Unusual heat stroke caused by herbal therapy with traditional Chinese medicine

Traditional Chinese medicine (TCM) comprises a range of traditional medical practices that originate in China, including herbal medicine as a major therapy. Through its 4 natures; namely, cold, hot, warm, and cool, herbal medicine may regulate sympathetic nerves and basal metabolic rate and affect the CNS and the endocrine system. Heat stroke is a severely life-threatening heat-related illness that is most commonly seen during summer heat waves and high environmental temperatures. The intake of medications or toxins is considered one of the risk factors leading to heat stroke, as they may affect body thermoregulation. We report a case of heat stroke that was associated with herbal therapy with TCM. This case highlights the importance of paying more attention to unidentified folk prescriptions in the use of TCM.

[Heat stroke related to the use of topiramate. The importance of prevention]

Heat stroke is the most severe pathology related to heat. It is defined as an increase in core body temperature accompanied by signs of neurological dysfunction. In the absence of an early treatment, it has a very high mortality rate. Topiramate is a well known drug widely used in epilepsy treatment and migraine prevention. Oligohydrosis has been described amongst topiramate side effects, favouring the risk of hyperthermia and heatstroke. We present the case of a patient who developed heat stroke due to physical exercise while under topiramate treatment.

Fatal exertional heat stroke in a patient receiving zuclopenthixol, quetiapine and benztropine

OBJECTIVE

To report a case of fatal exertional heat stroke associated with the use of zuclopenthixol, quetiapine and benztropine.

CASE SUMMARY

A 36-year-old male with a history of schizophrenia and bipolar disease was working as a roofer during the third day of a heat wave. His medications included zuclopenthixol, quetiapine, benztropine, carbamazepine and levothyroxine. He developed loss of consciousness late in the day and presented to hospital with a Glasgow Coma Scale 3 and a rectal temperature of 42.2 degrees C. He progressed to severe multiple organ dysfunction and asystole, and expired the following morning. Neuroleptic and anticholinergic agents have long been associated with heat alteration, but there are few reports involving the newer antipsychotic agents. Physicians and pharmacists should ensure that appropriate counseling is given to patients receiving these medications regarding early recognition of signs and symptoms and prompt treatment of heat related illness and heat stroke.

Atypical antipsychotics and newer antidepressants

Atypical antipsychotics and newer antidepressants are commonly prescribed medications responsible for tens of thousands of adverse drug exposures each year. The emergency medicine physician should have a basic understanding of the pharmacology and toxicity of these agents. This knowledge is crucial to providing proper care and timely management of patients presenting with adverse drug effects from exposure to atypical antipsychotics and newer antidepressants.

Drug-associated heat stroke

During the June 1998 heat wave in New Orleans, 8 patients came to the emergency department of a large public hospital over a 14-day period. They were subsequently admitted to the intensive care unit with a diagnosis of heat stroke. On each of these days, the ambient temperature exceeded 33.3 degrees C (91.9 degrees F). Although the highest recorded temperature was only 35.6 degrees C (96 degrees F), the heat index reached a high of 44.5 degrees C (112 degrees F). Weather-related heat illnesses are well documented, but the reports rarely address contributing medications or drugs. In this series, 6 patients (75%) had been using medication or drugs known to induce or worsen hyperthermia. A seventh patient had been prescribed a phenothiazine, but actual use could not be established. An eighth patient had an unidentified agent detected on toxicologic screening. The most common drug identified was cocaine. Other drugs included diphenhydramine, tricyclic antidepressants, and phenothiazines. Six patients (75%) had rhabdomyolysis; 3 of them also had disseminated intravascular coagulation. There were 2 deaths, yielding a 25% mortality rate.

The neurosurgeon in sport: awareness of the risks of heatstroke and dietary supplements

THE SCIENCE OF fluid replacement in athletic training, particularly with regard to American football players, has advanced during the past 3 decades. This advance has resulted in substantial decreases in heatstroke-related deaths during summer training sessions. Recent trends in football heatstroke fatalities toward significant increases may, in part, be attributable to or aggravated by the use of dietary supplements. Credible scientific evidence has been found that amphetamine derivatives and the ergonomic aid creatine may contribute to subclinical dehydration and heatstroke in selected individuals. Caution is urged in the education and evaluation of football players who train during the hot summer months.

Heat stroke-like episode in a child caused by zonisamide

A 2-year-old mentally retarded boy with frontal lobe epilepsy presented with an episode that resembled heat stroke during the administration of zonisamide. He developed hyperpyrexia with oligohidrosis and central neurological symptoms, including, chorea-like involuntary movements, resting tremor, and cogwheel rigidity. A sweat test using pilocarpine iontophoresis revealed a marked reduction in the sweat response, which suggested a postganglionic sweating dysfunction. A skin biopsy examined by light and electron microscopy showed no morphological abnormality in the sweat glands. The oligohidrosis caused by zonisamide was reversible in that the patient regained the ability to sweat within 2 weeks of the cessation of drug administration. Children receiving zonisamide should be monitored for oligohidrosis and the development of neurological symptoms associated with an elevation of body temperature.

Oxybutynin-induced heatstroke in an elderly patient

OBJECTIVE

To report an elderly patient with oxybutynin-induced heatstroke and to remind clinicians of the possibility of drugs as an etiology of hyperthermia.

CASE SUMMARY

An elderly man was admitted to the emergency department in a confused state. The day of admission was the hottest of the summer months in the San Francisco area. Because his rectal temperature was 40 degrees C and his skin was hot and dry, he was immediately packed in ice, given intravenous NaCl 0.9%, and a cooling fan was used to aid in external cooling. The patient was taking oxybutynin chloride, a drug with anticholinergic properties. The previous summer he had been admitted with a rectal temperature of 41.1 degrees C. No infectious etiology could be found. He was discharged in an improved state after a 48-hour observation period. The drug was discontinued.

DISCUSSION

It is important to recognize heatstroke and institute prompt management because of the high mortality associated with this thermoregulatory disorder. Prompt treatment should consist of rapid cooling and vigorous cardiopulmonary support.

CONCLUSIONS

The possibility of drug-induced heatstroke should be investigated in all patients admitted during the summer months with unexplained hyperthermia, especially the elderly. To our knowledge this is the first reported case of heatstroke associated with the use of oxybutynin.