Makindo Medical Notes

Related Subjects: Acute Kidney Injury |Acute Rhabdomyolysis |Hyperkalaemia |Neuroleptic Malignant Syndrome |Malignant Hyperpyrexia (Malignant Hyperthermia) |Parkinson Hyperpyrexia Syndrome |Serotonin syndrome |Cholinergic crisis-syndrome |Anticholinergic syndrome

🧠 Parkinson Hyperpyrexia Syndrome (PHS) is a rare, life-threatening emergency seen in Parkinson’s disease. It often follows the abrupt withdrawal or reduction of dopaminergic drugs (💊 levodopa) or occurs during intercurrent illness, surgery, or trauma. ⚡ Pathophysiology: sudden dopamine deficiency → severe motor decompensation + autonomic failure, similar to neuroleptic malignant syndrome (NMS).

🔥 Key Clinical Features

• 🌡️ Hyperpyrexia: Fever >38°C, rapid onset.
• ⚡ Severe Rigidity: Worse than baseline Parkinsonism.
• 💓 Autonomic Dysfunction: Sweating, tachycardia, unstable BP, dehydration.
• 🧩 Neuro Features: Confusion, delirium, dysphagia, stupor → coma in severe cases.
• 🩸 Rhabdomyolysis & AKI: Risk of renal failure from myoglobinuria.

⚠️ Common Triggers

• ❌ Sudden withdrawal of levodopa or dopamine agonists.
• 🤒 Intercurrent infection (pneumonia, UTI).
• 🩺 Post-surgery or trauma.
• Dehydration, metabolic stress, or hospitalisation without correct drug administration.

🧪 Investigations

• 📈 ↑ Creatine kinase (muscle breakdown).
• 🧪 Abnormal renal & liver function, high WCC.
• 💧 Electrolyte imbalance: hypernatraemia, AKI.
• Rule out sepsis with cultures & CXR.

🔍 Differential Diagnosis

• NMS: Antipsychotic drug exposure.
• Sepsis: Infection as cause of fever/confusion.
• Malignant Hyperthermia: Triggered by anaesthesia.
• Heat Stroke: Environmental exposure.

🚨 Complications

• Acute kidney injury (rhabdomyolysis).
• Aspiration pneumonia, respiratory failure.
• Sepsis, DIC, thromboembolism.
• ⚰️ Death if untreated.

💊 Management

• Restart Dopaminergic Therapy: Resume levodopa/agonist at full dose. - NG tube if not swallowing. - Rotigotine patch (2–4 mg/24h) or SC Apomorphine (1–2 mg/hr) if needed.
• Fluids & Electrolytes: IV fluids to prevent AKI.
• Temperature Control: Cooling blankets, antipyretics.
• ICU Care: Ventilation or haemodialysis in severe cases.
• Muscle Relaxants: Dantrolene (10 mg/kg/day) if rigidity severe.
• Palliation: Consider in advanced/end-stage PD after a trial of active therapy.

💡 Exam Tip: - PHS vs NMS: PHS = Parkinson’s patient + sudden levodopa withdrawal. NMS = antipsychotic use. - Always check the patient’s medication history in acute confusion/fever with rigidity. - ⚠️ Hospitals sometimes miss Parkinson’s drug timings → can precipitate PHS!