Last reviewed: November 2017
Last updated: November  2017

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors
  • agitation, irrationality, restlessness, sometimes aggressive behaviour
  • hyperthermia >38°C (>100°F) but <39.5°C (<103°F)
  • hyperthermia >39.5°C (>103°F)
  • seizures
  • diaphoresis, flushed facial skin
  • tachycardia and palpitations
  • traumatic injury
  • headache
  • serotonin drug interaction
  • hypertension
  • chest pain
  • cardiac arrhythmia
  • hyper-reflexia and clonus

Other diagnostic factors

  • hx of hepatitis B or C, HIV
  • tremor, repetitive movements
  • disorientation, confusion, delirium
  • malnutrition
  • superficial venous abnormalities
  • rapid speech, pacing, trismus
  • hallucinations or delusions
  • tremor, hypertonicity, or muscle rigidity
  • paranoia, hypervigilance, or psychosis
  • mydriasis
  • hx of heart disease
  • tachypnoea
  • dyspnoea
  • lack of thirst
  • abdominal pain
  • positive Babinski
  • focal neurological signs, papilloedema

Risk factors

  • high ambient temperature
  • volume depletion
  • exercise and sweating
  • excessive alcohol intake
  • polydrug usage
  • anxiety and depression
  • hx of behavioural disturbance
  • hx of delinquency or crime
  • ADHD
  • attendance at dance club or rave party
  • hx of drug misuse for more than 1 year
  • genetic predilection

Diagnostic investigations

1st investigations to order

  • serum glucose
  • serum electrolytes
  • serum creatinine, urea
  • ABG
  • serum AST, ALT, gamma-GT
  • serum PT, PTT, INR
  • urinalysis
  • urine toxicology screen
  • serum alcohol level
  • serum creatine kinase
  • serum troponin
  • ECG
  • CXR
Full details

Investigations to consider

  • serum D-dimer
  • abdominal x-ray
  • CT of the head
  • MRI of the head
  • cerebral angiography
Full details

Treatment algorithm

ACUTE

Contributors

Authors VIEW ALL

Professor

Department of Emergency Medicine

University of California, Davis Medical Center

Sacramento

CA

Disclosures

JRR is an author of a number of references cited in this monograph.

Dr John R. Richards would like to gratefully acknowledge Dr Alison Jones, a previous contributor to this monograph. AJ is an author of a number of references cited in this monograph.

Peer reviewers VIEW ALL

Assistant Professor

Department of Emergency Medicine

Johns Hopkins University Hospital

Baltimore

MD

Disclosures

AS declares that he has no competing interests.

Associate Clinical Professor of Medicine

University of California San Francisco School of Medicine

San Francisco

CA

Disclosures

RJG declares that he has no competing interests.

Consultant Physician and Clinical Toxicologist

Guy's and St Thomas' Poisons Unit

London

UK

Disclosures

DW is an author of a reference cited in this monograph.

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