47 Copyright © All rights are reserved by Juan F Martin Lazaro. Global Journal of Anesthesia & Pain Medicine Case Report Detox - Haemofiltration for The Neuroleptic Malignant Syndrome Juan F Martin Lazaro 1 *, Marc Brown 1 , Emily Gould 1 , Johann Grundlingh 1 , Michal Brys Ieva Norkiene 1 , Joaquim Cevallos 1 , James Napier 1 , Khyati Lad 2 and Jacek Jablonski 3 1 Intensive Care Unit. Newham University Hospital, UK 2 Pharmacy Department, Newham University Hospital, UK. 3 Beloit Memorial Hospital, USA *Corresponding author: Juan F Martin Lazaro, Intensive Care Unit, Newham University Hospital, London, UK Received: April 04, 2019 Published: April 23, 2019 Introduction Neuroleptic malignant syndrome (NMS) is a medical emergency, made more difficult by the lack of any diagnostic investigations, making it an entirely clinical diagnosis. Four criteria are used as parameters for a likely diagnosis: a change in mental status, a muscle rigidity (lead-pipe type), hyperthermia and signs of autonomic instability. TOXBASE guidelines state that in cases of suspected poisoning, activated charcoal may be used within 1 hour of ingestion; However, in cases like this where the patient is late in presentation, options are more limited. To our current knowledge, there is no specific antidote, and recommended therapy is supportive only. A few case reports have suggested the use of CVVH, peritoneal dialysis, and haemodialysis. In the absence of any diagnostic tests, we felt it was prudent to initiate renal replacement therapy in an attempt to filter any precipitating substances, without waiting for the development of further symptoms. Here we discuss the use of albumin enhanced continuous renal replacement therapy to treat a likely neuroleptic malignant syndrome. Case Report A 60-year-old male presented to the Accident and Emergency Department with reduced conscious level, diarrhoea and vomiting. The patient had ingested an unknown powder sent from Nigeria two days before presentation, for use as a treatment for his recently diagnosed Hepatitis B infection. Other past medical history includes type 2 diabetes mellitus, hypertension and hypercholesterolemia, treated with metformin, gliclazide, ramipril and atorvastatin respectively. The patient’s wife subsequently gave a collateral history, explaining that the patient had taken the unknown substance from Nigeria, knowing that it would make him very unwell for 3 days. She called for the ambulance on the 2 nd day due to his reduced conscious level and vomiting. Upon initial assessment, respiratory rate was 35/min, heart rate 115/min, blood pressure 100/60mHg and temperature of 39oC. On auscultation he had crackles at both lung bases, a finding consistent with a chest x ray that demonstrated bilateral infiltrates, suggestive of either bronchoaspiration or Abstract Removal of serum toxins using haemofiltration with human albumin has been demonstrated to be a useful option for the treatment of a patient following the ingestion of unknown substance. Here, a case is described in which a patient presented with symptoms of neuroleptic malignant syndrome after ingesting an unknown Nigerian herbal remedy. Albumin enhanced continuous veno-venous haemodialysis has been previously used for intoxications. When combining continuous renal replacement therapy with albumin, the toxins are bound to the larger molecule which prevents the toxins moving through the filter; allowing for clearance from the blood. We suggest that Intensive Care Units should consider basic tools, such as detox haemofiltration when an unknown poison is suspected. DOI: 10.32474/GJAPM.2019.01.000111 ISSN: 2644-1403