رجل عمره ٧٢ سنة عنده باركنسون، منوم لعملية في البطن، وفاتته جرعات الليفودوبا يوماً كاملاً لأنه صائم. صار متيبساً جداً، وحرارته ٣٩، ومشوشاً، ويتعرق، والضغط ١٦٨/٩٨، والنبض ١٢٤. ما الخطر؟

A 72-year-old man with Parkinson’s admitted for abdominal surgery missed levodopa doses for a whole day while fasting. He is now very rigid, febrile at 39 °C, confused and sweating; BP 168/98, HR 124. What is the danger?

1. A simple urinary infection unrelated to the drug
2. Expected improvement after stopping the drug
3. A new epileptic seizure from fasting
4. A neuroleptic malignant-like syndrome from abrupt withdrawal

Answer: D) A neuroleptic malignant-like syndrome from abrupt withdrawal. Abrupt withdrawal of Parkinson’s drugs can cause severe rigidity, fever and autonomic instability. Doses are given on time even when nil by mouth, by alternative routes as ordered.