General Management

The management of drug-induced hyperthermia is mainly supportive. Syndrome specific therapies will be outlined later.

• Discontinue causative agent
• Ensure adequate airway protection, breathing and circulation
• Consider administration of activated charcoal if within 1 hour of ingestion and patient able to protect own airway
• Control hyperthermia by reducing excessive muscle activity from agitation, seizures or shivering with the use of benzodiazepines for sedation. In severe cases (temperature >41.1°C) the patient is likely to require intubation and paralysis
• External cooling measures e.g. cooling blankets, ice packs, ice water submersion, cool water mist and fans
• Volume replacement as indicated
• Patients with moderate to severe symptoms will require treatment in a HDU or intensive care setting
• Patients should be monitored for complications that might arise and treated appropriately. Complications of severe hyperthermia include respiratory dysfunction, seizures, vomiting and diarrhoea, rhabdomyolysis, acute kidney injury, hepatic injury, DIC, multi-organ failure and death

Learning bite

The treatment for all the drug induced hyperthermia syndromes is mainly supportive. This includes maintaining adequate airway, breathing and circulation, external cooling measures, and controlling the hyperthermia by eliminating excessive muscle activity by sedation and in some cases paralysis. Malignant hyperthermia is the only syndrome that requires immediate administration of treatment with dantrolene. The other syndrome specific therapies are used when supportive measures alone are not enough to control the hyperthermia.