From the Guidelines
The primary treatment for a 25-year-old patient with heat stroke (hyperthermia) should focus on rapid physical cooling rather than medication, as medications like dantrolene are not indicated for exertional heat stroke 1.
Key Considerations
- The patient's condition requires immediate attention to lower the body temperature, and physical cooling methods are the most effective approach.
- Medications such as acetaminophen and ibuprofen are ineffective for severe hyperthermia, as they target the hypothalamic set point, which is not the issue in heat stroke.
- Dantrolene is specifically indicated for malignant hyperthermia, not for exertional heat stroke, as evident from the guidelines for malignant hyperthermia management 1.
Recommended Treatment
- Continue and intensify physical cooling methods, such as:
- Ice packs to groin and axillae
- Cold water immersion
- Evaporative cooling with fans
- Cold IV fluids
- Possibly cold gastric or bladder lavage
- These physical methods directly remove heat from the body and can rapidly lower core temperature, which is crucial as mortality increases significantly with prolonged hyperthermia above 40°C.
Evidence Summary
- A study from 1991 found no significant difference in cooling time, organ dysfunction, length of hospital stay, or mortality between patients treated with dantrolene and those treated with evaporative cooling alone 1.
- The most recent guidelines for malignant hyperthermia emphasize the importance of aggressive body cooling and do not recommend dantrolene for exertional heat stroke 1.
From the FDA Drug Label
Dantrolene Sodium for Injection is indicated, along with appropriate supportive measures, for the management of the fulminant hypermetabolism of skeletal muscle characteristic of malignant hyperthermia crises in patients of all ages The medication indicated for a 25-year-old patient with heat stroke (hyperthermia) is Dantrolene (IV), as it is used to manage malignant hyperthermia crises, which can present with hyperthermia despite initial cooling measures 2.
- The dose of Dantrolene Sodium for Injection for adults is a minimum of 1 mg/kg, and continuing until symptoms subside or the maximum cumulative dose of 10 mg/kg has been reached 2.
- It is essential to note that administration of Dantrolene Sodium for Injection should be continuous until symptoms subside.
From the Research
Medication for Heat Stroke (Hyperthermia)
- Dantrolene is indicated for the treatment of heat stroke (hyperthermia) despite initial cooling measures, as it has been used successfully in a few cases of heat stroke 3.
- The medication acts primarily by affecting calcium flux across the sarcoplasmic reticulum of skeletal muscle, which helps to reduce the body temperature and other symptoms associated with hyperthermia 3, 4.
- Dantrolene has also been used in the treatment of malignant hyperthermia, neuroleptic malignant syndrome, and spasticity, with a high success rate in reducing mortality and improving patient outcomes 3, 4, 5, 6, 7.
Mechanism of Action
- Dantrolene depresses the intrinsic mechanisms of excitation-contraction coupling in skeletal muscle, which helps to reduce the intracellular calcium concentration and alleviate symptoms of hyperthermia 4, 6.
- The ryanodine receptor, the calcium release channel of the sarcoplasmic reticulum, is thought to be the direct molecular target of dantrolene, and its inhibition is fundamental in the molecular action of dantrolene 4, 6, 7.
Clinical Use
- Dantrolene is the only available drug for effective and specific therapy of malignant hyperthermia, and its use has significantly reduced the mortality rate associated with this condition 4, 5, 6, 7.
- Prompt recognition and immediate treatment with dantrolene administration and body cooling are essential for effective management of heat stroke and malignant hyperthermia 5, 7.