Hyperthermic syndrome: etiology, pathogenesis, diagnosis and intensive care

M.V. Bondar, M.M. Pylypenko, T.V. Ovsienko, I.M. Nevmerzhitsky

Abstract


The lecture presents etiology, pathogenesis, pathophysiology, clinical picture and treatment of main hyperthermic syndromes. At the prehospital stage, heat exhaustion (body temperature < 39–40 °С) and heat stroke (body temperature > 40 °С) occur most often among hyperthermic syndromes. The most important forms of hospital-acquired hyperthermia for the anesthesiologist are: malignant hyperthermia, malignant neuroleptic syndrome and serotonin syndrome. Primary tissue damage in heat stroke occurs due to direct damage to body cells, with body temperature above 42 °C. At this temperature, the functions of mitochondria are impaired, with the development of intracellular energy deficiency. This leads to the malfunction of enzymatic reactions, primarily those responsible for supporting intracellular electrolyte homeostasis and, as a result, intracellular ion homeostasis, membrane potential and cell functions are disturbed. This cytotoxic effect of excessively high temperature extends to almost all organs and tissues that lead to multiple organ dysfunction. Such manifestations of hyperthermia as dehydration, metabolic acidosis, hypoxia increase hyperthermic tissue may result in multiple organ failure. The main adaptive functions of the body in excessive hyperthermia are increased sweating, vasodilation of the skin vessels and increased cardiac output, but in a heat stroke, they are decompensated. At the same time, hemodynamic disorders progress, with an increase in the activity of the sympathoadrenal system, which temporarily ensures the perfusion of vital organs. To prevent the development of irreversible changes, first aid must be provided in time — the action of factor that causes excessive hyperthermia should be stopped. Treatment includes the use of physical methods of cooling, rehydration and maintenance of vital functions, corresponding to the principles of intensive care.

Keywords


hyperthermia; hyperthermia syndromes; critical thermal maximum; thermal exhaustion; classical heat stroke as a result of external body overheating; heat stroke; thermal stroke as a result of physical loading; malignant hyperthermia; neuroleptic malignant syndrome; serotonin syndrome

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DOI: https://doi.org/10.22141/2224-0586.2.89.2018.126596

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