Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content + Download Section PDF Listen ++ For further information, see CMDT Part 38-09: Poisoning or Overdose-Related Hyperthermia + Key Features Download Section PDF Listen +++ ++ A rapidly life-threatening complication May be due to poisoning by Amphetamines and other synthetic stimulants (cathinones, piperazines) Atropine and other anticholinergic drugs Cocaine Salicylates Strychnine 2,4-dinitrophenol Tricyclic antidepressants Overdose of serotonin reuptake inhibitors (eg, fluoxetine, paroxetine) alone or combined with monoamine oxidase inhibitor may cause agitation, hyperactivity, hyperthermia (serotonin syndrome) Antipsychotic agents can cause rigidity and hyperthermia (neuroleptic malignant syndrome) Malignant hyperthermia is associated with general anesthetic agents (rare) + Clinical Findings Download Section PDF Listen +++ ++ Severe hyperthermia (temperature > 40–41°C) can rapidly cause brain damage and multiorgan failure, including Rhabdomyolysis Advanced chronic kidney disease Coagulopathy + Treatment Download Section PDF Listen +++ ++ Remove clothing Spray skin with tepid water High-volume fanning of the patient Alternatively, the patient can be placed in an ice water bath (not simply applying ice to selected surfaces) Induce neuromuscular paralysis with a nondepolarizing neuromuscular blocker (eg, rocuronium, vecuronium) If rectal temperature not normal in 30–40 min If there is significant muscle rigidity or hyperactivity Once paralyzed, patient must be intubated, mechanically ventilated, and sedated Once the patient is paralyzed, the absence of visible muscular convulsive movements may give the false impression that brain seizure activity has ceased; bedside electroencephalography may be useful in recognizing continued nonconvulsive seizures Dantrolene, 2–5 mg/kg intravenously, may be effective for muscle rigidity unresponsive to neuromuscular blockade (ie, malignant hyperthermia) Bromocriptine, 2.5–7.5 mg daily orally, for neuroleptic malignant syndrome Cyproheptadine, 4 mg every hour for 3–4 doses orally, or chlorpromazine, 25 mg intravenously or 50 mg intramuscularly, for serotonin syndrome