Hyperthermia and rhabdomyolysis

Hyperthermia and rhabdomyolysis are caused by psychomotor agitation, seizures, and concomitant vasoconstriction. Rapid cooling with water and an ice bath coupled with a convection system as well as sedation help treat the potentially lethal increase in temperature. Cooling and sedation also prevent acidemia which may induce dysrhythmias from sodium-channel blockade and increase the risk of acute tubular necrosis by causing precipitation of urinary myoglobin. Normal saline with sodium bicarbonate is appropriate in these situations not only to compete with sodium-channel blockade, but also to alkalinize the blood (to pH 7.40-7.55) and urine (to pH 7.50-8.00).

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