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‘ ‹