The Problem With Prozac and Heat Intolerance

July 1, 2002

Dear Group,

Anyone taking Prozac, or any other SSRI, and the weather is warm, must be

very careful not to overheat. The body's ability to cool its core

temperature is damaged. noticed that there is a HOT MED policy in

place where those on Prozac and the like are restricted to air-conditioned

rooms when the temp approaches 90 degrees. Here is the reason why:

Ann N Y Acad Sci 1997 Mar 15;813:553-8 Related Articles, Books, LinkOut

Heat intolerance induced by antidepressants.

Epstein Y, Albukrek D, Kalmovitc B, Moran DS, Shapiro Y.

Heller Institute of Medical Research, Sheba Medical Center, Tel Hashomer,

Israel.

A case in which prescription medications induced heat intolerance which led

to heat stroke is presented. A subject who suffered from depression and was

treated with fluoxetine HCL (prozac) and lithium carbonate was engaged in

mild intermittent work for 4 hours under hot/dry climatic conditions (Ta =

37 degrees C, rh = 15%). The subject lost consciousness, was hyperthermic

and suffered from disseminated intravascular coagulation. A year later

residual cerebellar symptoms were still evident and severe atrophy of the

cerebellar tissue was demonstrated in a CT scan. It is suggested that

drug-induced heat intolerance was the predisposing factor that reduced the

patient ability to sustain exercise-heat stress, and under the favorable

environmental circumstances led to excessive heat accumulation which

ultimately caused heat stroke. This is the first description, to our

knowledge, of heat intolerance of a patient treated by a combination of

fluoxetine and lithium carbonate.

PMID: 9100934 [PubMed - indexed for MEDLINE]

Hosp Community Psychiatry 1982 Jun;33(6):474-6 Related Articles, Books,

LinkOut

The prevention and treatment of heatstroke in psychiatric patients.

Bark NM.

Heatstroke is a serious medical condition that affects people in all

climates. There is some preliminary evidence that psychiatric patients and

those on psychotropic drugs are particularly susceptible. The author

discusses the signs and symptoms of heatstroke, the factors that lead to it,

and the appropriate preventive and treatment measures that should be taken.

He concludes that heatstroke in psychiatric patients is totally preventable,

but that should heatstroke occur, quick recognition and treatment can

prevent death.

PMID: 6124500 [PubMed - indexed for MEDLINE]

Am J Psychiatry 2000 Aug;157(8):1327-9 Related Articles, Books, LinkOut

Heat intolerance in patients with chronic schizophrenia maintained with

antipsychotic drugs.

Hermesh H, Shiloh R, Epstein Y, Manaim H, Weizman A, Munitz H.

Geha Psychiatric Hospital, Petah Tiqva, Israel. hermesh@...

OBJECTIVE: Schizophrenia may be associated with hyperthermic syndromes such

as febrile catatonia, neuroleptic malignant syndrome, and heatstroke. The

authors hypothesized that an exercise-heat tolerance test would disclose

abnormal thermoregulation in schizophrenic patients. METHOD: Seven male

schizophrenic outpatients in remission maintained on depot antipsychotic

treatment and eight healthy comparison subjects completed a heat tolerance

test that consisted of two 50-minute bouts of walking a motor-driven

treadmill at 40xC (relative humidity=40%). RESULTS: A significantly higher

rise in rectal and skin temperatures was observed in the patient group. No

differences in heart rate, blood pressure, or perspiration were detected.

CONCLUSIONS: Schizophrenic patients maintained on antipsychotic drugs

exhibit impaired heat tolerance. Possible explanations are a reduced ability

to convey heat from the body's core to the periphery with or without

excessive heat production. The hyperthermic response to the heat tolerance

test may reflect a dysfunction associated with schizophrenia, a

neuroleptic-induced side effect, or both.

PMID: 10910799 [PubMed - indexed for MEDLINE]

Lancet 1996 Apr 13;347(9007):1016 Related Articles, Books, LinkOut

A depressed workman with heatstroke.

Albukrek D, Moran DS, Epstein Y.

IDF Medical Corps, Institute of Military Physiology; and Heller Institute of

Medical Research, Sheba Medical Center, Tel Hashomer, Israel.

PMID: 8606565 [PubMed - indexed for MEDLINE]

Prog Brain Res 1998;115:193-204 Related Articles, Books, LinkOut

The effects of drugs on thermoregulation during exposure to hot

environments.

