Abstract
In Reply.— Unfortunately, controlled studies of patients with various types of thermic stress have not been done. Therefore, causal mechanisms are not as fully understood as Dr Knochel suggests. His statement that muscle rigidity is absent in heat stroke is incorrect, for heat stroke and malignant hyperthermia may both cause muscle rigidity, although it is not invariably found in either condition. In fact, heat stroke has been classified into myonecrotic and non-myonecrotic types. Muscle damage, elevations of muscle enzyme levels, myoglobinuria, and renal tubular failure may occur in heat stroke as well as in malignant hyperthermia. Patients with heat stroke, like those with malignant hyperthermia, may die with uncontrolled temperature elevations. 1 The relationships between these syndromes have been ill defined but must be considered if appropriate study and treatment is to evolve. The treatment of thermic stress of all types should emphasize the emergent need for discontinuing triggering factors
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