title: Simple intravenous fluid regimens to control fever in hospitalized stroke patients: a theoretical evaluation.
abstract: Fever is an independent predictor of worse outcome in stroke patients. We hypothesized that a peripheral infusion of saline in chilled or ice slurry form can be a practical adjuvant therapy to maintain euthermia. We developed a theoretical model simulating systemic body cooling in response to 0 degrees C saline and 50% ice slurry. Temperature elevations up to 39 degrees C were studied with respect to the time needed to reach a core temperature of 37 degrees C. Mathematical modeling identified a cooling rate of 0.48 degrees C/hr and 0.24 degrees C/hr using a 450 mL/hr infusion of 50% ice slurry and chilled saline. A reduction of the infusion rate to 150 mL/hr decreased euthermia time by a factor of 3; however, the total amount of coolant remained constant. Thus, based on mathematical modeling, peripheral infusions of saline in chilled or ice slurry form can be used as an adjunct therapy to achieve euthermia and control fever. Using intravenous coolants in an on-demand, temperature-guided and supervised treatment setting seems most reasonable to avoid potentially unsafe use of extended fluid volumes and infusion times.
authors.affiliation: Department of Neurology and Neurosurgery, F-610, New York Presbyterian Hospital-Weill Cornell Medical Center, 525 East 68th Street, New York, NY 10021, USA. arosenga@uchicago.edu
authors.forename: Axel J
authors.initials: AJ
authors.lastname: Rosengart
authors.forename: Liang
authors.initials: L
authors.lastname: Zhu
authors.forename: Thomase
authors.initials: T
authors.lastname: Schappeler
authors.forename: Fernando D
authors.initials: FD
authors.lastname: Goldenberg
mesh_terms: D001790:Blood Physiological Phenomena; D001833:Body Temperature Regulation / Q000502:physiology*; D003080:Cold Temperature; D017679:Cryotherapy / Q000379:methods*; D005334:Fever / Q000209:etiology / Q000628:therapy*; D006760:Hospitalization; D006801:Humans; D007053:Ice; D007262:Infusions, Intravenous / Q000379:methods; D008954:Models, Biological; D012965:Sodium Chloride / Q000008:administration & dosage; D020521:Stroke / Q000097:blood / Q000150:complications / Q000628:therapy
chemical_list: D007053:Ice; D012965:Sodium Chloride