Acute Infections of the Urinary Tract and the Urethral Syndrome in General Practice
Authors: D. J. A. Gallagher, J. Z. Montgomerie, J. D. K. North
Journal: BMJ (1965)

Erythrodermic Skin Diseases-Fox et al.MEDIBALJOURNAL has shown that this can stimulate non-shivering thermogenesis in man.Cold-adapted subjects also showed an increased calorigenic action of noradrenaline (Joy, 1962 ;Davis, 1963), so that the slightly raised V.M.A. excretions found in this study may be important.Shivering tends to disappear in the cold-adapted subject, and this may explain why all except one of our patients with a relative hypothermia failed to shiver.These observations emphasize certain aspects of the manage- ments of these patients.Because of the reduced capacity to thermoregulate, with its attendant dangers of hypothermia or hyperthermia, body temperature must be accurately observed, using a low-temperature thermometer when indicated.Patients usually require more clothes and a warmer room than the aver- age person, and the risk of hypothermia is obviously greatest during winter months and when they are treated at home, but even in hospital care is needed during treatment periods.If the patient develops a high body temperature steps should be taken to reduce it in order to avoid an excessive increase in the cardiac load.The aim should be to steer a course between the two extremes and keep body temperature close to normal.If the patient is seen to be shivering, complains of the cold, or has a subnormal temperature, the room temperature or his clothing should be promptly increased.The temperature at which he becomes comfortable and shivering ceases should be recorded and used as a guide to adjust his environment.Prompt treatment of the skin condition, usually with corticosteroids, is the best way of avoiding heart failure.The unexplained high mortality of patients with erythrodermic skin diseases may in large part be due to the haemodynamic and thermoregulatory problems we have discussed. SummaryHaemodynamic studies on six patients with widespread erythrodermic skin conditions have shown marked increases in skin blood-flow equivalent to up to two-thirds of that seen in normal subjects when fully vasodilated by heat ; there was a considerable further increase in skin blood-flow when the body temperature was raised.All had a raised venous pressure with hypervolaemia, and in two patients the cardiac output was moderately increased.Body-temperature regulation was grossly disturbed.Four out of five patients had either a fever or an elevation of the set point for temperature regulation with body temperatures below the fever level.The capacity to thermoregulate is greatly diminished in these patients, and hypothermia, which is an important risk, is related to the high skin blood-flow and inability of the skin blood-vessels to constrict fully.The basal metabolic rate was raised considerably in 9 out of 11 patients.Radioactive iodine studies showed no evidence of hyperthyroidism, but there was a slight increase in vanillyl mandelic acid excretion.The hypermetabolism is probably mainly due to the abnormal skin metabolism, but the develop- ment of non-shivering thermogenesis may also play a part.Two of us (S. S. and J. M.)