Hyperthermia in a Teenager: Is it Just a Heat Stroke?

Maria Limbert; Luzia Condessa; Carina Cardoso; Erica Torres; Sofia Deuchande

doi:10.20344/amp.24465

Autores

Maria Limbert Pediatrics Service. Children’s Department. Hospital de Cascais Dr. José de Almeida. Alcabideche. https://orcid.org/0000-0002-0977-5596
Luzia Condessa Pediatrics Service. Children’s Department. Hospital de Cascais Dr. José de Almeida. Alcabideche. https://orcid.org/0000-0002-4188-168X
Carina Cardoso Pediatrics Service. Children’s Department. Hospital de Cascais Dr. José de Almeida. Alcabideche. https://orcid.org/0000-0002-6030-8256
Erica Torres Pediatric Intensive Care Unit. Pediatrics Department. Hospital de Santa Maria. Unidade Local Saúde Santa Maria. Lisboa. https://orcid.org/0000-0002-0507-1380
Sofia Deuchande Pediatrics Service. Children’s Department. Hospital de Cascais Dr. José de Almeida. Alcabideche. https://orcid.org/0000-0002-8319-8635

DOI:

https://doi.org/10.20344/amp.24465

Palavras-chave:

Adolescente, Golpe de Calor, Hipertermia/etiologia, Síndrome Maligna dos Neurolépticos

Resumo

Um adolescente do sexo masculino, com obesidade e perturbação do espetro do autismo, recorreu ao serviço de urgência por início agudo de confusão, calafrios, rigidez muscular e hipertermia grave (temperatura timpânica 41,9ºC), após esforço físico sob calor extremo. A medicação habitual incluía antipsicóticos. A avaliação laboratorial revelou disfunção multiorgânica, sugerindo diagnóstico de golpe de calor concomitante com síndrome neuroléptica maligna. Foram iniciadas medidas de suporte avançado de vida e arrefecimento externo, com transferência para unidade de cuidados intensivos pediátricos. A abordagem incluiu a suspensão da terapêutica antipsicótica, administração de dantroleno e bromocriptina, controlo ativo da temperatura com recurso a Criticool^®, benzodiazepinas e fluidoterapia intravenosa agressiva. Verificou-se uma melhoria progressiva, com alta após quatro dias de cuidados intensivos e 14 dias de internamento em enfermaria, mantendo a terapêutica com aripiprazol e clonidina. Este caso destaca a complexa interação entre o calor extremo e a síndrome neuroléptica maligna, evidenciando os desafios diagnósticos e terapêuticos associados.

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