Medication Summary

In patients with heat stroke, benzodiazepines play a major role in providing sedation, 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; vasopressors may be needed for hypotension refractory to fluid repletion. Treatment of rhabdomyolysis involves infusing large amounts of intravenous fluids (as much as 10 L may be required), alkalinization of urine, and mannitol infusion.

Class Summary

Benzodiazepines are safe and effective in controlling agitation, convulsions, and shivering.

Lorazepam (Ativan)

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Predictability and ease of use make lorazepam the drug of choice in most cases. It may be used intravenously and is well absorbed after intramuscular injection. Its onset of action is within minutes, effects peak in 15-20 minutes, and the duration of action is 6-8 hours.

Midazolam (Versed)

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Midazolam is a rapidly acting benzodiazepine with a short duration of action. It is ideal for sedation during short procedures and may be effective in convulsions.

Class Summary

Alkalinizing agents are indicated for severe acidosis and rhabdomyolysis.

Sodium bicarbonate (Neut)

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

Class Summary

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

Mannitol (Osmitrol)

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

Class Summary

Adrenergic agonist agents produce vasodilation and increase the inotropic state.

Dobutamine (Dobutrex)

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Dobutamine is a synthetic compound structurally similar to catecholamines. It is the drug of choice for circulatory support in heat stroke.

Questions

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Media Gallery

Sample display of equipment useful for noninvasive cooling techniques. Clockwise from top: ice pack and water, air-cooling blanket, Foley catheter, and intravenous fluids.
Sample display of equipment useful for cooling via gastric lavage. Clockwise from top: ice water, nasogastric tube, endotracheal tube, and lavage bag.
Sample display of equipment useful for cooling via peritoneal lavage. Clockwise from top: iced water, peritoneal catheter, and saline fluid.