Treatment for drug-associated hyperthermia

Irrespective of the cause of drug-associated hyperthermia, the principles of management are to commence active cooling, and control shivering and agitation. Despite having raised blood pressure and tachycardia, hyperthermic patients are usually volume depleted—intravenous fluid rehydration is important.

The first-line treatment for drug-associated hyperthermia is cold intravenous fluid therapy (ie fluid stored at approximately 4ºC in a standard refrigerator) infused at standard administration rates for maintenance intravenous fluids. Infusion of more than 20 mL/kg is seldom required.

Use small doses of intravenous benzodiazepines to treat agitation and suppress shivering without causing significant sedation. For adults and children, use:

Avoid restraining combative patients because the use of physical restraints can increase the risk of hyperthermia.

The choice of further cooling methods depends on the availability of equipment and expertise. The simpler (but less effective) methods include:

• ice packs to groins and axillae
• tepid sponging and fanning
• specialised cooling mats or blankets.

For patients with severe hyperthermia (ie temperature more than 41ºC) or refractory cases, use more effective cooling methods:

• neuromuscular paralysis, intubation and ventilation—ventilate using nonhumidified air at ambient temperature (ie turn off the humidifier on the ventilator)
• immersion in an ice bath.

If available, consider extracorporeal cooling (eg haemodialysis, extracorporeal membrane oxygenation [ECMO], cooling catheter).

Antidotal therapies are important in reversing the cause of hyperthermia; see individual monographs for antidotes used for specific poisonings.

Do not use antipyretic drugs (eg paracetamol, aspirin, ibuprofen) to treat drug-associated hyperthermia because they are ineffective.