20 something year old male found down in some sort of barn. Unresponsive, EMS called and brought to the ED. Noticed to be VERY warm, rectal temp...108! Pt unresponsive, GCS <8, intubated, central line started, art line started, foley with cold irrigation, NG with cold irrigation (no pill fragments found), cooling blanket and fans placed near the pt. Ended up getting about 6L of NS. Tachy, often near 150s, but hanging in the 110-120, BP all over the place, but looked more stable once the Art line was placed (90s / 50s). (assumed cuff errors) More history obtained, pt has mild MR (mental, not mitral), is watched 'closely' by loved ones. Stated he had been acting a bit 'weird' over the past week. Unfortunately, he takes 3 psych meds but I cannot remember them although was doubly assured that there was NO WAY an OD could have happened (family controls meds, seems reliable... no pill fragments). Family denied any other medical problems. CT read as negative, CXR negative, LP done, slightly traumatic... awaiting those results. Rest of normal Trauma labs were unremarkable. UDS negative. Temperature was at a peak of 108, and headed south with the above interventions. Leveled off in the upper 101s. At one point, some 'possible' extensor posturing was noted. Occured in the 104 temp range. Additional info: EKG showed slight QT prolongation, 102 temperature outside, no evidence of Rhabdo. Urine was clean. PE: Pupils 2mm, responsive, no evidence of head trauma, struggling slightly with breathing, nothing noted in OP. No response to verbal or painful stimulus. Occasionally would 'buck' and move all extremities. Some stool noted on buttocks/legs, but unsure if pts or 'manure'. No abrasions, trauma, etc noted anywhere. Admitted to the ICU. Thoughts? We were thinking of some sort of heat induced pathology, but what threw that was the fact that family insisits he has acted 'different' for the past week. That prompted the LP looking for an enceph. I am anxious to get back in today and see the results of the LP. Update: I learned that the LP was negative. We tried to electronically access the progress notes with no luck. The thyroid storm is an interesting idea. I will have to check the labs on him and see if a free T4 was done (is that a normal Trauma lab... I would not think, but really do not know..I would assume TSH would not have time to change in storm, but then again I am not sure. I have something to read about....).