Exertional heat stroke induced by amphetamine analogues

Watson, Joe; Ferguson, Christopher J.; Hinds, C. J.; Skinner, R.D.; Coakley, J. H.

doi:10.1111/j.1365-2044.1993.tb07526.x

Cited by 69 publications

(13 citation statements)

References 25 publications

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“…Athletes who take certain medications or drugs, particularly medications with a dehydrating effect, are at an increased risk for a heat illness. [101][102][103][104][105][106][125][126][127][128][129][130][131][132][133][134][135][136] Alcohol, caffeine, and theophylline at certain doses are mild diuretics. 106,137,138 Caffeine is found in coffee, tea, soft drinks, chocolate, and several over-the-counter and prescription medications.…”

Section: Lack Of Acclimatization Tomentioning

confidence: 99%

National Athletic Trainers' Association Position Statement: Exertional Heat Illnesses

Casa¹,

DeMartini²,

Bergeron³

et al. 2015

Journal of Athletic Training

168

338

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Objective: To present recommendations for the prevention, recognition, and treatment of exertional heat illnesses and to describe the relevant physiology of thermoregulation.Background: Certified athletic trainers evaluate and treat heat-related injuries during athletic activity in ''safe'' and highrisk environments. While the recognition of heat illness has improved, the subtle signs and symptoms associated with heat illness are often overlooked, resulting in more serious problems for affected athletes. The recommendations presented here provide athletic trainers and allied health providers with an integrated scientific and practical approach to the prevention, recognition, and treatment of heat illnesses. These recommendations can be modified based on the environmental conditions of the site, the specific sport, and individual considerations to maximize safety and performance.Recommendations: Certified athletic trainers and other allied health providers should use these recommendations to establish on-site emergency plans for their venues and athletes. The primary goal of athlete safety is addressed through the prevention and recognition of heat-related illnesses and a welldeveloped plan to evaluate and treat affected athletes. Even with a heat-illness prevention plan that includes medical screening, acclimatization, conditioning, environmental monitoring, and suitable practice adjustments, heat illness can and does occur. Athletic trainers and other allied health providers must be prepared to respond in an expedient manner to alleviate symptoms and minimize morbidity and mortality.Key Words: heat cramps, heat syncope, heat exhaustion, heat stroke, hyponatremia, dehydration, exercise, heat tolerance H eat illness is inherent to physical activity and its incidence increases with rising ambient temperature and relative humidity. Athletes who begin training in the late summer (eg, football, soccer, and cross-country athletes) experience exertional heat-related illness more often than athletes who begin training during the winter and spring. [1][2][3][4][5] Although the hot conditions associated with late summer provide a simple explanation for this difference, we need to understand what makes certain athletes more susceptible and how these illnesses can be prevented. PURPOSEThis position statement provides recommendations that will enable certified athletic trainers (ATCs) and other allied health providers to (1) identify and implement preventive strategies that can reduce heat-related illnesses in sports, (2) characterize factors associated with the early detection of heat illness, (3) provide on-site first aid and emergency management of athletes with heat illnesses, (4) determine appropriate return-toplay procedures, (5) understand thermoregulation and physiologic responses to heat, and (6) recognize groups with special concerns related to heat exposure. ORGANIZATIONThis position statement is organized as follows:1. Definitions of exertional heat illnesses, including exerciseassociated muscle (heat) cramps, he...

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Section: Lack Of Acclimatization Tomentioning

confidence: 99%

National Athletic Trainers' Association Position Statement: Exertional Heat Illnesses

Casa¹,

DeMartini²,

Bergeron³

et al. 2015

Journal of Athletic Training

168

338

View full text Add to dashboard Cite

show abstract

“…13 It was this logic that introduced the use of dantrolene, the treatment for malignant hyperpyrexia through inhibition of Ca 2+ release, as a treatment for MDMA-related hyperpyrexia. Dantrolene's first reported use for a patient with hyperpyrexia induced by MDMA was in 1992 14 and numerous reports of dantrolene use for this indication have followed, some advocating for 8,[15][16][17][18][19][20][21] and some cautioning against [22][23][24] its use. Dantrolene is currently recommended for MDMAinduced hyperpyrexia by several poison control centres.…”

