Hyperthermia vs fever:
- hyperthermia: thermoregulatory mechanisms (vasodilation/sweat) overwhelmed by excessive metabolic production of heat/environmental heat or impaired heat dissipation; hypothalamic set-point is normal
- Fever: intact homeostatic responses; hypothalamic set point is increased by the action of circulating pyrogenic cytokines
Anticholinergic toxicity management:
- ABC’s, sodium bicarb if QRS prolongation/arrhythmias, benzodiazepines for agitation/seizures, cooling for hyperthermia
- Physostigmine (an acetylcholinesterase inhibitor that crosses the blood brain barrier) use is controversial due to concern for cardiac side effects (including asystole) and cholinergic toxicity
- if given, have atropine ready to counter cholinergic toxicity, and tox consult on hand!
Utox’s at SFGH: see the lab manual (accessible from CHN website) for details on what is included
- Drugs of abuse screen, urine: detects:
- amphetamines, benzodiazepines, cocaine, heroin, methadone, opiates, oxycodone
- Comprehensive drug screen: $$$$ lots of meds!, order with a tox consult to tailor screening
- opioids (many – see lab manual)
- anti-epileptics (except valproic acid – order seperately)
- sedatives (including benzos, phenobarbital, zolpidem)
- stimulants (including amphetamine, cocaine, MDMA, ketamine)
- cardiac meds (beta blockers, calcium channel blockers)
- other meds, including metformin, trimethoprim, dextromethorphan, many others depending on suspicion!
Simon, HB. Hyperthermia, NEJM 1993;329: 483-487.
Burns et al. A comparison of physostigmine and benzodiazepines for the treatment of anticholinergic poisoning. Ann Emerg Med