Diferencia entre revisiones de «Hyperthermia»

Revisión actual - 22:55 20 mar 2026

Background

Hyperthermia is an elevation in core body temperature due to failure of thermoregulation (distinct from fever, which is a regulated increase mediated by pyrogens)
Core temperature >40°C (104°F) is generally considered severe hyperthermia
The key distinction is: fever = hypothalamic set-point is raised (treat infection); hyperthermia = heat gain exceeds heat loss (active cooling required)
Antipyretics (acetaminophen, NSAIDs) are ineffective in true hyperthermia because the thermoregulatory set-point is normal

Differential Diagnosis

Fever

Infectious

Critical
- Sepsis
- PNA with respiratory failure
- Peritonitis
- Meningitis
- Cavernous Sinus Thrombosis
- Necrotizing Fasciitis
Emergent
- PNA
- Peritonsillar Abscess
- Retropharyngeal Abscess
- Epiglottitis
- Endocarditis
- Pericarditis
- Appendicitis
- Cholecystitis
- Diverticulitis
- Intra-abdominal abscess
- Pyelonephritis
- Tubo-ovarian abscess
- Encephalitis
- Brain abscess
- Cellulitis
- Abscess
- Malaria
Non-emergent
- Viral syndrome
- Otitis Media
- Sinusitis
- Pharyngitis
- Influenza
- TB
- UTI
- Epididymitis
- Prostatitis

Non-infectious

Critical
Emergent
- CHF
- Dehydration
- Recent Seizure
- Sickle Cell Dz
- Transplant rejection
- Pancreatitis
- DVT
- Serotonin Syndrome
Non-emergent
- Drug fever (except as in NMS and Serotonin Syndrome)
- Malignancy
- Gout
- Sarcoidosis
- Crohn's Disease
- Postmyocardiotomy syndrome
- Sweet's syndrome

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Toxicologic causes of Hyperthermia

Endocrine causes of Hyperthermia

Neurologic causes of Hyperthermia

Evaluation

Core temperature (rectal or esophageal preferred; oral/temporal may underestimate)
CBC, BMP, LFTs, coagulation studies, CK, lactate, urinalysis
Consider blood cultures, LP, CXR if infectious cause not excluded
Toxicology screen if ingestion or drug-related cause suspected
Consider CT head if altered mental status

Management

Active external cooling is the mainstay for all severe hyperthermia:
- Ice water immersion (most effective for exertional heat stroke; target temp <39°C / 102.2°F within 30 min)
- Evaporative cooling (mist and fan) if immersion not feasible
- Ice packs to axillae, groin, neck
Treat the underlying cause:
- Heat stroke → aggressive cooling, IVF (see Heat stroke)
- Malignant hyperthermia → dantrolene (see Malignant hyperthermia)
- Neuroleptic malignant syndrome → dantrolene, bromocriptine (see Neuroleptic malignant syndrome)
- Serotonin syndrome → cyproheptadine, benzodiazepines (see Serotonin syndrome)
- Anticholinergic toxicity → physostigmine (see Anticholinergic toxicity)
- Sympathomimetic toxicity → benzodiazepines, cooling
Avoid succinylcholine if malignant hyperthermia or hyperkalemia suspected

Disposition

Admit all patients with heat stroke, malignant hyperthermia, NMS, or serotonin syndrome
ICU for altered mental status, organ dysfunction, or temperature >41°C (105.8°F)
Mild heat-related illness (heat exhaustion, heat cramps) may be discharged after treatment with adequate follow-up

References

Authors:

@@ Línea 1: / Línea 1: @@
-===[[Acute fever]]===
+==Background==
-{{Template:Heat Emergencies}}
+*Hyperthermia is an elevation in core body temperature due to failure of thermoregulation (distinct from [[Acute fever|fever]], which is a regulated increase mediated by pyrogens)
+*Core temperature >40°C (104°F) is generally considered severe hyperthermia
+*The key distinction is: '''fever''' = hypothalamic set-point is raised (treat infection); '''hyperthermia''' = heat gain exceeds heat loss (active cooling required)
+*Antipyretics (acetaminophen, NSAIDs) are '''ineffective''' in true hyperthermia because the thermoregulatory set-point is normal
+==Differential Diagnosis==
+{{Differential diagnosis hyperthermia}}
+==Evaluation==
+*Core temperature (rectal or esophageal preferred; oral/temporal may underestimate)
+*CBC, BMP, LFTs, coagulation studies, CK, lactate, urinalysis
+*Consider [[blood cultures]], LP, [[CXR]] if infectious cause not excluded
+*Toxicology screen if ingestion or drug-related cause suspected
+*Consider CT head if altered mental status
+==Management==
+*'''Active external cooling''' is the mainstay for all severe hyperthermia:
+**Ice water immersion (most effective for exertional [[heat stroke]]; target temp <39°C / 102.2°F within 30 min)
+**Evaporative cooling (mist and fan) if immersion not feasible
+**Ice packs to axillae, groin, neck
+*Treat the underlying cause:
+**[[Heat stroke]] → aggressive cooling, [[IVF]] (see [[Heat stroke]])
+**[[Malignant hyperthermia]] → [[dantrolene]] (see [[Malignant hyperthermia]])
+**[[Neuroleptic malignant syndrome]] → dantrolene, [[bromocriptine]] (see [[Neuroleptic malignant syndrome]])
+**[[Serotonin syndrome]] → [[cyproheptadine]], benzodiazepines (see [[Serotonin syndrome]])
+**[[Anticholinergic toxicity]] → physostigmine (see [[Anticholinergic toxicity]])
+**[[Sympathomimetic toxicity]] → benzodiazepines, cooling
+*Avoid [[succinylcholine]] if [[malignant hyperthermia]] or [[hyperkalemia]] suspected
+==Disposition==
+*Admit all patients with [[heat stroke]], [[malignant hyperthermia]], [[NMS]], or [[serotonin syndrome]]
+*ICU for altered mental status, organ dysfunction, or temperature >41°C (105.8°F)
+*Mild heat-related illness (heat exhaustion, heat cramps) may be discharged after treatment with adequate follow-up
+==See Also==
+*[[Environmental heat diagnoses]]
+*[[Heat stroke]]
+*[[Heat exhaustion]]
+*[[Malignant hyperthermia]]
+*[[Neuroleptic malignant syndrome]]
+*[[Serotonin syndrome]]
+*[[Acute fever]]
+==References==
+<references/>
+[[Category:Environmental]]
 [[Category:ID]]
-[[Category:Environmental]]
 [[Category:Toxicology]]