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发热患者:急性药物性高热

The hot patient: acute drug-induced hyperthermia.

作者信息

Jamshidi Nazila, Dawson Andrew

机构信息

Royal Prince Alfred Hospital, Sydney.

NSW Poisons Information Centre, Sydney Children's Hospital Network.

出版信息

Aust Prescr. 2019 Feb;42(1):24-28. doi: 10.18773/austprescr.2019.006. Epub 2019 Feb 1.

Abstract

Drugs can cause dysregulation of the hypothalamic–pituitary–adrenal axis which can result in a rise in core temperature. This type of hyperthermia is unresponsive to antipyretics and can be complicated by rhabdomyolysis, multi-organ failure and disseminated intravascular coagulation Organic causes of fever such as infection must be ruled out. Syndromes associated with drug-induced fever include neuroleptic malignant syndrome and anticholinergic, sympathomimetic and serotonin toxicity The class of offending drugs, as well as the temporal relationship to starting or stopping them, assists in differentiating between neuroleptic malignant syndrome and serotonin toxicity Immediate inpatient management is needed. The mainstay of management is stopping the drug, and supportive care often in the intensive care unit

摘要

药物可导致下丘脑 - 垂体 - 肾上腺轴功能失调,进而引起核心体温升高。这种类型的高热对抗热药物无反应,可能并发横纹肌溶解、多器官功能衰竭和弥散性血管内凝血。必须排除感染等发热的器质性病因。与药物性发热相关的综合征包括抗精神病药物恶性综合征以及抗胆碱能、拟交感神经和5-羟色胺毒性反应。引起问题的药物类别以及与开始或停用这些药物的时间关系,有助于区分抗精神病药物恶性综合征和5-羟色胺毒性反应。需要立即进行住院治疗。治疗的主要方法是停用药物,并通常在重症监护病房进行支持性护理。

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