Management

1. Rapid cooling should be instituted when temperatures exceed 41°C.

2. Supportive treatment includes fluid replacement and seizure control.

3. Clothing should be removed and patients should be nursed in a cool environment.

4. Surface cooling may be achieved with a fan, tepid sponging, wet sheets, ice packs or a cool bath.

5. Handling should be minimised and active cooling measures should be stopped when the core temperature is <39°C.

6. Internal cooling may be considered by gastric lavage or peritoneal lavage using cooled fluids.

7. Phenothiazines may be used to reduce temperature and prevent shivering (not in neuroleptic malignant syndrome).

8. Muscle relaxants should be used if the patient is ventilated.

9. For malignant hyperthermia the offending drug should be stopped and dantrolene 1mg/kg given IV every 5min to a maximum dose of 10mg/kg.

10. Mechanical ventilation with high FIO2 and treatment of hyperkalaemia are required.

11. The neuroleptic malignant syndrome is treated by stopping the offending drug, giving dantrolene as above, and dopamine agonists (e.g. L-dopa or bromocriptine).

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