Lomax P, Schonbaum E.

School of Medicine, University of California, Los Angeles 90024, USA.

Publication Types:

Review

Review, Tutorial

PMID: 9632937 [PubMed - indexed for MEDLINE]

Ned Tijdschr Geneeskd 1995 Jul 8;139(27):1391-3 Related Articles, Books,

LinkOut

Comment in:

• Ned Tijdschr Geneeskd. 1996 Feb 17;140(7):388.

[Psychiatric drugs as risk factor in fatal heat stroke]

[Article in Dutch]

Fijnheer R, van de Ven PJ, Erkelens DW.

Afd. Interne Geneeskunde, Academisch Ziekenhuis, Utrecht.

Two men aged 33 and 31 years suffered a fatal heat stroke on a warm summer

day. One of them used pimozide and clomipramine, the other zuclopenthixol,

dexetimide, droperidol, promethazine and propranolol as psychiatric

medication. Both of them had a body temperature > 42.3 degrees C, without

perspiring. At first only a comatose situation with practically normal

laboratory values existed; this was rapidly followed by massive liver

damage, disseminated intravascular coagulation, anaemia, thrombopenia and

acute renal failure. In spite of adequate and rapid treatment these

complications were fatal. Both patients used medication with an

antidopaminergic and anticholinergic (side) effect. The set point of the

temperature regulation centre can be elevated by the antidopaminergic

activity of antipsychotics. Use of anticholinergic medication can disturb

the thermoregulation via inhibition of the parasympathicomimetically

mediated sweat secretion. It is recommended to point out the danger of

unusually high outdoor temperatures to patients using this medication.

PMID: 7617062 [PubMed - indexed for MEDLINE]

: Ned Tijdschr Geneeskd 1995 Aug 26;139(34):1759-60 Related Articles, Books,

LinkOut

Comment on:

Ned Tijdschr Geneeskd. 1995 Jul 8;39(27):1391-3

[Psychiatric medication as risk factor for fatal heat collapse]

[Article in Dutch]

Conemans JM.

Publication Types:

Comment Letter

PMID: 7566248 [PubMed - indexed for MEDLINE]

Chest 1981 Aug;80(2):244-5 Related Articles, Books, LinkOut

Heat stroke related to psychotropic medications and prior history of heat

stroke.

Caldroney RD.

Publication Types:

Letter

PMID: 7249779 [PubMed - indexed for MEDLINE]

J Neurol Neurosurg Psychiatry 1983 Feb;46(2):183-5 Related Articles, Books,

LinkOut

Cerebellar syndrome following neuroleptic induced heat stroke.

Lefkowitz D, Ford CS, Rich C, Biller J, McHenry LC Jr.

We report a patient in whom extreme hyperthermia, rhabdomyolysis, acute

renal failure and a residual pancerebellar syndrome occurred while taking a

combination of perphenazine and amitriptyline. We postulate that impaired

thermoregulation due to psychotropic drugs was responsible for the

development of heat stroke and that the cerebellar syndrome resulted

directly from the elevated temperature.

PMID: 6842224 [PubMed - indexed for MEDLINE]

Minn Med 1977 Feb;60(2):103-6 Related Articles, Books, LinkOut

Heat stroke associated with medications having anticholinergic effects.

BE, Manoguerra AS, Lilja GP, Long RS, Ruiz E.

PMID: 840206 [PubMed - indexed for MEDLINE]

J Neurol Neurosurg Psychiatry 1987 Jul;50(7):937-8 Related Articles, Books,

LinkOut

Heat stress and neuroleptic drugs.

Tacke U, Venalainen E.

Publication Types: Letter

PMID: 2887638 [PubMed - indexed for MEDLINE]

J Clin Psychiatry 1982 Sep;43(9):377-80 Related Articles, Books, LinkOut

Heatstroke in psychiatric patients: two cases and a review.

Bark NM.

Two fatal cases of heatstroke in psychiatric patients are described. A

literature search revealed published reports of heatstroke involving 51

psychiatric patients, 22 of whom died. The mean age of these patients was 44

years; the majority has schizophrenia. Almost all were male and were taking

antipsychotic or other drugs with anticholinergic effects. The implications

for prevention, recognition, and treatment are discussed.

PMID: 6126476 [PubMed - indexed for MEDLINE]

Ann Anesthesiol Fr 1979;20(8):709-16 Related Articles, Books, LinkOut

[Heatstroke among psychiatric patients under neuroleptic therapy. Apropos of

2 fatal cases]

[Article in French]

Ducrot P, Jouan JC, Sala JP, Mathon J.

