[Hyperpyrexia and shock (author's transl)].
In childhood hyperpyrexia is the most important factor causing the irreversibility of shock. The combination of high fever and circulatory impairment is more frequent during the first years of life. This behaviour is due to the high resistance of the arterial system in infancy. Marked general vasoconstriction increases the risk of a reduction in circulation and of heat loss, and causes hypoxia and rise of fever. The further course of shock is largely determined by microcirculatory failures. Under hyperpyrexia the disturbance of homeostasis can be intensified by shivering, blocking of perspiratio sensibilis, hyperosmolarity, brain edema, and DIC. In most cases of meningococcal sepsis shock and DIC begin with vasoconstrictive centralisation of circulation. The high-output-shock is extremely rare in children with high fever. The control of all important functions of a febril child in shock is the best baseline for the treatment. It is necessary in all shock patients in hyperpyrexia to reduce the fever and to repair the peripheral circulation. The therapy consists of antipyretic drugs, physical cooling, infusions of buffer-bases, dopamine, antibiotics and so on. In DIC heparin or streptokinase are indicated. In severe circulatory impairment combined with high fever prednisone is useful, in brain edema dexamethasone. The fatality rate of our cases has been diminished by a systematic therapy of hyperpyrexia and shock from 10 to 3 percent.
D000293:Adolescent; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D004211:Disseminated Intravascular Coagulation / Q000150:complications; D005260:Female; D005334:Fever / Q000150:complications*; D006801:Humans; D007223:Infant; D008589:Meningococcal Infections / Q000503:physiopathology; D008833:Microcirculation; D018805:Sepsis / Q000503:physiopathology; D012769:Shock / Q000150:complications*; D014666:Vasomotor System / Q000503:physiopathology
Hyperpyrexie und Schock