Fijnheer R, van de Ven P J, Erkelens D W
Afd. Interne Geneeskunde, Academisch Ziekenhuis, Utrecht.
Ned Tijdschr Geneeskd. 1995 Jul 8;139(27):1391-3.
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.
两名年龄分别为33岁和31岁的男子在一个温暖的夏日中暑身亡。其中一人服用匹莫齐特和氯米帕明，另一人服用珠氯噻醇、地西替明、氟哌利多、异丙嗪和普萘洛尔作为精神科药物。两人体温均高于42.3摄氏度，且无出汗。起初仅存在昏迷状态，实验室检查值基本正常；随后迅速出现严重肝损伤、弥散性血管内凝血、贫血、血小板减少和急性肾衰竭。尽管进行了充分且迅速的治疗，这些并发症仍导致死亡。两名患者均使用了具有抗多巴胺能和抗胆碱能（副作用）的药物。抗精神病药物的抗多巴胺能活性可提高体温调节中枢的设定点。使用抗胆碱能药物可通过抑制副交感神经介导的汗液分泌来干扰体温调节。建议向使用此类药物的患者指出户外异常高温的危险。
