ICU · Physiology / thermoregulation
Thermoregulation
Also known as Thermoregulation · Body temperature regulation · Hypothalamic set point · Preoptic anterior hypothalamus · Fever · Hyperthermia · Malignant hyperthermia · Heat stroke · Heat exhaustion · Hypothermia · Swiss staging · Shivering · Non-shivering thermogenesis · Brown adipose tissue · Targeted temperature management · Therapeutic hypothermia · Neuroleptic malignant syndrome · Serotonin syndrome · Poikilothermia
Thermoregulation — the hypothalamic set point (37 degrees C). The heat production (the shivering, the metabolism, the thyroxine, the brown fat / non-shivering thermogenesis). The heat loss (the sweating, the vasodilation, the radiation, the convection, the conduction, the respiration). The fever (the prostaglandin E2 — the pyrogen raises the set point). The clinical: the malignant hyperthermia (the ryanodine receptor), the heat stroke, the hypothermia, the neuroleptic malignant syndrome.
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A previously well 24-year-old is anaesthetised for a hamstring repair. Thirty minutes in, the capnograph climbs to 7 kPa and keeps climbing despite doubling the minute volume, the heart rate is 140, the masseter is tight around the tube, and the skin is mottled. The temperature is still normal. The set point is normal. This is malignant hyperthermia until proven otherwise, and the first drug you reach for is not an antipyretic — it is dantrolene.[13]
Hold the question that owns this whole topic: is the set point raised (fever — antipyretics work) or normal (hyperthermia — cool actively)? Get that fork right and every thermoregulation stem on the page below resolves itself.[1]
References30ShowHide
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- [11]Brugger H, Durrer B, Elsensohn F, et al. Resuscitation of avalanche victims: Evidence-based guidelines of the international commission for mountain emergency medicine (ICAR MEDCOM): intended for physicians and other advanced life support personnel Resuscitation, 2013.PMID 23123559
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- [13]Rosenberg H, Pollock N, Schiemann A, Bulger T, Stowell K Malignant hyperthermia: a review Orphanet J Rare Dis, 2015.PMID 26238698
- [14]Boyer EW, Shannon M The serotonin syndrome N Engl J Med, 2005.PMID 15784664
- [15]Schneider M, Regente J, Greiner T, et al. Neuroleptic malignant syndrome: evaluation of drug safety data from the AMSP program during 1993-2015 Eur Arch Psychiatry Clin Neurosci, 2020.PMID 30506147
- [16]Riazi S, Biesecker LG, Rosenberg H, Dirksen RT (GeneReviews) Nonsyndromic Malignant Hyperthermia Susceptibility GeneReviews, 1993.PMID 20301325
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- [18]Perry PJ, Wilborn CA Serotonin syndrome vs neuroleptic malignant syndrome: a contrast of causes, diagnoses, and management Ann Clin Psychiatry, 2012.PMID 22563571
- [19]Badjatia N, Strongilis E, Gordon E, et al. Metabolic impact of shivering during therapeutic temperature modulation: the Bedside Shivering Assessment Scale Stroke, 2008.PMID 18927450
- [20]Badjatia N, Strongilis E, Prescutti M, et al. Metabolic benefits of surface counter warming during therapeutic temperature modulation Crit Care Med, 2009.PMID 19384208
- [21]Huynh C, Lui J, Behbahani V, et al. Pre Versus Post Implementation of a Pharmacologic Antishivering Protocol During Targeted Temperature Management Following Cardiac Arrest Neurocrit Care, 2022.PMID 34498206
- [22]Young P, Saxena M, Bellomo R, et al. Acetaminophen for Fever in Critically Ill Patients with Suspected Infection N Engl J Med, 2015.PMID 26436473
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- [25]Evans SS, Repasky EA, Fisher DT Fever and the thermal regulation of immunity: the immune system feels the heat Nat Rev Immunol, 2015.PMID 25976513
- [26]Paal P, Gordon L, Strapazzon G, et al. Accidental hypothermia-an update : The content of this review is endorsed by the International Commission for Mountain Emergency Medicine (ICAR MEDCOM). Scand J Trauma Resusc Emerg Med, 2016.PMID 27633781
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- [28]Ware MR, Feller DB, Hall KL Neuroleptic Malignant Syndrome: Diagnosis and Management Prim Care Companion CNS Disord, 2018.PMID 29325237
- [29]Choi J, Horner KA Dopamine Agonists StatPearls, 2026.PMID 31869150
- [30]Wasserman DD, Thurman J, Healy M EMS Methods to Cool a Patient in the Field StatPearls, 2026.PMID 29083822