A 20 years old boy with known history of mental illness was brought to emergency room with aggressive behaviour and tendency to attack others physically. After psychiatric evaluation, he was prescribed some new drugs and dose of previous drugs changed. After 3 days, he presents to emergency room again with fever (1050C), stiff limbs, altered sensorium and elevated serum CPK levels. What is the immediate management for this condition?

(Refer: Kaplan & Sadock's CTP, 10th Ed Chap 34.17  P.7849) Neuroleptic malignant syndrome A 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 urine Raised 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.