Internal Medicine

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

770 Hyperthermia Hyperthyroidism

■Dantrolene sodium: For malignant hyperthermia of anesthesia or

neuroleptic malignant syndrome: repeat dose until symptoms sub-

side or max dose reached, immediate interruption of anesthesia or

discontinuation of neuroleptic indicated

■Bromocriptine may be useful in neuroleptic malignant syndrome

Side Effects & Complications

■Shivering and vasoconstriction common: treat with chlorpromazine

IM or diazepam IV

■Chlorpromazine can lower seizure threshold

■Dantrolene sodium may cause generalized muscle weakness, seda-

tion and hepatitis

■Aggressive IV fluid replacement can result in pulmonary edema,

esp in patients who develop myoglobinuria-induced renal failure

or myocardial infarction

Contraindications

■Relative: dantrolene sodium not effective for heat stroke

follow-up

During Treatment

■Monitor core temperature continuously; changes in rectal tempera-

ture may lag changes in actual core temperature

■Cool as rapidly as possible until temperature <38.9◦C

complications and prognosis

■Time to correction of temperature correlates with severity of neuro-

logic injury and residual deficits.

■Febrile seizure in 2 to 4% of children

■Renal failure in 5–25% of patients with severe hyperthermia

■Mortality from severe hyperthermia 10% with treatment and

increases to 76% in patients with temperature >41.0◦C

■Mortality from malignant hyperthermia of anesthesia and neurolep-

tic malignant syndrome 8–20% with treatment

Hyperthyroidism....................................

LAWRENCE CRAPO, MD, PhD

history & physical

History

■Personal or family history of thyroid disease

■Recent viral illness