The 'H' in Hemorrhagic Shock and Encephalopathy Syndrome

Sir.—I agree with the recent editorial by Corrigan¹ that hyperpyrexia is an important, striking element in the so-called hemorrhagic shock and encephalopathy syndrome. My experience with these patients has led me to conclude that the most striking features of this syndrome are the sudden onset of high fever, severe shock, and mental status changes in a previously healthy infant. The shock state is very impressive in that it requires almost unbelievable amounts of volume expanders to reverse it, and occurs suddenly without any loss of extracellular fluid or blood from the body. Presumably this means that the shock is the result of massive third spacing in the gastrointestinal tract and/or massive vasodilatation. Both mechanisms suggest that a toxin is involved. It is my guess that this same, unidentified toxin affects skeletal muscle metabolism in such a way as to cause the hyperpyrexia. I agree with Corrigan¹ that