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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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Need Help In Diagnosing And Managing A Medical Problem

Hi.My patient is a 18 y/o girl , a known case of bipolar disorder.she have developed psychosis Since 5 days ago(acutly and without any precipitants) Now she is admitted , cpk is rising from 500(yesterday) to 19000(today morning) and 56000 now(afternoon).LDH is 2000.HB is 11.4 wbc:8800 U/A: 1+ blood with 8-10 RBC, BUN,cr,Na,K :normal

She is oriented,with a low grade fever without rigidity, without pain, normal neurological exam,All drugs are holded(previous drugs:lithium and risperidone from 1yr ago till today morning)

WOULD U PLZ HELP ME TO DIAGNOSE AND MANAGE THE PROBLEM
Wed, 25 Jun 2014
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Psychiatrist 's  Response
Hello,
She is developing NMS most probably but appears to have better prognosis as she is hospitalised and drugs are stopped. It is good she has no rigidity and some tests are normal, she is oriented and neurolgically normal.
The only managment presently is supportive and involves controlling fever, maintaing fluid and electrolyte balance and prevention of kidney functioning.

Let her be hospitalised, under 24hrs survillance till her CPK and Blood counts improve. She cannot be managed at home presently.
The treating team is doing good work, I think you should trust them.

Wish you good luck.
Dr. Manisha Gopal
MD Neuropsychiatry
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Psychiatrist Dr. Srikanth Reddy's  Response
Hello,
Thanks for choosing health care magic for posting your query.
I have gone through your question in detail and I can understand what you are going through.
If the present antipsychotics are not showing improvement then the dosage of antipsychotics have to be increased.
Hope I am able to answer your concerns.
If you have any further query, I would be glad to help you.
In future if you wish to contact me directly, you can use the below mentioned link:
bit.ly/dr-srikanth-reddy
                                        
Wish you good health,
Kind regards
Dr. Srikanth Reddy M.D
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Need Help In Diagnosing And Managing A Medical Problem

Hello, She is developing NMS most probably but appears to have better prognosis as she is hospitalised and drugs are stopped. It is good she has no rigidity and some tests are normal, she is oriented and neurolgically normal. The only managment presently is supportive and involves controlling fever, maintaing fluid and electrolyte balance and prevention of kidney functioning. Let her be hospitalised, under 24hrs survillance till her CPK and Blood counts improve. She cannot be managed at home presently. The treating team is doing good work, I think you should trust them. Wish you good luck. Dr. Manisha Gopal MD Neuropsychiatry