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Muna1:
A 47-year-old man with a known history of schizophrenia is admitted to the Emergency Department due to confusion. A bottle of procyclidine tablets are found in his pocket. On examination the temperature is 38.1ºC with a blood pressure of 155/100 mmHg. Neurological examination reveals a GCS of 13/15 but assessment of his peripheral nervous system is difficult due to generalised increased muscle tone. What is the most likely diagnosis?

Doctoor:
This is probably the side effects of Procyclidine toxicity.
Procyclidine is an anticholinergic drugs used to treat in parkinsonism, also can be used in schizopherenic patien and it's overdose effects include large pupils; warm, dry skin; flushed face; fever; dry mouth; fast or irregular heartbeat; anxiety; hallucinations; confusion; agitation; hyperactivity; loss of consciousness; and seizures.

This can be reversed by giving physostigmine drug intravenously or subcutaneosly.

Hope this is the answer
Doctoor!

Doctoor:

well then.
There can be other diagnoosis [neuroleptic malignant syndrome(NMS)].
NMS is caused almost exclusively by antipsychotics drugs including procyclidine, and the patient presents with the same symtoms and signs like; muscular rigidity, high fever, confusion, coma, unstable blood pressure, the patient is febrile and have muscular tremors which can be difficult to examine him.

The treatment is to remove the patient from any neuroleptic or antipsychotic drugs being taken and to treat fever aggressively.

Hope this is the correct answer
Doctoor!

Muna1:
it is the correct answer,it is neuroleptic malignant syndrome(NMS)].
thank you for your best answer:D

Admin:
Congratulations
The 15 points of this case goes to Doctoor
Dr.Mahdi

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