Hyperthermia and

Robinson R, Carpenter D, Shaw MA et al (2006) Mutations in RYR1 in malignant hyperthermia and central core disease. Hum Mutat 27 977-989... 

The nurse monitors the patient for signs and symptoms of acute salicylate toxicity or salicylism (see Display 17-1). Initial treatment includes induction of emesis or gastric lavage to remove any unabsorbed drug from the stomach. Activated charcoal diminishes salicylate absorption if given within 2 hours of ingestion. Further therapy is supportive (reduce hyperthermia and treat severe convulsions with diazepam). Hemodialysis is effective in removing Hie salicylate but is used only in patients with severe salicylism. 

Nowak, T.S., Bond, U., Schlesinger, M.J. (1990). Heat shock levels in brain and other tissues after hyperthermia and transient ischemia. J. Neurochem. 54,451-458. 

Loke J, MacLennan DH Malignant hyperthermia and central core disease disorders of Ca release channels. Am J Med 1998 104 470. 

Broening, H.W., Morford, L.L., Vorhees, C.V. Interactions of dopamine D, and D2 receptor antagonists with D-methamphetamine-induced hyperthermia and striatal dopamine and serotonin reductions. Synapse. 56 84, 2005. 

At present it is not clear whether extreme agitation, delirium, hyperthermia, and rhabdomyolysis are effects of cocaine that occur independently and at random among cocaine users, or whether these features are linked by common toxicologic and pathologic processes.20 Ruttenber and colleagues20 have examined excited delirium deaths in a population-based registry of all cocaine-related deaths in Dade County. This study has led to clear description of the cocaine delirium syndrome, its pattern of occurrence in cocaine users over time, and has identified a number of important risk factors for the syndrome. 

In addition to this serious diet-drug interaction, irreversible MAOIs also potentiate the effects of sympathomimetic drugs like ephedrine found in over-the-counter cold remedies and recreational stimulants like amphetamine. The MAOIs also interact with drugs that increase synaptic concentrations of 5-HT, such as the tricyclic antidepressant clomipramine and the herbal SSRI antidepressant St John s wort (Hypericum spp.). The resulting serotonin syndrome is characterised by hyperthermia and muscle rigidity. While devoid of these side effects the reversible MAO-A inhibitor moclobemide has yet to establish itself as a first-line alternative to the SSRIs. 

Dafters RI (1994). Effects of ambient temperature on hyperthermia and hyperkinesis induced by 3,4-methylenedioxymethamphetamine (MDMA or ecstasy ) in rats. Psychopharmacology, 114, 505-508. 

The combination of an SSRI with another 5-HT augmenting agent can lead to the serotonin syndrome, which is characterized by symptoms such as clonus, hyperthermia, and mental status changes. 

Neuroleptic malignant syndrome is an acute iatrogenic condition caused by neuroleptics, characterized by tremor, catatonia, fluctuating consciousness, hyperthermia, and cardiovascular instability. It is relatively uncommon, occuring in 1-1.5% of patients but is fatal in 11-38%, most often due to cardiovascular collapse (Jahan et al. 1992). The pathogenesis of neuroleptic malignant syndrome is poorly understood, but it is believed to result from altered dopamine and serotonin transmission in the hypothalamus, spinal cord, and striatum. Treatment includes discontinuation of neuroleptics and administration of drugs that increase dopamine transmission bromocriptine or L-dopa (Jahan etal. 1992 Baldessarini 1996). 

Kiock JC, Boerner U, Becker CE. (1975). Coma, hyperthermia, and Weeding associated with massive LSD overdose, a report of eight cases. Clin Toxicol. 8(2) 191-203. 

Yu X, Imam SZ, Newport GD, Slikker W Jr, Ali SF. (1999). Ibogaine blocked methamphetamine-induced hyperthermia and induction of heat shock protein in mice. Brain Res. 823(1-2) 213-16. Zaczek R, Coyle JT. (1982). Excitatory amino acid analogues neurotoxicity and seizures. Neuropharmacology. 21(1) 15-26. 

Serotonin syndrome Some TCAs inhibit neuronal reuptake of serotonin and can increase synaptic serotonin levels (eg, clomipramine, amitriptyline). Either therapeutic or excessive doses of these drugs, in combination with other drugs that also increase synaptic serotonin levels (such as MAOIs), can cause a serotonin syndrome consisting of tremor, agitation, delirium, rigidity, myoclonus, hyperthermia, and obtundation. 

Besides stimulating the CNS, these drugs activate the autonomic nervous system. Individuals have tachycardia, hypertension, and possibly arrhythmias. Autonomic hyperactivity is also expressed as hyperthermia and mydriasis. More serious effects include the possibility of myocardial infarction, cerebrovascular hemorrhage, seizure, and death. 

D. These are classic features of opioid abstinence syndrome. The abstinence syndrome in chronic alcohol or barbiturate users consists of hallucinations, tremors, hyperthermia, and autonomic hyperactivity. The abstinence syndrome for users of cocaine and amphetamine is not as stereotyped as for opioids or CNS depressants, such as alcohol and barbiturates. 

Neuroleptic malignant syndrome (NMS) is a rare, medication-induced syndrome that may be due to dopamine receptor blockade in the basal ganglia. An altered level of consciousness, autonomic instability, hyperthermia, and severe muscular rigidity typically... 

At the doses usually used by stimulant abusers, euphoria and wakefulness are accompanied by a sense of power and wellbeing. At higher doses, restlessness, agitation, and acute psychosis may occur, accompanied by hypertension and tachycardia. Prolonged muscular hyperactivity can cause dehydration and eventually hypotension. Seizures and muscle activity may contribute to hyperthermia and rhabdomyolysis. Body temperatures as high as 42°C (107.6°F) have been recorded. Hyperthermia can cause brain damage, hypotension, coagulopathy, and renal failure. 

At higher doses, cocaine can produce undesirable effects, including tremor, emotional lability, restlessness, irritability, paranoia, panic, and repetitive stereotyped behavior. At even higher doses, it can induce intense anxiety, paranoia, and hallucinations, along with hypertension, tachycardia, ventricular irritability, hyperthermia, and respiratory depression. In overdose, cocaine can cause acute heart failure, stroke, and seizures. Acute intoxication with cocaine produces these various clinical effects, depending on the dose these effects are mediated by inhibition of the dopamine transporter and in turn by the effects of excessive dopamine activity in dopamine synapses, as well as by norepinephrine and serotonin in their respective synapses. 

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