TAILIEUCHUNG - Chapter 017. Fever and Hyperthermia (Part 2)

Hyperthermia Although most patients with elevated body temperature have fever, there are circumstances in which elevated temperature represents not fever but hyperthermia (Table 17-1). Hyperthermia is characterized by an uncontrolled increase in body temperature that exceeds the body's ability to lose heat. The setting of the hypothalamic thermoregulatory center is unchanged. In contrast to fever in infections, hyperthermia does not involve pyrogenic molecules (see "Pyrogens," below). Exogenous heat exposure and endogenous heat production are two mechanisms by which hyperthermia can result in dangerously high internal temperatures. Excessive heat production can easily cause hyperthermia despite physiologic and behavioral control of body. | Chapter 017. Fever and Hyperthermia Part 2 Hyperthermia Although most patients with elevated body temperature have fever there are circumstances in which elevated temperature represents not fever but hyperthermia Table 17-1 . Hyperthermia is characterized by an uncontrolled increase in body temperature that exceeds the body s ability to lose heat. The setting of the hypothalamic thermoregulatory center is unchanged. In contrast to fever in infections hyperthermia does not involve pyrogenic molecules see Pyrogens below . Exogenous heat exposure and endogenous heat production are two mechanisms by which hyperthermia can result in dangerously high internal temperatures. Excessive heat production can easily cause hyperthermia despite physiologic and behavioral control of body temperature. For example work or exercise in hot environments can produce heat faster than peripheral mechanisms can lose it. Table 17-1 Causes of Hyperthermia Syndromes Heat Stroke Exertional Exercise in higher-than-normal heat and or humidity Nonexertional Anticholinergics including antihistamines antiparkinsonian drugs diuretics phenothiazines Drug-Induced Hyperthermia Amphetamines cocaine phencyclidine PCP methylenedioxymethamphetamine MDMA ecstasy lysergic acid diethylamide LSD salicylates lithium anticholinergics sympathomimetics Neuroleptic Malignant Syndrome Phenothiazines butyrophenones including haloperidol and bromperidol fluoxetine loxapine tricyclic dibenzodiazepines metoclopramide domperidone thiothixene molindone withdrawal of dopaminergic agents Serotonin Syndrome Selective serotonin reuptake inhibitors SSRIs monoamine oxidase inhibitors MAOIs tricyclic antidepressants Malignant Hyperthermia Inhalational anesthetics succinylcholine Endocrinopathy Thyrotoxicosis pheochromocytoma Central Nervous System Damage Cerebral hemorrhage status epilepticus hypothalamic injury Source After FJ Curley RS Irwin JM Rippe et al eds Intensive Care Medicine 3d ed. Boston Little Brown stroke

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