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Hyperpyrexia

Fever 106 Degrees F or Over


Presentation

  • The patient presented with a 2-week history of fever and increasing confusion, in the context of a number of changes to his medication regimen. On presentation, he was noted to be febrile with autonomic instability, diaphoresis and marked rigidity.[ncbi.nlm.nih.gov]
  • Of 162 male patients studied, 120 (86.4%) presented with hyperpyrexia (i.e., an axillary temperature or 40 degrees C).[ncbi.nlm.nih.gov]
  • Here, we present an exceptional case affected by this syndrome. Its singularity is 2-fold. On one hand, the patient presented periodic episodes of dyskinesia-hyperpyrexia during 3 consecutive summers.[ncbi.nlm.nih.gov]
  • We present the case of a young paraplegic who developed an extreme hyperpyrexia, which to our knowledge is the highest occurring temperature reported in contemporary medical literature.[ncbi.nlm.nih.gov]
  • CASE PRESENTATION: We present a 30 year old Cameroonian female gravida 1 para 1 who had a vaginal delivery at 40 weeks of gestation complicated by primary postpartum haemorrhage (PPH).[ncbi.nlm.nih.gov]
Fever
  • The prevalence of serious bacterial infection (SBI) among those patients with hyperpyrexia was compared with febrile infants with lower fever. RESULTS: 5279 infants younger than 3 months with fever were reviewed.[ncbi.nlm.nih.gov]
  • : Fever, although a common presentation in the ER in the presence of various symptoms and comorbidities can obscure the diagnosis and lead to unwarranted evaluations. As such this patients case identifies a diagnosis of a fatal ascension of fever.[ncbi.nlm.nih.gov]
  • Fever was secondary to a phaeochromocytoma in one patient and sepsis in the other. These observations suggest that high fever may be one possible aetiology of critical illness polyneuropathy.[ncbi.nlm.nih.gov]
  • The potential for hyperpyrexia to occur with cimetidine should be considered in patients with unexplained fever who are receiving this drug.[ncbi.nlm.nih.gov]
  • The pathophysiology, clinical features, and management of this uncommon cause of fever are discussed.[ncbi.nlm.nih.gov]
Malaise
  • .- ) · throat ( R07.0 ) · tongue ( K14.6 ) · tooth ( K08.8 ) renal colic ( N23 ) R52.0 Acute pain R52.1 Chronic intractable pain R52.2 Other chronic pain R52.9 Pain, unspecified Generalized pain NOS R53 Malaise and fatigue Asthenia NOS Debility: · NOS[apps.who.int]
Respiratory Distress
  • CASE PRESENTATION: This case illustrates a 39-year-old white American man referred from another medical facility where he had undergone an upper gastrointestinal tract diagnostic procedure which became complicated by blood aspiration and respiratory distress[ncbi.nlm.nih.gov]
  • He subsequently developed acute respiratory distress syndrome and required intensive care for 33 days.[academic.oup.com]
Hypotension
  • Hyponatremia and other electrolyte disturbances are also quite common, as is hypotension, hyperpyrexia or, late in the disease, hypothermia. "It's called hyperpyrexia ," Laurie said, staring at Stuart Morgan.[diki.pl]
  • Later signs include complex arrhythmias, cyanosis, hypoxia, hypotension, electrolyte abnormalities, rhabdomyolysis and severe hyperthermia. Hyperthermia is a late sign. Rhabdomyolysis is a sign of the severity of the condition.[patient.info]
  • ( I95.1 ) neurogenic orthostatic hypotension ( G90.3 ) shock: · NOS ( R57.9 ) · cardiogenic ( R57.0 ) · complicating or following: · abortion or ectopic or molar pregnancy ( O00-O07 , O08.3 ) · labour and delivery ( O75.1 ) · postoperative ( T81.1 )[apps.who.int]
Orthostatic Hypotension
  • hypotension ( I95.1 ) neurogenic orthostatic hypotension ( G90.3 ) shock: · NOS ( R57.9 ) · cardiogenic ( R57.0 ) · complicating or following: · abortion or ectopic or molar pregnancy ( O00-O07 , O08.3 ) · labour and delivery ( O75.1 ) · postoperative[apps.who.int]
Visual Hallucination
  • He was disoriented and responding to visual hallucinations. Investigations revealed an elevated creatine kinase and a provisional diagnosis of PHS was made.[ncbi.nlm.nih.gov]
