Fatal hyperpyrexia during chlorporomazine therapy. J Clin Exp Psychopathol Q Rev Psychiatr Neurol 1956;17:189-192. 2. Hollister LE: Adverse reactions to phenothiazine. JAMA 1964;189:143-145.Crossref 3. Greenblatt DJ, Gross PL, Harris J, et al: Fatal hyperthermia following therapy of sedative-hypnotic withdrawal. J Clin Psychiatry 1978;39:673-675. 4. Cohen WJ, Cohen NH: Lithium, haloperidol, and irreversible brain damage. JAMA 1974;230:1283-1287.Crossref 5. Geller B, Greydamus DE: Haloperidol-induced comatose state with hyperthermia and rigidity in adolescence. J Clin Psychiatry 1979;49:102-103. 6. Caroff SN: The neuroleptic malignant syndrome. J Clin Psychol 1980;41:79-82. 7. Ouchterlony 0: Diffusion-in-gel methods of immunological analysis. Prog Allergy 1958;5:1-11. 8. Mann SC, Boger MR: Psychotropic drugs, summer heat, humidity and hyperpyrexia: A danger restated. Am J Psychol 1978;135:1097-1102. 9. Westlake RJ, Rastegar A: Hyperpyrexia from drug combinations. JAMA 1973;225:1250.Crossref 10. Meltzer HY: Rigidity, hyperpyrexia and coma following fluphenazine enanthate. Psychopharmacologia 1973;29:337-346.Crossref 11. Knochel JP: Environmental heat illness. Arch Intern Med 1974;133:841-864.Crossref 12. Henderson VW, Wooten GF: Neuroleptic malignant syndrome: A pathogenetic role for dopamine receptor blockade? Neurology 1981;31:132-137.Crossref 13. Lin MT: Effects of dopaminergic antagonist and agonist on thermoregulation in rabbits. J Physiol 1979;293:217-228. 14. Gram LF, Overo KF: Drug interactions: Inhibitory effects of neuroleptics on metabolism of tricyclic antidepressants in man. Br Med J 1972;1:463-465.Crossref 15. Jansen PA: The pharmacology of haloperidol. Int J Neuropsychiatry 1967;3:510-518. 16. Kennedy MS, Burks TF: Dopamine receptors in the central thermoregulatory mechanism of the cat. Neuropharmacology 1974;13:119-128.Crossref 17. Kruk ZL: The effect of drugs acting on dopamine receptors on the body temperature of the rat. Life Sci 1972;13:119-128. 18. Axelrod J: Noradrenaline: Fate and control of its biosynthesis. Science 1971;173:598-606.Crossref 19. Myers RD: Temperature regulation: Neurochemical systems in the hypothalamus , in Haymarket W, Anderson E (eds): The Hypothalamus: Anatomical, Functional and Clinical Aspects . Springfield, Ill, Charles C Thomas Publisher, 1969, p 507. 20. Tangrik K, Bhargava AK, Bhargava KP: Interrelation between monoaminergic and cholinergic mechanisms in the hypothalamus thermoregulatory centre of rabbits. Neuropharmacology 1974;13:333-346.Crossref 21. Loveless AH, Maxwell DR: A comparison of effects of imipramine, trimpramine and some other drugs in rabbits treated with a monoamine oxidase inhibitor. Br J Pharmacol 1965;25:158-170. 22. Gatz EE, Jones JR: Haloperidol antagonism to the hyperpyrexia and lethal effects of 2,4-dinitrophenol in rats. Anesth Analg 1970;49:773-880.Crossref

Journal

Archives of Internal MedicineAmerican Medical Association

Published: Mar 1, 1982

References