Template:Serotonin syndrome vs neuroleptic malignant syndrome
- Differentiation between the serotonin syndrome and NMS can be challenging. History of a new serotonergic drug or a dose increase of a serotonergic drug are helpful. serotonin syndrome is usually much more acute in onset than NMS which may develop over days or weeks. On physical exam the presence of ‘lead pipe’ rigidity is typical of NMS, while patients with serotonin syndrome manifest tremor and hyperreflexia.
- Elevations in creatine kinase, liver function tests (lactate dehydrogenase, aspartate transaminase), and white blood cell count, coupled with a low serum iron level, distinguishes NMS from serotonin syndrome among patients taking neuroleptic and serotonin agonist medications simultaneously.