  • Other signs of overdose may include: confusion, disturbed concentration, transient visual hallucinations, dilated pupils, agitation, hyperactive reflexes, stupor, drowsiness, muscle rigidity, vomiting, hypothermia, hyperpyrexia .[diki.pl]
  • She was alert, but visual hallucination and disorientation were noted. Dyskinesia was too severe for her to lie on a bed safely, and body temperature was 40.3 C. She had not eaten well for a few days because of appetite loss.[e-jmd.org]
Severe Mental Retardation
  • During an upper respiratory tract infection with severe hyperpyrexia at the age of 14months he developed an acute encephalopathic crisis resulting in severe mental retardation and marked internal and external cerebral atrophy.[ncbi.nlm.nih.gov]
Confusion
  • We observed a patient who, during the administration of intravenous cimetidine, became hyperpyretic and confused. Six hours after cimetidine therapy was discontinued, he became afebrile.[ncbi.nlm.nih.gov]
  • The patient presented with a 2-week history of fever and increasing confusion, in the context of a number of changes to his medication regimen. On presentation, he was noted to be febrile with autonomic instability, diaphoresis and marked rigidity.[ncbi.nlm.nih.gov]
  • Her mental status was alert without confusion at the time of arrival, but after several hours, her dyskinesia grew worse and she became confused. Body temperature was 39.2 C. Her blood test showed mild leukocytosis (WBC 10,090/mm 3 ).[e-jmd.org]
  • My text said something similar, but I guess what confuses me is the interventions are not the same and I don't quite understand the rationale.[allnurses.com]
  • Other signs of overdose may include: confusion, disturbed concentration, transient visual hallucinations, dilated pupils, agitation, hyperactive reflexes, stupor, drowsiness, muscle rigidity, vomiting, hypothermia, hyperpyrexia .[diki.pl]
Agitation
  • At the end of surgery, following extubation he developed agitation, intense shivering and hyperpyrexia, and his level of consciousness decreased to a Glasgow Coma score of 7.[ncbi.nlm.nih.gov]
  • Other signs of overdose may include: confusion, disturbed concentration, transient visual hallucinations, dilated pupils, agitation, hyperactive reflexes, stupor, drowsiness, muscle rigidity, vomiting, hypothermia, hyperpyrexia .[diki.pl]
  • The person is treated with intravenous fluids in order to rehydrate fairly slowly, often sedation is required as the victim can become very agitated, in some cases, a bear hugger will be required.[overheating-heat-stroke.knoji.com]
  • Patients may be confused, agitated or anxious. Findings of generalized hyperreflexia and sustained clonus are very suggestive of serotonin toxicity.[calpoison.org]
Stupor
  • Diagnosis Code T67.0 Heatstroke and sunstroke 2016 2017 2018 2019 Non-Billable/Non-Specific Code Applicable To Heat apoplexy Heat pyrexia Siriasis Thermoplegia Use Additional code(s) to identify any associated complications of heatstroke, such as: coma and stupor[icd10data.com]
  • The Neuropsychiatric Guide to Modern Everyday Psychiatry Stuporous patients are unable to eat or drink and, if untreated,, can develop severe dehydration, hemoconcentration, hyperpyrexia , ketosis, and eventually cardiovascular collapse and death.[wordnik.com]
  • Other signs of overdose may include: confusion, disturbed concentration, transient visual hallucinations, dilated pupils, agitation, hyperactive reflexes, stupor, drowsiness, muscle rigidity, vomiting, hypothermia, hyperpyrexia .[diki.pl]
Altered Mental Status
  • As this condition progresses, the person will have tachycardia (rapid heart rate), tachypnea (rapid breathing, typically shallow), confusion, altered mental status, agitation, seizures, nausea, and vomiting.[overheating-heat-stroke.knoji.com]
  • Serotonin toxicity is characterized by a triad of altered mental status, autonomic effects, and neuromuscular excitation.[calpoison.org]
Febrile Convulsions
  • convulsions R56.8 Other and unspecified convulsions Fit NOS Seizure (convulsive) NOS R57 Shock, not elsewhere classified Excludes: shock (due to): · anaesthesia ( T88.2 ) · anaphylactic (due to): · NOS ( T78.2 ) · adverse food reaction ( T78.0 ) · serum[apps.who.int]

