Template:AMS and fever DDX

Altered mental status and fever

• Sepsis
• Neuroleptic malignant syndrome - Serotonin Syndrome(SS) vs Neuroleptic Malignant Syndrome(NMS)
  • Differentiation between the SS and NMS can be challenging. History of a new serotonergic drug or a dose increase of a serotonergic drug are helpful. SS is usually much more acute in onset than NMS which may develop over days or weeks. On physical exam the presence of ‘lead pipe’ rigidity is typical of NMS, while patients with SS manifest tremor and hyperreflexia.
  • Elevations in creatine kinase, liver function tests (lactate dehydrogenase, aspartate transaminase), and white blood cell count, coupled with a low serum iron level, distinguishes NMS from SS among patients taking neuroleptic and serotonin agonist medications simultaneously.
• Serotonin syndrome
• Malignant hyperthermia
• Sympathomimetic toxicity (cocaine, amphetamine, ketamine)
• Anticholinergic toxicity
• Meningitis
• Encephalitis
• Heat stroke
• Delirium tremens
• Hypothalamic stroke
• Pheochromocytoma
• Thyroid storm