A client receiving haloperidol develops a temperature of 40°C (104°F), severe muscle rigidity, confusion, labile blood pressure, and elevated creatine kinase. Which action is the priority?
1Give the next haloperidol dose early to reduce autonomic agitation.
2Apply restraints and postpone evaluation until the creatine kinase is repeated tomorrow.
3Encourage oral exercise and protein intake to reduce muscle rigidity.
4Stop haloperidol, notify the provider urgently, and begin intensive supportive management.✓ Correct answer
Explanation
Hyperthermia, severe rigidity, altered mental status, autonomic instability, and elevated creatine kinase after antipsychotic exposure indicate neuroleptic malignant syndrome. Haloperidol must be stopped immediately, and the client needs urgent supportive treatment such as cooling, fluid and electrolyte management, renal and cardiac monitoring, and treatment of complications. Delaying care or giving more haloperidol can be fatal.
Clinical reasoning Neuroleptic malignant syndrome is a medical emergency involving extreme muscle activity, impaired thermoregulation, autonomic instability, and risk of rhabdomyolysis and renal failure.
Decision rule Immediately discontinue the causative antipsychotic and initiate intensive symptomatic treatment and monitoring; additional drug therapy is individualized.
Scenario A 34-year-old male with schizophrenia received haloperidol 5 mg IM for acute agitation in the ED 2 hours ago. Current findings: muscle rigidity, fever 39.8°C, tachycardia 124, hypertension 168/96, diaphoresis, and altered mental status. CK and electrolytes are pending.
Neuroleptic malignant syndrome — A rare, life-threatening antipsychotic reaction characterized by hyperthermia, rigidity, mental-status change, and autonomic instability.
Creatine kinase — An enzyme released with skeletal-muscle injury; marked elevation can support concern for rigidity-related rhabdomyolysis.
Extrapyramidal symptoms (EPS) — Movement-related side effects of antipsychotics — acute dystonia, akathisia, parkinsonism, tardive dyskinesia — treated with benztropine or diphenhydramine; distinct from NMS.