Heat stroke is uncommon in temperate climates but may be favourised by drug

treatment. A report of two cases of fatal hyperthermia occuring in patients

treated with neuroleptic drugs and during a heat wave is followed by a

discussion of the characteristics which may be used to differentiate heat

stroke from the hyperthermia of malignant twenty cases. It indicated that

high degree of severity of this type of heat stroke, in great part related

to the high prevalence of massive inhalation. The action of neuroleptics is

very probably central by an effect upon the thermostat and also by changes

in behaviour. The role of associated anti-parkinsonian agents is discussed.

A review of treatment emphasises its difficulties.

Publication Types: Review

PMID: 44988 [PubMed - indexed for MEDLINE]

1: Gen Hosp Psychiatry 1985 Oct;7(4):361-3

Related Articles, Books, LinkOut

Heatstroke in a chronic schizophrenic patient treated with high-potency

neuroleptics.

Lazarus A.

A fatal case of heatstroke occurred in a chronic schizophrenic patient

treated with high-potency neuroleptics. The author differentiates heatstroke

from other hyperthermic syndromes related to treatment with major

tranquilizers and suggests that an awareness of factors that predispose

psychiatric patients to the development of heatstroke may aid in its

prevention.

PMID: 2866145 [PubMed - indexed for MEDLINE]

Pitt DC, Kriel RL, Wagner NC, Krach LE.

Related Articles

Kluver-Bucy syndrome following heat stroke in a 12-year-old girl.

Pediatr Neurol. 1995 Jul;13(1):73-6.

PMID: 7575855 [PubMed - indexed for MEDLINE]

Pediatr Neurol 1987 May-Jun;3(3):162-5 Related Articles, Books, LinkOut

Kluver-Bucy syndrome in children.

Tonsgard JH, Harwicke N, Levine SC.

Department of Pediatrics, University of Chicago, IL 60637.

Kluver-Bucy syndrome is an uncommon syndrome of behavioral abnormalities

following bilateral temporal lobe injury. Only four children have been

reported previously with this syndrome. We report three additional pediatric

patients who developed Kluver-Bucy syndrome following hypoxic insults. In

two patients, features of the syndrome were transient. Problems in

intermediate memory were present in each patient. Behavioral abnormalities

did not respond to the medications administered. Our experience suggests

that Kluver-Bucy syndrome may occur more commonly in children than was

suspected previously, especially following hypoxia.

PMID: 3508062 [PubMed - indexed for MEDLINE]

J Neurosurg Sci 1997 Sep;41(3):269-72 Related Articles, Books, LinkOut

The Kluver-Bucy syndrome.

Goscinski I, Kwiatkowski S, Polak J, Orlowiejska M, Partyk A.

Jagiellonian University, Medical Faculty, Department of Neurotraumatology,

Krakow, Poland.

Evolution of psychological disorders following head injury including memory

disorders and other cognitive ones are common. The best known are

psychiatric disturbances of various kind after lesions of frontal lobes.

Cognitive, behavioural and emotional disorders are not usually seen in

patients with bilateral temporal lesions. In our Department of

Neurotraumatology we observed 4 patients with post-traumatic lesions

localized bitemporally. They developed Kluver-Bucy syndrome--rarity in human

pathology--with combination of three or more the following syndromes:

increased oral activity, hypersexuality, hypermetamorphosis, memory

disorders, placidity, loss of people recognition, bulimia. Several symptoms

responded dramatically to carbamazepine. We conclude that it may be a useful

agent in treatment of this unusual syndrome.

PMID: 9444580 [PubMed - indexed for MEDLINE]

Am Fam Physician 1998 Sep 1;58(3):749-56, 759 Related Articles, Books,

LinkOut

Heat-related illnesses.

Barrow MW, KA.

State University School of Medicine, Dayton, Ohio, USA.

Heat-related illnesses cause 240 deaths annually. Although common in

athletes, heat-related illnesses also affect the elderly, persons with

predisposing medical conditions and those taking a variety of medications.

