• A. Sahib El-Radhi


Hyperthermia is a state of thermoregulatory failure resulting from excessive heat production with a normal rate of heat loss (e.g. malignant hyperthermia) or inability to dissipate heat at a sufficient rate (e.g. heat stroke). Dehydration is the most common cause of mild hyperthermia. Hyperthermia may coexist with fever: e.g. dehydration may occur on top of fever due to infection.

In contrast to fever, hyperthermia is not mediated by pyrogen or interleukin-1 (IL-1), and the body temperature is higher than the hypothalamic set point, which is usually normal. Because hyperthermia is not regulated centrally, a temperature in excess of 42 °C is common, and the presence of such degree makes hyperthermia a likely diagnosis. This very high degree of temperature rarely occurs, if ever, with fever alone, even with the most severe infections.

Hyperthermia caused by increased heat production includes physiologically exercise-induced hyperthermia, pathologically malignant hyperthermia, neuroleptic malignant syndrome, serotonin syndrome, drug-induced hyperthermia, and endocrine hyperthermia. Hyperthermia caused by decreased heat loss includes neonatal hyperthermia, heat stroke, haemorrhagic shock and encephalopathy, sudden infant death syndrome (SIDS) and drug-induced hyperthermia. Heat stroke is due to failure of the heat-regulating mechanisms of the hypothalamus subsequent to inhibition of sweating. It is defined as a core temperature greater than 40.6 °C, accompanied by hot, dry skin and CNS abnormalities such as convulsion, delirium and coma. The two principal causes of heat stroke are high ambient temperature and water deprivation. If the temperature rises above 40.2 °C, cell deaths occur, and the condition is associated with high mortality of around 80%.

The chapter also describes “unclassified hyperthermia” such as factitious fever, induced illness and induced illness by proxy.


Differentiating hyperthermia from fever Causes of hyperthermia Neonatal hyperthermia Malignant hyperthermia Heat stroke Therapeutic effects of hyperthermia 


Clinical Effects of Hyperthermia

  1. 1.
    Bynum GD, Pandolf KB, Schuette WH, et al. Induced hyperthermia in sedated humans and the concept of critical thermal maximum. Am J Phys. 1978;235:R228–36.Google Scholar

Exercise-Induced Hyperthermia

  1. 2.
    Bar-Or O. Climate and the exercising child-review. Int J Sports Med. 1980;1:53–65.CrossRefGoogle Scholar
  2. 3.
    Committee on sports medicine. Climatic heat stress and the exercising child. Pediatrics. 1982;69:808–9.Google Scholar

Malignant Hyperthermia (MH)

  1. 4.
    Girard T, Joehr M, Schaefer C, et al. Perinatal diagnosis of malignant hyperthermia susceptibility. Anesthesiology. 2006;104:1353–6.CrossRefGoogle Scholar

Neuroleptic Malignant Syndrome (NMS)

  1. 5.
    Caroff SN, Mann SC. Neuroleptic malignant syndrome. Med Clin North Am. 1993;77:185–202.CrossRefGoogle Scholar
  2. 6.
    Nierenberg D, Disch M, Manheimer E, et al. Facilitating prompt diagnosis and treatment of the neuroleptic malignant syndrome. Clin Pharmacol Ther. 1991;50:580–6.CrossRefGoogle Scholar
  3. 7.
    Oruch R, Pryme IF, Engelsen BA, et al. Neuroleptic malignant syndrome: an easily overlooked neurologic emergency. Neuropsychiatr Dis Treat. 2017;13:161–75.CrossRefGoogle Scholar

Serotonin Syndrome

  1. 8.
    Halloran L, Bernard DW. Management of drug-induced hyperthermia. Curr Opin Pedaitr. 2004;16:211–5.CrossRefGoogle Scholar

Endocrine Hyperthermia

  1. 9.
    Simon HB, Daniels GH. Hormonal hyperthermia, endocrinological causes of fever. Am J Med. 1979;66:257–63.CrossRefGoogle Scholar
  2. 10.
    Kilbane BJ, Mehta S, Backeljauw PF, et al. Approach to management of malignant hyperthermia-like syndrome in pediatric diabetes mellitus. Pediatr Crit Care Med. 2006;7:169–73.CrossRefGoogle Scholar
  3. 11.
    Goodman EL, Knochel JP. Endocrine hyperthermia. Heat stroke and other forms of hyperthermia. In: Mackowiak P, editor. Fever: basic mechanisms and management. New York: Raven Press; 1991. p. 281.Google Scholar

Neonatal Hyperthermia

  1. 12.
    Ws C. The early detection of pyrexia in the newborn. Arch Dis Child. 1963;38:29–39.CrossRefGoogle Scholar

