Table 2 |
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Differential diagnosis and specific treatment in syndromes associated with hyperthermia |
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| Syndrome |
Associated features |
Treatment |
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| Adrenergic fever |
Hyperpyrexia, autonomic storm, convulsions, liver failure, myocardial infarction,
subarachnoid hemorrhage |
Sympatholytics (for example, carvedilol), benzodiazepines |
| Neuroleptic malignant syndrome |
Slowly progressive generalized muscular rigidity (usually over one to three days),
mental status change, autonomic instability, hyperthermia |
Bromocriptine, dantrolene, L-dopa, amantadine, muscle relaxants |
| Anticholinergic fever |
Anticholinergic toxidrome: peripheral (dry red skin, tachycardia) and central signs
(mydriasis, tremor, disorientation, coma) |
Sedatives, physostigmin (controversial) |
| Serotonin syndrome |
Onset within 12 hours, self-limited hyperreflexia, akathisia, tremor, sustained clonus,
confusion, coma, cognitive changes, autonomic instability (often hypertensive) |
Serotonin antagonists as cyproheptadine and chlorpromazine, benzodiazepines, esmolol |
| Uncoupling of oxidative phosphorylation |
Tachypnea, tachycardia, and marked diaphoresis (PCP) |
PCP: supportive treatment, exchange transfusion (controversial) |
| Intractable acidosis, renal failure, pulmonary edema and CNS disturbances (salicylates) |
Salicylates: hemodialysis |
|
| Malignant hyperthermia |
Fulminant muscle rigidity, hypermetabolic state, hypercarbia |
Discontinuation of anesthetics, dantrolene |
| Drug induced fever |
Mainly unspecific; broad clinical spectrum from looking and feeling surprisingly well
to looking severely ill and profoundly septic; fever pattern varies broadly |
Discontinuation of any drugs not essentially needed; distinguish from infectious causes,
for example, using the infection probability score |
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PCP, pentachlorphenol. |
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Eyer and Zilker Critical Care 2007 11:236 doi:10.1186/cc6177 |
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