Reactions 432 - 19 Dec 1992

SDesipramine

Hyperpyrexia: case reportA 17-year-old boy developed hyperpyrexia while receiving

treatment for depression with desipramine 4.5 mg/kg/day forapproximately 1 year After taking part in vigorous soccerpractice for 2 hours on a hot, humid day, he became pale andweak and had tonic clonic seizure activity for 20 min. He had acore temperature of 108 deg F, a pulse of 130 beats/min andBP of 130/80 mmHg. He was obtunded but was able to followsimple commands. The patient was hospitalised and treatedwith diazepam and phenytoin, which resolved the seizure.Dantrolene, naloxone, furosemide and ceftriaxone were alsoadministered. His temperature was reduced with gastric icelavage and a cooling mattress. During hospitalisation, he hadmassive diarrhoea and low grade, disseminated, intravascularclotting Liver enzyme levels were elevated. The patient wasdischarged on day 15 with no further seizure activity or othersymptoms.

Author comment: ‘It is likely that chronic TCA (tricyclicantidepressants) treatment played a significant role in thedevelopment of this patient’s hyperpyrexia... Physiciansshould be aware of this risk and should discuss the importanceof avoiding strenuous exercise in extreme temperatures withpatients who are taking these medications.’Squires LA, et al. Hyperpyrexia in an adolescent on desipramine treatment.Clinical Pediatrics 31: 635-636, Oct 1992 - USA 800168609

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Reactions 19 Dec 1992 No. 4320114-9954/10/0432-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved