Internal Medicine

0521779407-09 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:13

Hypertension Hyperthermia 767

■Lipid profile: every 12 months

■ECG every 2–4 years depending on baseline abnormalities

■Consider reducing therapy (“step down”), especially in patients with

significant improvements in lifestyle

complications and prognosis

■Cardiovascular disease: Left ventricular hypertrophy (2–15% by

ECG), Left ventricular systolic dysfunction, heart failure due to

systolic and/or diastolic dysfunction, ischemic heart disease and

myocardial infarction

■Cerebrovascular disease: Stroke, dementia

■Renal disease: nephrosclerosis, renal failure

■Aortic dissection

■Atherosclerosis and related complications: Myocardial ischemia/

infarction, TIAs/stroke, peripheral vascular disease

Hyperthermia.......................................

DAVID C. MCGEE, MD and STEPHEN J. RUOSS, MD

history & physical

History

■Excessive heat production: exercise in heat by unacclimatized indi-

viduals, drug abuse (cocaine, amphetamines), salicylate intoxica-

tion, malignant hyperthermia of anesthesia, neuroleptic malig-

nant syndrome, endocrine disorders (thyrotoxicosis, pheochromo-

cytoma), status epilepticus, generalized tetanus

■Diminished heat dissipation: heat exposure and inappropriate

homeostasis (chronic illness, old age, dementia, high humidity, obe-

sity, lack of air-conditioning, no access to fluids); anticholinergic

agents, dehydration, autonomic dysfunction, and neuroleptic malig-

nant syndrome

■Disordered temperature regulation: neuroleptic malignant syn-

drome, CVA, encephalitis, sarcoidosis, granulomatous infections,

and trauma

■Infection can accompany any of the above

Signs & Symptoms

■Hyperthermia=core body temperature > 38.5◦C; need rectal probe

or tympanic membrane thermometer

■Mild to moderate hyperthermia (38.6–40◦C): headache, nausea,

vomiting, dizziness, weakness, irritability, muscle cramps, diaphore-

sis