Acute and Critical Care

Case Reports

Neurology
Myoclonic status epilepticus after severe hyperthermia in a patient with coronavirus disease 2019: Katherine A Hill, John J Peters, Sara M Schaefer; Acute Crit Care. 2023;38(4):509-512. Published online March 24, 2022; DOI: https://doi.org/10.4266/acc.2021.01452

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Abstract PDF: Myoclonic status epilepticus (MSE) is a sign of severe neurologic injury in cardiac arrest patients. To our knowledge, MSE has not been described as a result of prolonged hyperpyrexia. A 56-yearold man with coronavirus disease 2019 presented with acute respiratory distress syndrome, septic/hypovolemic shock, and presumed community-acquired pneumonia. Five days after presentation, he developed a sustained fever of 42.1°C that did not respond to acetaminophen or ice water gastric lavage. After several hours, he was placed on surface cooling. Three hours after fever resolution, new multifocal myoclonus was noted in the patient’s arms and trunk. Electroencephalography showed midline spikes consistent with MSE, which resolved with 40 mg/kg of levetiracetam. This case demonstrates that severe hyperthermia can cause cortical injury significant enough to trigger MSE and should be treated emergently using the most aggressive measures available. Providers should have a low threshold for electroencephalography in intubated patients with a recent history of hyperpyrexia.

Hyperthermia Plus Tachycardia Is Predictive of Fatal Outcome in Pontine Hemorrhage: A Case Report: Dong Woong Eom, Kyoung Dong Jeon, Jung Soo Kim; Korean J Crit Care Med. 2010;25(4):263-265.; DOI: https://doi.org/10.4266/kjccm.2010.25.4.263

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Pontine hemorrhage is characterized by high mortality and morbidity. We report a case of pontine hemorrhage treated by extraventricular drainage (EVD) of cerebrospinal fluid (CSF) and control of intracranial pressure (ICP) at the neuro-intensive care unit (NICU). The patient's ICP was well controlled, but hyperthermia with tachycardia developed 8 hours after admission, and the patient expired with sudden cardiac arrest. A literature review revealed that high fever (>39degrees C) developing within 24 hours after onset of hemorrhage with tachycardia (>110 beat/min) is a clinical indicator for high probability of death. Therefore, it is important that not only ICP and neurological changes but also vital signs, especially body temperature and heart rate, be monitored in pontine hemorrhage patients.

Citations

Citations to this article as recorded by

Korean Medical Treatment for Prolonged Central Hyperthermia Following Pontine Hemorrhage: A Case Report
Chan-sol Yi, Song-won Park, Seungcheol Hong, Youngji Kim, Juyeon Song, Jeong-yun Lee, Gil-cho Shin, Dong-jun Choi
The Journal of Internal Korean Medicine.2018; 39(5): 1061. CrossRef

Delayed Onset of Malignant Hyperthermia: A Case Report: Jeong Wook Lim, Seok Kon Yeo, Seong Hwan Yang, In Seok Hwang, Jong Soo Lee; Korean J Crit Care Med. 2009;24(3):168-171.; DOI: https://doi.org/10.4266/kjccm.2009.24.3.168

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Abstract PDF: Malignant hyperthermia is a potentially fatal genetic and metabolic myopathy that presents with high fever, and muscle rigidity, and it often occurs after administering anesthetic medication. Most cases of malignant hyperthermia occur during anesthesia or surgery, but delayed malignant hyperthermia is very rare, and if it is detected late, it has a high mortality rate. A 39-year-old male with an acute subdural hematoma underwent decompressive craniectomy without any intraoperative medical problems, but a high fever above 40degrees C occurred after 8 hours and he was dead in spite of aggressive management after 48 hours postoperatively. We present here a case of delayed malignant hyperthermia along with a review of the related literature.

Dantrolene and Post-operative Hyperthermia: A Case Report: Ja Kyung Koo, Cheol Hong Kim, Ah Leum Lim, Se Ah Kwon, Ji Young Park, Soon Jae Lee, In Gyu Hyun, Je Hyun Yoo; Korean J Crit Care Med. 2009;24(2):92-98.; DOI: https://doi.org/10.4266/kjccm.2009.24.2.92

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Abstract PDF: Malignant hyperthermia is a rare, fatal pharmacogenetic disorder that occurs during general anesthesia following exposure to a depolarizing muscle relaxant, such as succinylcholine, or volatile anesthetics. Clinical findings in malignant hyperthermia include muscle rigidity, sinus tachycardia, increased CO2 production, skin cyanosis with mottling, and marked hyperthermia. For treatment, cooling techniques must be accompanied by discontinuation of the provocative medication. Furthermore, dantrolene administration is the mainstay of treatment for malignant hyperthermia, and should be initiated as soon as the diagnosis is suspected. We recently experienced a case with post-operative fever of 41.0degrees C refractory to conventional anti-pyretic measures and finally resolved with dantrolene administration, in a patient with methicillin-sensitive Staphylococcus aureus monoarthritis of the knee and rapid progression of diffuse septic pneumonia requiring mechanical ventilation.

