Hyperthermia is a state of thermoregulatory failure resulting from excessive heat production with a normal rate of heat loss (e.g. malignant hyperthermia) or inability to dissipate heat at a sufficient rate (e.g. heat stroke). Dehydration is the most common cause of mild hyperthermia. Hyperthermia may coexist with fever: e.g. dehydration may occur on top of fever due to infection.
In contrast to fever, hyperthermia is not mediated by pyrogen or interleukin-1 (IL-1), and the body temperature is higher than the hypothalamic set point, which is usually normal. Because hyperthermia is not regulated centrally, a temperature in excess of 42 °C is common, and the presence of such degree makes hyperthermia a likely diagnosis. This very high degree of temperature rarely occurs, if ever, with fever alone, even with the most severe infections.
Hyperthermia caused by increased heat production includes physiologically exercise-induced hyperthermia, pathologically malignant hyperthermia, neuroleptic malignant syndrome, serotonin syndrome, drug-induced hyperthermia, and endocrine hyperthermia. Hyperthermia caused by decreased heat loss includes neonatal hyperthermia, heat stroke, haemorrhagic shock and encephalopathy, sudden infant death syndrome (SIDS) and drug-induced hyperthermia. Heat stroke is due to failure of the heat-regulating mechanisms of the hypothalamus subsequent to inhibition of sweating. It is defined as a core temperature greater than 40.6 °C, accompanied by hot, dry skin and CNS abnormalities such as convulsion, delirium and coma. The two principal causes of heat stroke are high ambient temperature and water deprivation. If the temperature rises above 40.2 °C, cell deaths occur, and the condition is associated with high mortality of around 80%.
The chapter also describes “unclassified hyperthermia” such as factitious fever, induced illness and induced illness by proxy.
Differentiating hyperthermia from fever Causes of hyperthermia Neonatal hyperthermia Malignant hyperthermia Heat stroke Therapeutic effects of hyperthermia
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Clinical Effects of Hyperthermia
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