Presentation on Hyperthermia Syndrome In children

1. Hyperthermia Syndrome in
Children
• Name: Sesha Bhattar SriKalyan
• Group - 7616m2a
• Course - Fourth

2. Definition
• Hyperthermia syndrome is a pathological
condition characterized by a sudden increase in
body temperature up to 104° F and higher due to
a violation of thermoregulation. It is more
common in young children. In adults, it can occur
as a consequence of various pathologies of the
brain (trauma, tumor, hemorrhage, etc.), as a
complication in anesthesia.

3. Causes
• Disruption in the thermoreguatory center located in the Hypothalamus of the
brain.
• Various infections (viral and bacterial). e.g, - Pneumonia, Sepsis, Influenza
etc.
• Drug induced hyperthermia e.g.- Anesthesia Induced Malignant
Hyperthermiia.
• In children, the hyperthermia syndrome often occurs because of the not fully
formed mechanism of thermoregulation, endocrine disorders. At this age,
the body produces a lot of heat energy, the return of which is insufficient.

4. Signs and Symptoms
• lethargy, inhibition of reactions
• convulsions
• shallow breathing
• rapid pulse of unknown origin
• blanching of the skin, while it can remain cold
• chills
• dehydration of the body
• a sharp drop in blood pressure
• loss of consciousness, hallucinations

5. Warning Signs!
• In children, the situation can worsen and the
consequences will be dangerous. If the body
temperature rises to the critical temperature (107° F), the
heart rate increases, and its rhythm breaks down.
Metabolism in the body and blood circulation are
violated. There is shortness of breath, exhilaration,
uncontrolled urination and as a consequence,
dehydration, possible convulsions and clotting, the
destruction of blood proteins inside the vessels. Such a
pathological condition can lead to the death of the child,
unless timely emergency care and treatment is provided.

6. General Measures
• To reduce body temperature, combined treatment should be carried
out using both pharmacological and physical methods of cooling.
• Originally oxygen therapy, infusion therapy for correction of water-
electrolyte disorders and CBS.
• At a hyperthermia above 104 F, it is necessary to lower a body
temperature, for this purpose take off the clothes and apply the
above-mentioned physical methods of cooling.
• Apply paracetamol (now appeared the intravenous form) 15 mg / kg.
Or analgin 50% 0,1-0,2ml. for each year of life.

7. Cont..
• If there are violations of peripheral circulation, you can use
vasodilator drugs such as papaverine, nicotinic acid, novocaine and
others.
• Antihistamines (dimedrol, tavegil, suprastin) intensify the effect of
antipyretics. They have a mild sedative and spasmolytic effect.
• With a sedative purpose, you can use benzodiazepines (seduxen,
relanium, diazepam, sibazon) at a dose of 0.2-0.3 mg / kg.
• Lytic mixtures, which include droperidol or aminazine in the form of
2.5% solution.

8. • Litical mixture:
• 1 ml of a 2.5% solution of aminazine,
• 1 ml of a 2.5% solution of diprazine (pipolpene),
• 8 ml of 0.25% solution of novocaine.
• A solution of diprazine (pipolpene) can be replaced with 1 ml of a 2%
solution of suprastin.

9. additional points
• Today we have limited choice of medications. this is paracetamol(in
different forms) and physical methods of cooling to manage this
condition.
• Some doctors use complex preparations of meications -
spasmalgon, spazgan.
• There are pediatricians who use mefenamic acid
• ( for patients >5 y.o) , but in the modern literature no one
recommends it.

10. Drugs that shouldn’t be prescribed.
• As a rule, children are not prescribed the following antipyretic
agents:
• acetylsalicylic acid (the risk of developing Ray’s syndrome in ARVI)
• metamizole (danger of agranulocytosis)
• amidopyrine (high toxicity)
• nimesulide (hepatotoxicity)
• In the treatment of hyperthermia syndrome, one should refrain from
the use of vasopressors, atropine and calcium preparations.

11. Prognosis
• The prognosis depends on the course of the underlying
disease. Hyperthermia syndrome, caused by anesthesia,
often ends in death. A favorable outcome is possible
under the condition of early diagnosis and immediate
intensive treatment. The prognosis for malignant
hyperthermia in children is always questionable.
• But with timely management and prompt usage of drugs
there is 90% cure rate.

12. Anesthesia Induced Malignant
Hyperthermia.
• This condition is an autosomal dominant genetic disorder.
• This condtion is prevalent in <1:1,000,000 of the population.
• Mortality rate : 80-90% if not identified and treated immediately.
• Cause: This is a true anesthesia induced disease and is only seen
when vapor anesthesia or succinylcholine is used.
• Pathophysiology - It is a disorder of muscle calcium metabolism
leading to muscle fiber breakdown and increase in temperature of
the body and causing metabolic acidosis and further compliacations.

13. Complications of anethesia induced hyperthermic
syndrome.
• Renal Failure
• Cerebral Edema
• Pulmonary Edema
• Rapid death

14. Early signs and symptoms
• These early signs and symptoms are really non-specific
and fever as the sign being a really late sign and is often
misdiagnosed or left undiagnosed.
• Early non specific signs include:
1. Tachycardia without apparent cause.
2. Increase in end tidal Co2 concentration without apprent
cause.

15. Treatment of Anesthesia induced malignant hyperthermia.
• 1. Drug Of Choice - Dantrolene Sodium (IV)/ ( Dantrium)
• Dosage : 2mg/kg intially followed by 1-2mg/kg until
conditons improve (or) until 10mg/kg has been given.
• 2.Active cooling of the patient - ice packs, ice-cold
solutions lavage to bladder and pertioneum.
• 3. Patient must always be monitored in the ICU.

16. Drugs used.

18. • References used:
• https://www.rxmed.com
• Ghai Essential Pedaitrics 9th edition
• www.aanem.org