Need help in diagnosing and managing a medical problem
Patient: 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 Doctor: 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 GopalMD Neuropsychiatry