Drug-induced hyperthermia and muscle rigidity: a practical approach.
Body thermoregulation can be violently offset by drugs capable of altering the balance between heat production and dissipation. Such events may rapidly become fatal. The drugs that are involved in the eruption of such syndromes include inhalation anaesthetics, sympathomimetic agents, serotonin antagonists, antipsychotic agents and compounds that exhibit anticholinergic properties. The resultant hyperthermia is frequently accompanied by an intense skeletal muscle hypermetabolic reaction that leads to rapidly evolving rigidity, extensive rhabdomyolysis and hyperkalemia. The differential diagnosis should, however, rule out non-drug-induced causes, such as lethal catatonia, central nervous system infection or tetanus, strychnine poisoning, thyrotoxic storm and pheochromocytoma. Prompt life-saving procedures include aggressive body temperature reduction. Patients with a suspected drug (or non-drug) hypermetabolic reaction should be admitted into an intensive care area for close monitoring and system-oriented supportive treatment. We present six conditions, in decreasing order of gravity and potential lethality, in which hyperthermia plays an essential role, and suggest a clinical approach in such conditions.
Hadad
Eran
E
Department of Anesthesiology and Critical Care Medicine Tel Aviv Sourasky Medical Center and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Weinbroum
Avi A
AA
Ben-Abraham
Ron
R
D001833:Body Temperature Regulation / Q000187:drug effects; D018680:Cholinergic Antagonists / Q000009:adverse effects; D003937:Diagnosis, Differential; D005334:Fever / Q000139:chemically induced*; D006801:Humans; D008305:Malignant Hyperthermia / Q000209:etiology; D009127:Muscle Rigidity / Q000139:chemically induced* / Q000150:complications; D009459:Neuroleptic Malignant Syndrome / Q000209:etiology / Q000503:physiopathology; D013566:Sympathomimetics / Q000506:poisoning
D018680:Cholinergic Antagonists; D013566:Sympathomimetics