Hyperthermic syndromes induced by toxins

Daniel Rusyniak, Jon E. Sprague

Research output: Contribution to journalArticle

32 Citations (Scopus)

Abstract

Toxin-induced hyperthermic syndromes are important to consider in the differential diagnosis of patients presenting with fever and muscle rigidity. If untreated, toxin-induced hyperthermia may result in fatal hyperthermia with multisystem organ failure. All of these syndromes have at their center the disruption of normal thermogenic mechanisms, resulting in the activation of the hypothalamus and sympathetic nervous systems. The result of this thermogenic dysregulation is excess heat generation combined with impaired heat dissipation. Although many similarities exist among the clinical presentations and pathophysiologies of toxin-induced hyperthermic syndromes, important differences exist among their triggers and treatments. Serotonin syndrome typically occurs within hours of the addition of a new serotonergic agent or the abuse of stimulants such as MDMA or methamphetamine. Treatment involves discontinuing the offending agent and administering either a central serotonergic antagonist, such as cyproheptadine or chlorpromazine, a benzodiazepine, or a combination of the two. NMS typically occurs over hours to days in a patient taking a neuroleptic agent; its recommended treatment is generally the combination of a central dopamine agonist, bromocriptine or L-dopa, and dantrolene. In those patients in whom it is difficult to differentiate between serotonin and neuroleptic malignant syndromes, the physical examination may be helpful: clonus and hyperreflexia are more suggestive of serotonin syndrome, whereas lead-pipe rigidity is suggestive of NMS. In patients in whom serotonin syndrome and NMS cannot be differentiated, benzodiazepines represent the safest therapeutic option. MH presents rapidly with jaw rigidity, hyperthermia, and hypercarbia. Although it almost always occurs in the setting of surgical anesthesia, cases have occurred in susceptible individuals during exertion. The treatment of MH involves the use of dantrolene. Future improvements in understanding the pathophysiology and clinical presentations of these syndromes will undoubtedly result in earlier recognition and better treatment strategies.

Original languageEnglish
Pages (from-to)165-184
Number of pages20
JournalClinics in Laboratory Medicine
Volume26
Issue number1
DOIs
StatePublished - Mar 2006

Fingerprint

Serotonin
Serotonin Syndrome
Rigidity
Dantrolene
Benzodiazepines
Antipsychotic Agents
Fever
Serotonin Agents
Cyproheptadine
N-Methyl-3,4-methylenedioxyamphetamine
Bromocriptine
Methamphetamine
Dopamine Agonists
Chlorpromazine
Heat generation
Neurology
Levodopa
Therapeutics
Hot Temperature
Heat losses

ASJC Scopus subject areas

  • Medicine(all)
  • Biochemistry, Genetics and Molecular Biology(all)

Cite this

Hyperthermic syndromes induced by toxins. / Rusyniak, Daniel; Sprague, Jon E.

In: Clinics in Laboratory Medicine, Vol. 26, No. 1, 03.2006, p. 165-184.

Research output: Contribution to journalArticle

Rusyniak, Daniel ; Sprague, Jon E. / Hyperthermic syndromes induced by toxins. In: Clinics in Laboratory Medicine. 2006 ; Vol. 26, No. 1. pp. 165-184.
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