[Malignant neuroleptic syndrome under metoclopramide and neuroleptics in anuria].

A patient with myeloma nephropathy and acute, probably diclofenac-induced renal failure developed a neuroleptic malignant syndrome (NMS) during treatment with metoclopramide and neuroleptics. These drugs were withdrawn, symptomatic treatment of NMS was started and the patient was hemodialyzed because of uremia. During hemodialysis, the patient's condition improved dramatically and NMS did not recur during her further stay in the hospital. The temporal relationship between metoclopramide administration and the development of NMS, as well as the rapid reversal of NMS, suggest that NMS in this patient was caused by metoclopramide and not by neuroleptic drugs. Thus, metoclopramide should be used with caution in patients with renal failure and patients should be monitored closely for the development of neuroleptic malignant syndrome. Hemodialysis may be therapeutically effective in certain patients with metoclopramide-induced NMS.