Symptoms range from mild weakness, dizziness and fatigue in cases of heat

edema, to syncope, exhaustion and multisystem complications, including coma

and death, in cases of heat stroke. Milder heat-related symptoms can be

treated with hydration, rest and removal from the hot environment. Heat

stroke, a life-threatening problem, must be treated emergently. Prompt

recognition is critical since rapid cooling is the cornerstone of treatment

and must not be delayed. Fluid resuscitation with dextrose and normal or

half-normal saline is also important. These therapies should be instituted

while the patient is being stabilized. Heat illness may be prevented by

recognizing which individuals are at risk, using appropriate hydration and

paying attention to acclimatization and environmental conditions. Preventive

care should include drinking plenty of fluids before, during and after

activities, gradually increasing the time spent working in the heat and

avoiding exertion during the hottest part of the day.

Publication Types:

Review

Review, Tutorial

PMID: 9750542 [PubMed - indexed for MEDLINE]

http://abcnews.go.com/sections/living/Healthology/heatwave_dangers.html

Heat Wave Dangers

A. Finkel, MD, Massachusetts General Hospital

Most often, heat-related illnesses are preventable conditions. However, they

can have significant consequences, including death, if left untreated. The

illnesses are traditionally divided into two main categories-heat exhaustion

and heat stroke. These conditions can overlap in many ways and exist on a

continuum of severity. As a patient's body temperature rises, heat

exhaustion can rapidly progress to heat stroke.

Heat Exhaustion and Heat Stroke

Heat exhaustion develops when the body encounters excessively high

temperatures that it is not used to managing. It occurs at body temperatures

that are very high, but usually less than 40 degrees Celsius, or 104 degrees

Fahrenheit. The symptoms of heat exhaustion are not very specific, but

ultimately relate to a state of dehydration, which is the condition's

primary characteristic. Symptoms may include weakness, headache, and nausea.

Heat stroke is severe injury from high body temperatures that causes damage

to many organs, particularly the central nervous system, which include the

brain and spinal cord. In contrast to heat exhaustion, patients suffering

from heat stroke will have temperatures that are usually greater 104

degrees. Heat stroke may be divided into two categories-exertional and

classic.

Exertional heat stroke

Exertional heat stroke patients are usually people who are exercising in

excessively warm conditions. Their bodies cannot manage the stress of the

physical activity and the hot environment together.

Classic heat stroke

Classic heat stroke patients are often elderly or debilitated people who are

in warm environments for too long. The elderly are especially vulnerable to

the heat, as the body is less and less able to handle heat as it ages.

Elderly people may also have pre-existing illnesses that make them more

susceptible to heat stroke, or they make take medications that affect the

body's ability to manage hot temperatures. Elderly people, who, for economic

reasons, are not able to get out of the heat, are at great risk for heat

stroke.

Heat Transfer

In order to understand heat-related illnesses you need to know something

about the way the body normally gets rid of heat. There are four ways the

body transfers heat: radiation, evaporation, conduction, and convection.

Radiation

Radiation occurs when the body turns heat into electromagnetic waves. In

other words, waves of heat can escape from the body directly into the

surrounding air. This is the primary way that human beings are able to lose

heat from their bodies in very hot environments.

Evaporation

Evaporation is the transfer of heat that occurs during the transformation of

liquid to gas. Evaporation of sweat (even of sweat you cannot feel, called

insensiblelosses) is another significant method that the body uses to cool

down.

Convection and conduction

Convection and conduction are secondary ways for the body to lose heat after

radiation and evaporation. Convection is the passage of heat into the air

and into the vapor that surrounds the body. It is different from evaporation

in that the heat does not transform to the gas phase, as it does in

evaporation. Conduction is the transfer of heat through physical contact.

What Happens When it Gets Too Hot

In hot environments, the body initiates several processes to lose heat.

First, the anterior hypothalamus, the body's thermostat in the brain,

signals the body to open up blood vessels near the skin's surface so that

heat can be transferred outside by the methods listed above. This vessel

dilation is possible because blood is shunted away from the body's core. The

hypothalamus also mediates sweating and tells the body to respond to the

heat by taking off clothes and seeking a cooler environment.

When it becomes too hot, however, the body's ability to cool down becomes

overwhelmed. Symptoms like fatigue, headache, muscle aches, confusion, and

even coma can occur, depending on the severity of the condition.

This overwhelming of the body's means of handling heat can be caused by a

very warm environment or excessive exercising in the heat, as discussed

before. Also, though, patients may get overheated because of certain

illnesses like hyperthyroidism (high thyroid hormone level) or infections

causing fever. Additionally, some medications can cause high body

temperatures. A class of drugs called anticholinergics can decrease the

body's ability to sweat and, therefore, to lose heat. Other drugs called

sympathomimetics can decrease skin vessel dilation. There are other classes

of drugs that may also interfere with body temperature regulation through

various, sometimes complicated, mechanisms.

