What is the role of medications in the treatment of heat stroke?

Updated: Aug 02, 2019
  • Author: Robert S Helman, MD; Chief Editor: Joe Alcock, MD, MS  more...
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Antipyretics (eg, acetaminophen, aspirin, other nonsteroidal anti-inflammatory drugs) have no role in the treatment of heat stroke because antipyretics interrupt the change in the hypothalamic set point caused by pyrogens; they are not expected to work on a healthy hypothalamus that has been overloaded, as in the case of heat stroke. In this situation, antipyretics actually may be harmful in patients who develop hepatic, hematologic, and renal complications because they may aggravate bleeding tendencies.

Dantrolene has been studied as a possible pharmacologic option in the treatment of hyperthermia and heat stroke. To date, however, it has not proved efficacious in clinical trials.

Immediate administration of benzodiazepines is indicated in patients with agitation and shivering, to stop excessive production of heat. In addition, benzodiazepines are the sedatives of choice in patients with sympathomimetic-induced delirium as well as alcohol and sedative drug withdrawals.

Neuroleptics (eg, chlorpromazine), which were the mainstays of therapy in the past, are best avoided because of their deleterious adverse effects, including lowering of the seizure threshold, interference with thermoregulation, anticholinergic properties, hypotension, hepatotoxicity, and other adverse effects.

Benzodiazepines and, if necessary, barbiturates are the recommended agents for treatment of patients who are having convulsions. Barbiturates may be used despite their theoretical impedance of sweat production.

Phenytoin is not effective in controlling convulsions in this situation. Patients whose convulsions are refractory to benzodiazepines and barbiturates should be paralyzed and provided mechanical ventilation. Electroencephalographic monitoring is recommended in all such patients, and anticonvulsant medications should be adjusted accordingly.

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