Table 2 Differential diagnosis and specific treatment in syndromes associated with hyperthermia
From: Bench-to-bedside review: Mechanisms and management of hyperthermia due to toxicity
Syndrome | Associated features | Treatment |
|---|---|---|
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) |
| Â | 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 |