SFGH morning report pearls 7/15: hyperthermia vs fever and toxicology!

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-depressants
    • anti-epileptics (except valproic acid – order seperately)
    • antihistamines
    • anti-psychotics
    • sedatives (including benzos, phenobarbital, zolpidem)
    • stimulants (including amphetamine, cocaine, MDMA, ketamine)
    • ethanol
    • 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

Evernote link:

http://www.evernote.com/l/AoOjjTbsvepCw6zl-NmRWQ3-9e26gd8qBOs/

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