Workup

  • She was administered 2 liters of normal saline and a workup for possible infection ensued. Her sister later arrived and stated that her paroxetine dose was doubled from 20 to 40 mg last week and that she may have taken a few extra pills.[calpoison.org]

Treatment

  • After the patient failed to respond during a 2-week period to supportive measures, electroconvulsive therapy (ECT) treatment was commenced.[ncbi.nlm.nih.gov]
  • If the patient shows unexplained changes in consciousness with hyperpyrexia after surgery, PHS should be considered and adequate treatment should be given immediately to prevent death.[ncbi.nlm.nih.gov]
  • Although the treatment is recommended by several poison control centres, published data are primarily in the form of case reports and animal and in vitro experiments.[ncbi.nlm.nih.gov]
  • More frequent consideration of dantrolene treatment in heat injury is suggested and the term "heat-exercise hyperpyrexia" is proposed to replace "heat stroke" and "exertional hyperpyrexia".[ncbi.nlm.nih.gov]
  • He subsequently developed hyperpyrexia which failed to respond to conventional methods of treatment. Cold peritoneal lavage was employed which resulted in rapid lowering of his core temperature and helped manage his renal failure.[ncbi.nlm.nih.gov]

Prognosis

  • The prognosis is improved with early recognition and management. Mortality of up to 4% has been reported, but an additional one-third of patients have permanent sequelae.[ncbi.nlm.nih.gov]
  • Prognosis Currently associated with a less than 10% mortality rate, and getting significantly better.[medrevise.co.uk]

Etiology

  • Negative blood, cerebrospinal fluid, and stool cultures excluded bacterial sepsis as a possible etiology.[ncbi.nlm.nih.gov]
  • A wide range of etiologies have been identified in the literature for an insidious onset of hyperpryexia, however a rapid ascent higher than temperatures of 106.7 F has never been reported nor evaluated.[ncbi.nlm.nih.gov]
  • There are reports of dantrolene being used for hyperthermia secondary to other etiologies such as NMS, serotonin syndrome, baclofen withdrawal, thyroid storm and heat stroke.[calpoison.org]

Epidemiology

  • Epidemiology Pretty rare - about 1 in 10,000 operations will result in one of these. Pathophysiology It is an inherited autosomnal dominant condition.[medrevise.co.uk]
  • Epidemiology The incidence of MH is low, but the prevalence can be estimated as up to 1:3,000. [ 1 ] It is inherited as an autosomal dominant gene of variable penetrance. [ 6 ] As may be expected with any familial condition, there are geographical clusters[patient.info]
Sex distribution
Age distribution

Pathophysiology

  • The pathophysiology, clinical features, and management of this uncommon cause of fever are discussed.[ncbi.nlm.nih.gov]
  • Pathophysiology It is an inherited autosomnal dominant condition.[medrevise.co.uk]
  • Other agents such as desflurane, sevoflurane, and isoflurane can cause florid malignant hyperthermia (MH) reactions in the same way as halothane but are also associated with reactions with the onset delayed for several hours into anaesthesia. [ 3 ] Pathophysiology[patient.info]
  • The pathophysiology underlying PHS is generally accepted to be a hypo-dopaminergic state, and its clinical features can be explained as sequelae of central dopamine depletion4.[omicsonline.org]
  • The pathophysiology of NMS is related to central dopaminergic receptor-blockade.[calpoison.org]

Prevention

  • If the patient shows unexplained changes in consciousness with hyperpyrexia after surgery, PHS should be considered and adequate treatment should be given immediately to prevent death.[ncbi.nlm.nih.gov]
  • In the clinical management of hyperpyrexia, the goal is to treat the underlying cause of elevated temperature and prevent end organ damage.[ncbi.nlm.nih.gov]
  • Though STN–DBS might prevent PHS, fatal PHS can occur when the PD medications are reduced even when patients are under continuous STN stimulation [ 2 ].[omicsonline.org]
  • Medications commonly used to prevent or control blushing include beta blockers (Inderal) and anxiolytics (sedatives). These medications are usually of limited benefit in reducing blushing intensity and frequency of episodes.[hyperhidrosis-usa.com]
  • With summer fast approaching the North American Continent, it is critically important that Americans be prepared to prevent or at least minimize the risk of developing hyperpyrexia.[overheating-heat-stroke.knoji.com]

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