Q150) A 34 year old male nurse is brought to the Emergency Room by the EMS with altered mental status. As per his sister, the patient has been on Lithium for his manic symptoms for the past one year. However, his psychiatrist added Fluoxetine and Amitriptyline about 1 week ago for history of depression symptoms.
On physical examination, he has low grade fever at 100.5F, Blood pressure of 110/82 and Heart rate of 120/min. He is confused and the pupils are dilated. There is rigidity in extremities and deep tendon reflexes are exaggerated. Complete blood count, creatinine and Creatine kinase level are within normal limits. Most likely diagnosis:
A) Neuroleptic Malignant Syndrome
B) Lithium Toxicity
C) Serotonin Syndrome
D) Amphetamine abuse
E) Cocaine Intoxication
B,Lithium toxicity,In NMS increased CK, serotonin synd occurs with combination of SSRI and Mao
c?
c
c.
D/D NMS and Serotonin syndrom
NMS : hyporeflexia, -nt clonus
serotonin syndrome : hyperreflexia, +ve clonus and MYDRIASIS.
Patient in this scenerio also have dangereous combination of SSRIs and TCA
C