Symptoms and Signs

There are a variety of symptoms associated with heat-related illnesses. Heat

exhaustion patients may have vague complaints of symptoms that come on

slowly. These can include:

• Headache

• Weakness

• Lightheadedness

• Muscle aches

• Muscle cramps

• Agitation

Heat stroke patients can have the same complaints as heat exhaustion

patients, but they also suffer central nervous system problems, which can

include:

• Confusion hallucinations

• Bizarre behavior

• Seizure

• Coma

It was once thought that heat stroke patients did not sweat, but this

inability to sweat is variable, and often strikes the patient at the latest

stages of the condition.

Heat stroke patients, because of the resulting multi-organ damage, may also

complain of blood in the urine or stool, decline in the amount of urine

produced and shortness of breath, among other problems.

Other symptoms

There are secondary categories of heat-related illnesses to watch out for:

• Heat syncope occurs when a person overheats and then faints.

• Heat cramps are muscle contractions associated with electrolyte or mineral

abnormalities caused by the heat.

• Heat edema is characterized by swelling in the arms and legs because of

the heat.

• Prickly heat is a heat rash that is red and very itchy.

Treatment

There is a lot that you can do for a person suffering from a heat-related

illness. If you see someone who appears to be suffering from a heat-related

illness, you should call for help immediately. In the most rare, severe

cases, you should start cardiopulmonary resuscitation (CPR), if necessary.

If the person is not a trauma patient (has not been in an accident, fight,

or fall), you should move the individual from the hot environment to a

cooler location. Next you can sprinkle lukewarm water on the skin and fan

the patient; this will encourage evaporation. You can also apply ice packs

to the neck, underarms, and groin.

In the emergency room

Once a patient has been taken to the emergency room, the cooling process

will be continued. The doctor may use a cooling blanket and some other more

aggressive methods, but in general, treatment is similar to the methods that

should be initiated immediately, including fanning and ice packs.

The doctor may order tests to assess organ damage. These tests can include

electrolytes or minerals, blood-clotting tests, a urine analysis, creatine

phosphokinase (a muscle enzyme quantification), and a head computed

tomography (CT or cat) scan. Heat stroke patients are admitted to the

intensive care unit. Heat exhaustion patients are admitted to a regular

floor bed in the hospital. When patients are released from the hospital,

they should have a place to go to avoid the heat, and they must be able to

rehydrate themselves.

If caretakers are aggressive with these cooling techniques before delivering

the patient to the hospital, and the emergency department is able to treat

any related organ damage, then there is a good possibility that the

prognosis will be excellent.

Prevention

Heat-related illnesses are often preventable. When hot weather is expected,

the elderly and debilitated must be ensured access to cool, air-conditioned

shelter. People should be encouraged to wear light-colored, loose clothing

and bathe in tepid water. Also, hydration is critical, and people in hot

weather should increase their fluid intake substantially.

To avoid exertional heat stroke, athletes should not exercise in extreme

heat, and coaches should be aware of the symptoms of heat-related illnesses.

Athletes also must stay well-hydrated.

Summary

Heat-related illnesses are a continuum of conditions but have traditionally

been divided into heat exhaustion-characterized by dehydration-and heat

stroke, in which organs, particularly the central nervous system, are

damaged. Heat exhaustion patients may have vague complaints like weakness,

nausea and headache, whereas heat stroke patients often have these symptoms

plus confusion or hallucinations. Heat-related illnesses present a

potentially severe-even fatal-set of conditions that can often be prevented

if treated early and aggressively. Learning about the symptoms and

preventive care can help you help someone else.

Can You Handle the Heat?

be published, broadcast, rewritten or redistributed

http://www.merck.com/pubs/mmanual/section20/chapter279/279b.htm

Heatstroke

(Sunstroke; Thermic Fever; Siriasis)

Inadequacy or failure of heat loss mechanisms resulting in dangerous

hyperpyrexia.

Symptoms and Signs

An abrupt onset is sometimes preceded by headache, vertigo, and fatigue.