Original Article

The Effects of Chemotherapeutic Agents on Renal Function during Continuous Hyperthermic Peritoneal Perfusion: Jong Ho Choi, Eun Sung Kim; Korean J Crit Care Med. 2002;17(1):19-24.

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Abstract PDF: BACKGROUND
Continuous hyperthermic peritoneal perfusion (CHPP) has been introduced to improve the survival of the advanced cancer patients. It is a technique that allows uniform delivery of cytotoxic agents and heat to the peritoneal surface. However CHPP - induced acute changes of body temperature and intraabdominal pressure could produce various abnormal physiologic responses, especially hypoperfusion and hypoxia. These factors may further contribute to the renal dysfunction. Moreover, transperitoneal absorption of drugs resulting in systemic toxicity and certain anticancer drugs have an inherent nephrotoxicity. The aim of the present study was to investigate the effect of anticancer drugs on the kidney in the ovarian cancer patients after CHPP.
METHODS
CHPP with anticancer agents in warm saline was performed in 54 patients with cancer of the ovary at temperature 47 degrees C for 90 minutes under general anesthesia. Forty nine patients were given carboplatin and 5 patients were received cisplatin intraperitoneally at an equi-toxic dose. To clarify the effect of cisplatin and carboplatin on the kidney, serum creatinine and blood urea nitrogen (BUN) were measured before anesthesia, 1, 3 and 7th day after surgery in both agents.
RESULTS
There were no significant changes of creatinine level on 1, 3 and 7 days postoperatively compared to preoperative creatinine in carboplatin patients. In carboplatin patients, postoperative BUN levels were decreased significantly on 1 and 3 days, but they were within normal range. BUN level of postoperative 7 day showed no significant change. In cisplatin patient, there was insignificant increase of BUN and creatinine levels on 1, 3 and 7 days postoperatively.
CONCLUSIONS
These results suggest that carboplatin did not suppress renal function until 7 days after CHPP. Cisplatin markedly increased the creatinine and BUN until 7 days postoperatively, but there was no statistical significance.

Case Reports

Malignant Hyperthermia during General Anesthesia: Two cases: Eun Chung Cho, Eun Sung Kim, Young Ho Hong, Yeon Jang, Soo Seok Park; Korean J Crit Care Med. 1997;12(1):89-94.

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Abstract PDF: Malignant hyperthermia is a hypermetabolic disorder of skelectal muscle. It goes fatal progress in the majority of cases unless early diagnosis and treatment are performed. We experienced two cases of malignant hyperthermia during general anesthesia. First case is 7-year-old boy with congenital bilateral ptosis. Second case is 46-year-old male with lung cancer. We were faced to difficult intubation due to masseter muscle spasm. After induction, tachycardia, muscle rigidity, body temperature elevation, end tidal CO2 elevation and acidosis developed. Enflurane was discontinued, vigorous emergency treatment was attempted. Fortunately, two patients were recovered from malignant hyperthermia and then discharged without complications.

Malignant Hyperthermia Syndrome: A case report: Ji Yeon Kim, Eun Jung Kwon, Mi Kyoung Lee, Sang Ho Lim, Suk Min Yoon, Young Seok Choi; Korean J Crit Care Med. 1997;12(1):85-88.

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Abstract PDF: Malignant hyperthermia (MH) is an inherited skeletal muscle disorder characterized by hypermetabolism, muscle rigidity, rhabdomyolysis, fever, metabolic acidosis and death if untreated. The syndrome is believed to result from abnormal control of intracellular calcium ions in the skeletal muscle: on exposure to certain anesthetics, calcium level is increased, and then it activates contractile processes and biochemical events that support muscle contraction. We experienced a MH of 2 years-old male who had release of sternocleidomastoid muscle due to torticolis under general anesthesia. Anesthesia was induced with thiopental and succinylcholine, maintained with enflurane, nitrous oxide and oxygen (2 volume%: 2 L/min: 2 L/min). After induction of anesthesia, his heart rate, end-tidal CO2 tension and body temperature had been gradually increased and then those were reached to maximal value of heart rate (160~170 BPM), end-tidal CO2 tension (60~70 mmHg) and body temperature (41degrees C) 55 minutes later. He was immediately managed with symptomatic treatment such as hyperventilation with oxygen, cooling, beta-blocker, sodium bicarbonate and diuretics, so he was survived without any sequelae.

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