Section: Résumémentioning

confidence: 99%

Dantrolene in the treatment of MDMA-related hyperpyrexia: a systematic review

Grunau

Wiens

Brubacher

2010

CJEM

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Objective: The use of dantrolene in the treatment of hyperpyrexia related to MDMA (3,4-methylenedioxymethamphetamine) is controversial, with little data available to guide clinical decision-making. Although the treatment is recommended by several poison control centres, published data are primarily in the form of case reports and animal and in vitro experiments. We conducted a systematic review to investigate the published evidence regarding the safety and benefits of dantrolene for MDMA-related hyperpyrexia in humans. Data sources: A systematic search of Embase and MEDLINE was conducted from the earliest possible date to November 2008. Study selection: All human trials and case reports of MDMArelated hyperpyrexia were considered. Data extraction: Data were abstracted systematically and characteristics including use of dantrolene, adverse reactions attributed to dantrolene, peak temperature, complications from MDMA-related hyperpyrexia and survival were recorded. Data synthesis: Our search yielded 668 articles of which 53, reporting 71 cases of MDMA-induced hyperpyrexia, met our inclusion criteria. No clinical trials, randomized controlled trials, observational studies or meta-analyses were identified. Dantrolene was used in 26 cases. Patient characteristics were similar in the dantrolene and no dantrolene groups. The proportion of survivors was higher in the dantrolene group (21/26) than in the no dantrolene group (25/45). This difference was especially pronounced in those with extreme (≥ 42°C) and severe (≥ 40°C) fever, with a survival rate of 8 of 13 and 10 of 10, respectively, in the dantrolene group compared with 0 of 4 and 15 of 27 in the no dantrolene group. There were no reports of adverse events attributable to dantrolene with the exception of a possible association with an episode of transient hypoglycemia. Conclusion: Our systematic review suggests that dantrolene is safe for patients with MDMA-related hyperpyrexia. Dantrolene may also be associated with improved survival and reduced complications, especially in patients with extreme (≥ 42°C) or severe (≥ 40°C) hyperpyrexia, although this conclusion must be interpreted with caution given the risk of reporting or publication bias.

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“…Aggressive cooling measures should be undertaken to lower the patient's core temperature to levels that will lessen further muscle and end-organ injury. Dantrolene has been used with some success for ecstasy-associated hyperpyrexia, as in malignant hyperthermia (35)(36)(37)(38).…”

Section: Acute Kidney Injury Associated With Ecstasymentioning

confidence: 99%

The Agony of Ecstasy

Campbell

Rosner

2008

Clinical Journal of the American Society of Nephrology

108

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Ecstasy (MDMA, 3,4-methylenedioxymethamphetamine) is commonly used by college-aged individuals. Ecstasy leads to feelings of euphoria, emotional empathy, and increased energy. These effects come at a significant risk for complications. Ecstasy has been associated with acute kidney injury that is most commonly secondary to nontraumatic rhabdomyolysis but also has been reported in the setting of drug-induced liver failure and drug-induced vasculitis. More common, ecstasy has led to serious hyponatremia and hyponatremia-associated deaths. Hyponatremia in these cases is due to a "perfect storm" of ecstasy-induced effects on water balance. Ecstasy leads to secretion of arginine vasopressin as well as polydipsia as a result of its effects on the serotonergic nervous pathways. Compounding these effects are the ready availability of fluids and the recommendation to drink copiously at rave parties where ecstasy is used. The effects of ecstasy on the kidney as well as therapeutic measures for the treatment of ecstasy-induced hyponatremia are presented.

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Exertional heat stroke induced by amphetamine analogues

Cited by 69 publications

References 25 publications

National Athletic Trainers' Association Position Statement: Exertional Heat Illnesses

National Athletic Trainers' Association Position Statement: Exertional Heat Illnesses

Dantrolene in the treatment of MDMA-related hyperpyrexia: a systematic review

The Agony of Ecstasy

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