Sweating is usually decreased, and the skin is hot, flushed, and usually

dry. The pulse rate increases rapidly and may reach 160 to 180 beats/min;

respirations usually increase, but BP is seldom affected. Disorientation may

briefly precede unconsciousness or convulsions. The temperature climbs

rapidly to 40 to 41° C (104 to 106° F), causing a feeling of burning up.

Circulatory collapse may precede death; after hours of extreme hyperpyrexia,

survivors are likely to have permanent brain damage.

Diagnosis and Prognosis

Sudden development of hot, dry, flushed skin with a body temperature > 40° C

(> 104° F), a rapid pulse, and confusion or unconsciousness in a person

exposed to a hot environment are usually enough to distinguish heatstroke

from food, chemical, or drug poisoning. An acute infection (eg, septicemia,

meningitis) and toxic shock must be excluded. Drugs (see above) that may

have precipitated the episode should be considered.

1998-2002 On-line Medical Dictionary

http://cancerweb.ncl.ac.uk/cgi-bin/omd?query=disseminate & action=Search+OMD

Article 1. Heat Intolerance Induced by Antidepressants

Disseminate

To scatter or distribute over a considerable area. (18 Nov 1997)

intravascular

Within a vessel or vessels.

Origin: L. Vasculum = vessel (18 Nov 1997)

coagulation

1. <haematology> The process of clot formation.

2. <chemistry> The solidification of a sol into a gelatinous mass, an

alteration of a disperse phase or of a dissolved solid which causes the

separation of the system into a liquid phase and an insoluble mass called

the clot or curd. Coagulation is usually irreversible.

3. <surgery> The disruption of tissue by physical means to form an amorphous

residuum, as in electrocoagulation and photocoagulation.

Origin: L. Coagulatio (18 Nov 1997)

Article 3. Heat Intolerance in Patients… Maintained with Antipsychotic

Drugs

“Patients maintained on antipsychotic drugs exhibit impaired heat

tolerance.”

febrile

<symptom> Pertaining to or characterised by fever.

Origin: L. Febrilis (18 Nov 1997)

catatonia

<neurology, psychiatry> A syndrome of psychomotor disturbances seen in

schizophrenic disorders characterised by periods of either muscular

rigidity, excitement or stupor. (16 Mar 1998)

neuroleptic

<pharmacology> A term coined to refer to the effects on cognition and

behaviour of antipsychotic drugs, which produce a state of apathy, lack of

initiative and limited range of emotion and in psychotic patients cause a

reduction in confusion and agitation and normalisation of psychomotor

activity.

Origin: Gr. Lepsis = a taking hold (18 Nov 1997)

malignant

<oncology> Tending to become progressively worse and to result in death.

Having the properties of anaplasia, invasion and metastasis, said of

tumours.

Origin: L. Malignans = acting maliciously (18 Nov 1997)

heatstroke

A severe and often fatal illness produced by exposure to excessively high

temperatures, especially when accompanied by marked exertion.

It can manifest by elevated body temperature, lack of sweating, hot dry

skin, and neurologic symptoms; unconsciousness, paralysis, headache,

vertigo, confusion. In severe cases very high fever, vascular collapse, and

coma develop.

Synonym: heat apoplexy, heat hyperpyrexia, malignant hyperpyrexia, thermic

fever. (05 Mar 2000)

vertigo

<neurology, symptom> An illusion of movement, a sensation as if the external

world were revolving around the patient (objective vertigo) or as if he

himself were revolving in space (subjective vertigo).

The term is sometimes erroneously used to mean any form of dizziness.

Origin: L. Vertigo (18 Nov 1997)

heat apoplexy -->heatstroke

A severe and often fatal illness produced by exposure to excessively high

temperatures, especially when accompanied by marked exertion.

It can manifest by elevated body temperature, lack of sweating, hot dry

skin, and neurologic symptoms; unconsciousness, paralysis, headache,

vertigo, confusion. In severe cases very high fever, vascular collapse, and

coma develop.

Synonym: heat apoplexy, heat hyperpyrexia, malignant hyperpyrexia, thermic

fever. (05 Mar 2000

apoplexy

<clinical sign, neurology> Haemorrhage into the brain. A stroke. It is

usually associated with loss of consciousness and paralysis of various parts

of the body. (27 Sep 1997)

hyperpyrexia

<clinical sign> Exceptionally high fever either in comparison of the fever

usually accompanying a particular disease or absolutely (as in heatstroke).

(18 Nov 1997)

thermic fever -->heatstroke

A severe and often fatal illness produced by exposure to excessively high

temperatures, especially when accompanied by marked exertion.