Heat Stroke

  1. 13.
    Knochel JP. Environmental heat loss. Arch Intern Med. 1974;133:841–65.CrossRefGoogle Scholar
  2. 14.
    McLaren C, Null J, Quinn J. Heat stroke from enclosed vehicles: moderate ambient temperatures cause significant temperature rise in enclosed vehicles. Pediatrics. 2005;116:217.CrossRefGoogle Scholar
  3. 15.
    Ferrara P, Vena F, Caporale O, et al. Children left unattended in parked vehicles: a focus on recent Italian cases and a review of literature. Ital J Pediatr. 2013;39:71.CrossRefGoogle Scholar
  4. 16.
    Van Gestel JPJ, L’Hoir MP, ten-Berge M, et al. Risk of ancient parties in modern times. Pediatrics. 2002;110(6):1–3.Google Scholar

Hemorrhagic Shock and Encephalopathy (HSE)

  1. 17.
    Levin M, Kay JDS, Gould JD, et al. Hemorrhagic shock and encephalopathy. A new syndrome with high mortality in young children. Lancet. 1983;2:64–7.CrossRefGoogle Scholar
  2. 18.
    Levin M, Pincott JR, Hjelm M, et al. Haemorrhagic shock and encephalopathy: clinical, pathologic, and biochemical features. J Pediatr. 1989;114:194–203.CrossRefGoogle Scholar

Drug-Induced Hyperthermia

  1. 19.
    Grosso S, Franzoni E, Iannetti P, et al. Efficacy and safety of topiramate in refractory epilepsy. J Child Neurol. 2005;20:893–7.CrossRefGoogle Scholar

Unclassified Hyperthermia

    Sudden Death Infant Syndrome (SIDS)

    1. 20.
      American Academy of Pediatrics. The changing concept of SIDS: diagnosis, coding shifts, controversies regarding the sleeping environment. New variables to consider in reducing risk. Pediatrics. 2005;116:1245–55.CrossRefGoogle Scholar
    2. 21.
      Blair PS, Sidebotham P, Berry PJ, et al. Major epidemiological changes in SIDS: a 20-year population-based study in the UK. Lancet. 2006;367:314–9.CrossRefGoogle Scholar
    3. 22.
      Stanton AN. Overheating and cot death. Lancet. 1984;3:1199–201.CrossRefGoogle Scholar

Factitious Hyperthermia

  1. 23.
    Rumans LW, Vosti KL. Factitious and fraudulent fever. Am J Med. 1978;65:745–55.CrossRefGoogle Scholar
  2. 24.
    Edwards MS, Butler KM. Hyperthermia of trickery in an adolescent. Pediatr Infect Dis J. 1987;6:411–4.CrossRefGoogle Scholar

Induced Illness

  1. 25.
    Asher R. Munchausen’s syndrome. Lancet 1951; 1: 339–41.CrossRefGoogle Scholar
  2. 26.
    Sneed RC, Bell RF. The dauphin of Munchausen: factitious passage of renal stones in a child. Pediatrics. 1976;58:127–30.PubMedGoogle Scholar
  3. 27.
    Libow JA. Child and adolescent illness falsification. Pediatrics. 2000;105:336–42.CrossRefGoogle Scholar

Induced Illness by Proxy

  1. 28.
    Meadow R. Munchausen syndrome by proxy: the hinterland of child abuse. Lancet. 1977;2:343–5.CrossRefGoogle Scholar
  2. 29.
    Meadow R. Munchausen syndrome by proxy. Arch Dis Child. 1982;57:92–8.CrossRefGoogle Scholar
  3. 30.
    Bools CN, Neale BA, Meadow SR. Co-morbidity associated with fabricated illness (Munchausen syndrome by proxy). Arch Dis Child. 1992;67:77–9.CrossRefGoogle Scholar

Therapeutic Effects of Hyperthermia

  1. 31.
    Yerurshalmi A, Lwoff A. Traitement du coryza infectieux et des rhinitis persistantes allergiques par la thermotherapy. Camp Rendus Seances Acad Sci (Paris). 1980;291(Ser D):957–9.Google Scholar
  2. 32.
    Pennypacker C, Perelson AS, Nys N. Localized or systemic in vivo heat inactivation of HIV: a mathematical analysis. J Acquir Immune Defic Syndr Hum Retrovirol. 1995;8:321–9.CrossRefGoogle Scholar
  3. 33.
    Ismail ZRS, Zhavrid EA, Potapnev MP. Whole body hyperthermia in adjuvant therapy of children with renal cell carcinoma. Pediatr Blood Cancer. 2005;44:679–81.CrossRefGoogle Scholar
  4. 34.
    Shields CL, Meadows AT, Leahey AM, et al. Continuing challenges in the management of retinoblastoma with chemotherapy. Retina. 2004;24:849–62.CrossRefGoogle Scholar
  5. 35.
    Seifert G, Budach V, Keilholz U, et al. Regional hyperthermia combined with chemotherapy in paediatric, adolescents, and young adult patients: current and future perspectives. Radiat Oncol. 2016;11:65.CrossRefGoogle Scholar
  6. 36.
    Man J, Shoemake J, Ma T, et al. Hyperthermia sensitizes glioma stem-like cells to radiation by inhibiting AKT signaling. Cancer Res. 2015;75(8):1760–9.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • A. Sahib El-Radhi
    • 1
  1. 1.Chelsfield Park HospitalOrpingtonUK

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