(Refer: Kaplan & Sadock's CTP, 10th Ed Chap 34.17  P.7849) Neuroleptic 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 fatal Clinical features Hyperthermia Muscular rigidity – Increased muscle tone, dysphagia, dysponea Autonomic disturbance – Elevated BP, HR, salivation, incontinence of urineRaised WBC and creatinine phosphokinase Management Discontinuation of all medications Hyperventilate with 100% oxygen Administer sodium bicarbonate 1 – 2 mEq/kg IV and dantrolene sodium 2.5 mg/kg IV Administer inotropes, anti-arrhythmic agents Monitor urinary output, K+, Ca2+, blood gases, end tidal carbon dioxide Consider invasive monitoring of arterial blood pressure and central venous pressure Correction of acidosis and control of temperature.