It can manifest by elevated body temperature, lack of sweating, hot dry

skin, and neurologic symptoms; unconsciousness, paralysis, headache,

vertigo, confusion. In severe cases very high fever, vascular collapse, and

coma develop.

Synonym: heat apoplexy, heat hyperpyrexia, malignant hyperpyrexia, thermic

fever. (05 Mar 2000)

Article 6. Psychiatric Drugs as Risk Factor in Fatal Heat Stroke

anaemia

<haematology> Too few red blood cells in the bloodstream, resulting in

insufficient oxygen to tissues and organs.

Origin: Gr. Haima = blood (16 Dec 1997)

thrombopenia -->thrombocytopenia

<haematology> A decrease in the number of platelets in the blood, resulting

in the potential for increased bleeding and decreased ability for clotting.

Origin: Gr. Penia = poverty (18 Nov 1997)

renal failure

Chronic renal failure represents a slow decline in kidney function over

time. Chronic renal failure may be caused by a number of disorders which

include long-standing hypertension, diabetes, congestive heart failure,

lupus or sickle cell anaemia. If renal function declines to a low enough

level (end-stage renal disease) kidney dialysis may be necessary. A sudden

decline in renal function may be triggered by a number of acute disease

processes.

Examples include sepsis (infection), shock, trauma, kidney stones, kidney

infection, drug toxicity (aspirin or lithium), poisons or toxins (drug

abuse) or after injection with an iodinated contrast dye (adverse effect).

Both forms of renal failure result in a life-threatening metabolic

derangement. (27 Sep 1997)

“The set point of the temperature regulation centre can be elevated by the

antidopaminergic activity of antipsychotics”

antidopaminergic

Preventing or counteracting (the effects of) dopamine. (18 Nov 1997)

anticholinergenic

<pharmacology> Refers to an agent that inhibits parasympathetic neural

activity by blocking the neurotransmitter acetylcholine.

Origin: Gr. Gennan = to produce (09 Oct 1997)

parasympathetic

Pertaining to a division of the autonomic nervous system.

See: autonomic nervous system. (05 Mar 2000)

acetylcholine

<chemical, neurology, physiology> A chemical found in vertebrate neurons

that carries information across the synaptic cleft, the space between two

nerve cells. (06 May 1997)

“It is recommended to point out the danger of unusually high outdoor

temperatures to patients using this medication.”

Article 9. Cerebellar Syndrome Following Neuroleptic Induced Heat Stroke

cerebellar syndrome

<syndrome> The signs and symptoms of cerebellar deficiency: dysmetria,

dysarthria, asynergia, nystagmus, ataxia, staggering gait, and

adiadochokinesia. (05 Mar 2000)

dysmetria

An aspect of ataxia, in which the ability to control the distance, power,

and speed of an act is impaired. Usually used to describe abnormalities of

movement caused by cerebellar disorders.

See: hypermetria, hypometria.

Origin: dys-+ G. Metron, measure (05 Mar 2000)

hypermetria

Ataxia characterised by overreaching a desired object or goal; usually seen

with cerebellar disorders.

Compare: hypometria.

Origin: hyper-+ G. Metron, measure (05 Mar 2000)

hypometria

Ataxia characterised by underreaching an object or goal; seen with

cerebellar disease.

Compare: hypermetria.

Origin: hypo-+ G. Metron, measure (05 Mar 2000)

dysarthria

<clinical sign, neurology> Imperfect articulation of speech due to

disturbances of muscular control which result from damage to the central or

peripheral nervous system.

Origin: Gr. Arthroun = to utter distinctly (18 Nov 1997)

asynergia

Synonym: asynergy.

Origin: G. A-priv. + syn, with, + ergon, work (05 Mar 2000)

asynergy

Lack of coordination among various muscle groups during the performance of

complex movements, resulting in loss of skill and speed. When severe,

results in decomposition of movement, wherein complex motor acts are

performed in a series of isolated movements; caused by cerebellar disorders.

Synonym: asynergia. (05 Mar 2000)

nystagmus

<neurology> An involuntary, rapid, rhythmic movement of the eyeball, which

may be horizontal, vertical, rotatory or mixed, i.e., of two varieties.

Origin: Gr. Nystagmos = drowsiness, from nystazein = to nod (18 Nov 1997)

ataxia

<neurology> Failure of muscular coordination, irregularity of muscular

action.

