The neuroleptic malignant syndrome (NMS), an unusual idiosyncratic reaction to neuroleptic medications, may be fatal if unrecognized. Symptoms of NMS include rigidity, hyperpyrexia, altered consciousness, and autonomic instability. This syndrome is generally associated with neuroleptic medications used to treat psychotic and major depressive illnesses. We describe two diabetic patients at our institution who developed NMS in association with antiemetic metoclopramide hydrochloride.