Heatstroke Medication

  • Author: Robert S Helman, MD; Chief Editor: Rick Kulkarni, MD   more...
 
Updated: Oct 26, 2010
 

Medication Summary

In treating heatstroke, benzodiazepines play a major role in sedating patients, controlling convulsions, and controlling shivering. Barbiturates (eg, phenobarbital) may be used to control convulsions if benzodiazepines are not effective. Hypotension is treated first with cooling and intravenous crystalloid fluids; dobutamine is considered if patients are hypodynamic. Treatment of rhabdomyolysis involves infusing large amounts of intravenous fluids (may require as much as 10 L), alkalinization of urine, and mannitol infusion.

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Benzodiazepines

Class Summary

Safe and effective in controlling agitation, convulsions, and shivering.

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Lorazepam (Ativan)

 

Predictability and ease of use make it DOC in most cases. May be used IV and is well absorbed after IM injection. Onset of action is within minutes, effects peak in 15-20 min, and duration of action is 6-8 h.

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Midazolam (Versed)

 

Rapidly acting benzodiazepine with short duration. Ideal for sedation during short procedures and may be effective in convulsions.

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Alkalinizing agents

Class Summary

Indicated for severe acidosis and rhabdomyolysis.

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Sodium bicarbonate (Neut)

 

Useful in alkalization of urine to prevent acute myoglobinuric renal failure. May be administered as a bolus injection or as an infusion. The ideal solution to which sodium bicarbonate is added should be hypotonic.

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Diuretics (osmotic)

Class Summary

Osmotic effects retain water during urine formation and dilute electrolytes in the urine, making resorption less efficient.

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Mannitol (Osmitrol)

 

DOC for forced diuresis in patients with rhabdomyolysis because of a number of beneficial effects on the kidneys, including an antioxidant effect.

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Adrenergic agonist agents

Class Summary

Produce vasodilation and increase inotropic state.

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Dobutamine (Dobutrex)

 

Synthetic compound structurally similar to catecholamines. DOC for circulatory support in heatstroke.

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Contributor Information and Disclosures
Author

Robert S Helman, MD  Director, Department of Emergency Medicine, Peninsula Hospital Center

Disclosure: Nothing to disclose.

Coauthor(s)

Rania Habal, MD  Assistant Professor, Department of Emergency Medicine, New York Medical College

Disclosure: Nothing to disclose.

Specialty Editor Board

Laurie Robin Grier, MD  Medical Director of MICU, Professor of Medicine, Department of Emergency Medicine, Anesthesiology and OBGYN, Section of Pulmonary and Critical Care Medicine, Louisiana State University Health Science Center at Shreveport

Laurie Robin Grier, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, American Society for Parenteral and Enteral Nutrition, and Society of Critical Care Medicine

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Om Prakash Sharma, MD, FRCP, FCCP, DTM&H  Professor, Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Southern California Keck School of Medicine

Om Prakash Sharma, MD, FRCP, FCCP, DTM&H is a member of the following medical societies: American Academy of Allergy Asthma and Immunology, American College of Chest Physicians, American College of Physicians, American Federation for Medical Research, American Osler Society, American Thoracic Society, New York Academy of Medicine, and Royal Society of Medicine

Disclosure: Nothing to disclose.

Timothy D Rice, MD  Associate Professor, Departments of Internal Medicine and Pediatrics and Adolescent Medicine, St Louis University School of Medicine

Timothy D Rice, MD is a member of the following medical societies: American Academy of Pediatrics and American College of Physicians

Disclosure: Nothing to disclose.

Chief Editor

Rick Kulkarni, MD  Attending Physician, Department of Emergency Medicine, Cambridge Health Alliance, Division of Emergency Medicine, Harvard Medical School

Rick Kulkarni, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: WebMD Salary Employment

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