Early Bicarbonate Loading and Dantroline for Ziprasidone/Haloperidol-Induced Neuroleptic Malignant Syndrome

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Sir: Neuroleptic malignant syndrome (NMS), when severe, is associated with a 10% mortality rate.1 Many patients exhibit renal dysfunction often due to myoglobinuric renal failure secondary to rhabdomyolysis.1 In one series of cases of severe NMS, over 50% progressed to renal failure.2 Randomized controlled trials of early and preventive alkalinization with sodium bicarbonate have demonstrated protective effects in patients at risk for contrast-induced nephropathy,3 as well as protection against nephropathy in patients with early rhabdomyolysis, a variety of intoxication states, and acute ischemic renal failure in animal models.4

J Clin Psychiatry 2006;67(4):677-677