1/20. Hyperpyrexia in the emergency department.The differential diagnosis of the hyperpyrexic patient in the emergency department is extensive. It includes sepsis, heat illness including heat stroke, neuroleptic malignant syndrome, malignant hyperthermia, serotonin syndrome and thyroid storm. Each of these possible diagnoses has distinguishing features that may help to differentiate one from another. However, establishing the correct diagnosis is a challenge in the setting of the obtunded emergency patient who gives no history and where there may be limited access to any past medical or drug history. This paper presents such a case and reviews the features of the differential diagnoses and management of the hyperpyrexic patient.- - - - - - - - - - ranking = 1keywords = heat stroke, heat, stroke (Clic here for more details about this article) |
2/20. Collapse from exertional heat illness: implications and subsequent decisions.The implications of the collapse of a soldier early in an exercise from exertional heat illness (EHI) are considered. Such soldiers may be at risk from a genetic predisposition. malignant hyperthermia (MH) and isolated and improbable cases of EHI may be just two different expressions of the same mutated gene sequence. The genetics of MH are complex and present knowledge is incomplete. The use of the in vitro contraction test (IVCT) on cases of EHI, in addition to its proven role in MH, would be helpful in examining the relationship between MH and EHI. It has been shown that some soldiers collapsing with EHI may have subsequent positive IVCTs. The test, however, sometimes produces false positives and, in addition, a positive result could be a consequence of a heat insult rather than an antecedent. Further studies to establish the incidence of positive IVCTs in relatives of EHI probands, and thus test for heritability, are required. There is, at the moment, only one example of proven MH and proven EHI occurring in the same individual. dna from a 12-year-old boy who suffered MH and later died from the EHI and from his relatives showed relevant mutations as did the dna of two of three soldiers who survived EHI. Hajj pilgrims, who collapse with heat illness, do not show such mutations, but the etiology is different. The sedentary pilgrims succumbed to a very high external ambient temperature, the active soldiers to a huge output of internal metabolic heat. Only eventual advances in defining the genetics of MH and EHI will resolve the present confusion of the relationship between the two conditions. Meanwhile, there is a need to bypass considerations of the etiology of EHI and to identify the vulnerable and handicapped soldier by exposure after an interval of time to one or more exercise tolerance tests.- - - - - - - - - - ranking = 0.25915704875823keywords = heat (Clic here for more details about this article) |
3/20. Is there a link between malignant hyperthermia and exertional heat illness?Exertional heat illness (EHI) and malignant hyperthermia (MH) are two potentially lethal conditions. It has been suggested that a subset of MH susceptible persons may be predisposed to EHI. We examine the current understanding of these disorders and explore evidence of a relationship. Screening for the muscle type I ryanodine receptor gene should help clarify the relationship between MH and EHI.- - - - - - - - - - ranking = 0.16197315547389keywords = heat (Clic here for more details about this article) |
4/20. malignant hyperthermia following systemic rewarming after hypothermic cardiopulmonary bypass.malignant hyperthermia (MH) is a rare hypermetabolic disorder of skeletal muscle that can be fatal if not recognized and treated aggressively. We describe a patient with a suspected family history of MH who developed hyperpyrexia, acidosis, and hypermetabolism after cardiac surgery despite a nontriggering anesthetic. No drugs were identified as being causative and we theorize that systemic rewarming was the inciting cause of MH in this MH-susceptible individual via a mechanism similar to heat stroke.- - - - - - - - - - ranking = 0.96760536890522keywords = heat stroke, heat, stroke (Clic here for more details about this article) |
5/20. Evidence for related myopathies in exertional heat stroke and malignant hyperthermia.malignant hyperthermia may be a human stress syndrome, of which heat stroke is one manifestation. Two men in military service who had episodes of exertional heat stroke, and their immediate family members, were tested for susceptibility to malignant hyperthermia by in-vitro contracture tests on skeletal muscle samples. Muscle from both patients had a normal response to caffeine but an abnormal response to halothane. Muscle from the father of one patient had an abnormal response to halothane, and that from the father of the second patient had an abnormal response to ryanodine. The results indicate that clinical heat stroke may be associated with an underlying inherited abnormality of skeletal muscle that is similar, but not identical, to that of malignant hyperthermia.- - - - - - - - - - ranking = 6.7732375823365keywords = heat stroke, heat, stroke (Clic here for more details about this article) |
6/20. Muscle biopsy for diagnosis of malignant hyperthermia susceptibility in two patients with severe exercise-induced myolysis.Muscle biopsy and in vitro contracture tests for diagnosis of susceptibility to malignant hyperthermia (MH) were performed in two patients who had developed fever and severe myolysis during exercise. MH susceptibility was confirmed in one patient, but in the other, exercise-induced heat stroke proved to be the correct diagnosis. Clinical presentation and epidemiology of exercise-induced MH and its relation to the heat stroke syndrome are discussed.- - - - - - - - - - ranking = 1.9352107378104keywords = heat stroke, heat, stroke (Clic here for more details about this article) |
7/20. Concurrence of malignant hyperthermia and congenital abnormalities.Two children about to undergo corrective surgery were required to be investigated for malignant hyperthermia (MH). These investigations arose out of concern by the anesthetist who had obtained a history of unexplained pyrexial reactions to anaesthetic in other members of the family. Because over the years we have encountered several children with multiple congenital abnormalities who have been found to be susceptible to MH, we stressed the advisability of biopsying not only the patient but also the patient's parents. Positive responses for MH were obtained in the patients and in one of the parents on each occasion. The hypothesis of intrauterine MH with its pharmacogenetic propensity for heat production is considered as a possible etiological factor which may cause abnormalities of a congenital nature.- - - - - - - - - - ranking = 0.032394631094779keywords = heat (Clic here for more details about this article) |
8/20. neuroleptic malignant syndrome.The neuroleptic malignant syndrome (NMS) is a potentially fatal complication of antipsychotic drugs. It is characterized by severe muscular rigidity, hyperthermia, and autonomic disturbances. neuroleptic malignant syndrome is easily confused with other health problems; distinctions between it and malignant hyperthermia, heatstroke, and lethal catatonia are made. The relevant literature is reviewed; a case history is presented; and implications for nursing care (e.g., early detection) are discussed.- - - - - - - - - - ranking = 0.032851218554166keywords = heat, stroke (Clic here for more details about this article) |
9/20. Heat-exercise hyperpyrexia.A fatal case of "heat stroke" occurring on exercise in temperate conditions is described. Possible mechanisms for increased susceptibility are discussed and attention is drawn to a possible overlap with the malignant hyperpyrexia (MH) syndrome. The second day of strenuous exercise may be a time of special risk. More frequent consideration of dantrolene treatment in heat injury is suggested and the term "heat-exercise hyperpyrexia" is proposed to replace "heat stroke" and "exertional hyperpyrexia".- - - - - - - - - - ranking = 2keywords = heat stroke, heat, stroke (Clic here for more details about this article) |
10/20. psychotropic drugs, summer heat and humidity, and hyperpyrexia: a danger restated.The authors note an apparent unawareness of, as well as a paucity of recent literature pertaining to, hyperpyrexia as a complication of psychotropic drug treatment. They report a case of hyperpyrexia in a patient receiving psychotropic agents during a summer heat wave; massive muscle destruction (rhabdomyolysis) with myoglobinuria and acute renal failure make this case of particular interest. Causative mechanisms, preventive measures, and the benefits of prompt recognition and treatment of this condition are discussed.- - - - - - - - - - ranking = 0.16197315547389keywords = heat (Clic here for more details about this article) |
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