Origin: Gr. Taxis = order (16 Dec 1997)

adiadochocinesis -->adiadochokinesis

Inability to perform rapid alternating movements. One of the clinical

manifestations of cerebellar dysfunction.

See: dysdiadochokinesia.

Compare: diadochokinesia.

Synonym: adiadochocinesia, adiadochocinesis, dysdiadochokinesis.

Origin: G. A-priv. + diadochos, successive, + kinesis, movement (05 Mar

2000)

rhabdomyolysis

<pathology> The destruction of skeletal muscle cells. Often the result of

electrical injury, alcoholism, injury (or laying in one position for an

extended period of time), drug side effects or toxins. (27 Sep 1997)

Results for: pancerebellar

1 results found, sorted by relevance

1-1

THE MERCK MANUAL, Sec. 14, Ch. 179, Disorders Of Movement

Disorders of the cerebellum and its inflow or outflow pathways produce

deficits in the rate, range, and force of movement. ...

size 26.0K

Cerebellar And Spinocerebellar Disorders

Disorders of the cerebellum and its inflow or outflow pathways produce

deficits in the rate, range, and force of movement. Anatomically, the

cerebellum has three subdivisions. The archicerebellum (vestibulocerebellum)

comprises the flocculonodular lobe, helps maintain equilibrium and

coordinate eye-head-neck movements, and is closely interconnected with the

vestibular nuclei. The midline vermis (paleocerebellum) helps coordinate

movement of the trunk and legs. Vermis lesions result in abnormalities of

stance and gait. The lateral hemispheres, which make up the neocerebellum,

control ballistic and finely coordinated limb movements, predominantly of

the arms. Signs of cerebellar disease are listed in Table 179-3.

STRUCTURAL LESIONS OF THE CEREBELLUM

Articles 15 – 17. Kulver-Bucy Syndrome Following Heat Stroke

Results for: Kluver-Bucy syndrome

621 results found, top 500 sorted by relevance

1-10

THE MERCK MANUAL, Sec. 14, Ch. 171, Delirium And Dementia

lists many of the known causes of dementia. Dementia may occur at any age

and can affect young people as the result of injury or hypoxia ...

size 55.1K

Dementia

A chronic deterioration of intellectual function and other cognitive skills

severe enough to interfere with the ability to perform activities of daily

living.

Complications

Behavioral complications include hostility, agitation, wandering, and

uncooperativeness. Psychiatric complications include depression, anxiety,

and paranoid reactions. True psychosis (paranoia, delusions, and

hallucinations) probably occurs in about 10% of patients with Alzheimer's

disease. In addition, perhaps 80% of family members or caregivers develop

depression over time. Metabolic problems (eg, dehydration, infection, drug

toxicity) can worsen cognitive impairment and make patient management more

difficult. Other complications include falls, incontinence, and confusion at

dusk (sundowning). The drugs commonly used to treat Alzheimer's disease

(especially antipsychotics for behavior disorders) can cause a parkinsonian

movement disorder and orthostatic hypotension. Tricyclic drugs with

anticholinergic side effects can cause constipation, urinary retention,

glaucoma, and seizures. Nonprescription antihistamines can lead to worsened

confusion. These complications put the patient at risk of premature

institutionalization and should be avoided or quickly treated, because many

can be controlled or reversed.

Many drugs adversely affect the CNS, increasing confusion and lethargy.

Sedatives, such as benzodiazepines, should be avoided when possible.

Anticholinergic drugs, such as some tricyclic antidepressants,

antihistamines, antipsychotics, and benztropine, should be avoided

Article 18. Heat-Related Illnesses

edema -->oedema

<clinical sign> The presence of abnormally large amounts of fluid in the

intercellular tissue spaces of the body, usually applied to demonstrable

accumulation of excessive fluid in the subcutaneous tissues.

Oedema may be localised, due to venous or lymphatic obstruction or to

increased vascular permeability or it may be systemic due to heart failure

or renal disease.

Collections of oedema fluid are designated according to the site, for

example ascites (peritoneal cavity), hydrothorax (pleural cavity) and

hydropericardium (pericardial sac).

Massive generalised oedema is called anasarca.

Origin: Gr. Oide ma = swelling (18 Nov 1997)

syncope

<clinical sign> A temporary suspension of consciousness due to generalised

cerebral ischaemia, a faint or swoon.

(19 Jan 1998)