Heat stroke differential diagnosis

Revision as of 14:40, 5 June 2017 by Mehdi Pahlavani (talk | contribs)
(diff) ← Older revision | Latest revision (diff) | Newer revision → (diff)
Jump to: navigation, search

Heat stroke Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Heat Stroke from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms

Physical Examination

Laboratory Findings

X-rays

Ultrasound

CT Scan

MRI

Other Imaging Studies

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Heat stroke differential diagnosis On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Heat stroke differential diagnosis

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Heat stroke differential diagnosis

CDC on Heat stroke differential diagnosis

Heat stroke differential diagnosis in the news

Blogs on Heat stroke differential diagnosis

Directions to Hospitals Treating Breast cancer

Risk calculators and risk factors for Heat stroke differential diagnosis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Seyedmahdi Pahlavani, M.D. [2],Usama Talib, BSc, MD [3]

Overview

Heat stroke must be differentiated from other disease that may cause alteration in mental status and hyperthermia including: Neuroleptic malignant syndrome, Malignant hyperthermia, Serotonin syndrome, cocaine use and sepsis.[1][2][3][4][5][6]

Differentiating Heat stroke from other Diseases

Differentiation between 2 types of heat stroke (Classic vs Exertional) is based on history, clinical findings, and laboratory findings.[7][8] The following table summarizes their differentiating feature.

Characteristic Exertional Heat Stroke Classic Heat Stroke
Age Adults Early childhood or elderly
Health status Healthy and athlete Ill and debilitate
Weather condition Temperate or hot Heat wave
Activity Sustained or heavy exertion Sedentary
Medications or drug use Ergogenic aids, ecstasy, cocaine Diuretics, β-blockers, antihistamines,

antidepressants

Sweating Present Abscent
Laboratory findings Acid-base disturbance Metabolic acidosis Mixed metabolic and respiratory acidosis
Calcium Nl
Potassium ↓ or ↑ Nl
Phosphate
Blood glucose
Creatine kinase (CK) ↑↑↑
AST, ALT ↑↑↑
Complications Rhabdomyolysis Severe Mild
Acute renal failure Common (∼25%) Uncommon (∼5%)

Differentiating Heat stroke from other Diseases that may cause hyperthermia and altered mental status

Heat stroke must be differentiated from other conditions that may cause hyperthermia and altered mental status.[1][2][3][4][5][6]

Disease Symptoms and signs Labs Other findings
Heat stroke Electrolyte disturbances, increased CK, AST, and ALT Relevant history of excessive exercise and lack of water access
Sepsis
  • Altered mental status (confusion, altered consciousness, coma, or seizure)
  • Respiratory rate ≥22/minute
  • Systolic blood pressure ≤100 mmHg
Thrombocytopenia, leukocytosis, leukopenia, elevated Cr
Malignant hyperthermia Hypercarbia (PaCO2) >65 mmHg, hyperkalemia History of receiving anaesthetic agent
Neuroleptic malignant syndrome Electrolyte disturbances, increased CK, LDH, ALP, AST, and ALT, leukocytosis, myoglobinuria. Relevant history of recent use of anti-psychotics
Serotonin syndrome Elevated CK, LDH, ALP, AST, and ALT History of recent use of SSRIs, SNRIs , or MAOIs.

References

  1. 1.0 1.1 Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, Bellomo R, Bernard GR, Chiche JD, Coopersmith CM, Hotchkiss RS, Levy MM, Marshall JC, Martin GS, Opal SM, Rubenfeld GD, van der Poll T, Vincent JL, Angus DC (2016). "The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3)". JAMA. 315 (8): 801–10. doi:10.1001/jama.2016.0287. PMC 4968574. PMID 26903338.
  2. 2.0 2.1 Seymour CW, Liu VX, Iwashyna TJ, Brunkhorst FM, Rea TD, Scherag A, Rubenfeld G, Kahn JM, Shankar-Hari M, Singer M, Deutschman CS, Escobar GJ, Angus DC (2016). "Assessment of Clinical Criteria for Sepsis: For the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3)". JAMA. 315 (8): 762–74. doi:10.1001/jama.2016.0288. PMC 5433435. PMID 26903335.
  3. 3.0 3.1 Carbone JR (2000). "The neuroleptic malignant and serotonin syndromes". Emerg. Med. Clin. North Am. 18 (2): 317–25, x. PMID 10767887.
  4. 4.0 4.1 Bodner RA, Lynch T, Lewis L, Kahn D (1995). "Serotonin syndrome". Neurology. 45 (2): 219–23. PMID 7854515.
  5. 5.0 5.1 Ener RA, Meglathery SB, Van Decker WA, Gallagher RM (2003). "Serotonin syndrome and other serotonergic disorders". Pain Med. 4 (1): 63–74. PMID 12873279.
  6. 6.0 6.1 Larach MG, Gronert GA, Allen GC, Brandom BW, Lehman EB (2010). "Clinical presentation, treatment, and complications of malignant hyperthermia in North America from 1987 to 2006". Anesth. Analg. 110 (2): 498–507. doi:10.1213/ANE.0b013e3181c6b9b2. PMID 20081135.
  7. Bouchama A, Knochel JP (2002). "Heat stroke". N. Engl. J. Med. 346 (25): 1978–88. doi:10.1056/NEJMra011089. PMID 12075060.
  8. O'Connor FG, Casa DJ, Bergeron MF, Carter R, Deuster P, Heled Y, Kark J, Leon L, McDermott B, O'Brien K, Roberts WO, Sawka M (2010). "American College of Sports Medicine Roundtable on exertional heat stroke--return to duty/return to play: conference proceedings". Curr Sports Med Rep. 9 (5): 314–21. doi:10.1249/JSR.0b013e3181f1d183. PMID 20827100.
|}

Linked-in.jpg