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At least 19 recordsLinked to original sources
PubMed1989

Evidence of prolonged myocardial dysfunction in heat stroke.

Heat stroke is a life-threatening syndrome of multi-organ dysfunction caused by elevated body temperature. It may result from failure of the thermoregulatory mechanisms or from inadequate heat dissipation and affects members of several risk groups. A number of authors reported cardiac involvement in heat stroke, but heart failure rarely has been documented. We report the cases of two heat stroke victims, one of whom developed pulmonary edema and the other, peripheral edema. In both, RVG demonstrated dilatation and diffuse hypokinesis of the right ventricle, which persisted for several weeks. We conclude that the heart may be involved in heat stroke and that heart failure is a potential complication of the syndrome that can have a prolonged subclinical course. Fluid replacement in heat stroke should be done under careful observation, which may be facilitated by noninvasive assessment of cardiac function.

Adolescent↗
PubMed1993

Long-term psychological and physiological effects of heat stroke.

Heat stroke leads only rarely to permanent neurological deficits and the convalescence is almost complete. There are, however, some sporadic descriptions of disturbances that lasted for up to 4 months. Little has been mentioned in the literature on residual changes in personality and late neurological side effects. The present study was conducted to follow systematically late personality and behavioral abnormalities in a population of heat stroke victims. This study analyzed 21 young subjects (age: 21 +/- 2 years), who were inflicted by heat stroke. They were invited for a physiological and psychological follow-up examination at least 6 months post-hospitalization. The psychological assessment was comprised of the self-report symptom checklist-90R (SCL-90R), which inquires about symptoms during the 2 weeks preceding the interview. The results indicated that the subjects are psychologically healthy because their scores fell within the normal range. Comparison with a carefully matched control group strengthened this finding. The conclusion was that prominent neurological or behavioral sequelae in heat stroke victims are rare. The psychological assessments clearly indicate that heat stroke did not leave long-term adverse residues. However, one should be aware of the possible complications and follow the patient for several months after the event.

Adult↗
PubMed1998

Sudden death during jungle trekking: a case of heat stroke.

Heat stroke, which is also known as "sun stroke," is a medical emergency, and fatalities can occur unless it is diagnosed early and treated efficiently. Heat stroke may manifest quite suddenly, giving little time to differentiate it from extreme physical exhaustion in collapsed subjects. It is also known to lead to serious disseminated intravascular coagulation. Sudden death in a young female is presented who collapsed after trekking in a hilly, jungle area in Malaysia on a warm, humid day. She had joined a weight reduction programme a few weeks earlier. She was found collapsed and in a semiconscious state in the jungle by her groupmates and was taken to hospital. On admission she was unconscious, hyperpyrexic, with rapid, thready pulse and a low blood pressure. Biochemical studies revealed metabolic acidosis, elevated liver and cardiac enzymes and impairment of renal function. Her coagulation profile was found to be impaired and she started bleeding through the mouth and nostrils. She also developed watery diarrhoea and initially a septicaemic condition, including acute enteritis was suspected. Despite active treatment, her condition deteriorated and she died eight hours after admission. Autopsy confirmed a generalised bleeding tendency, with pulmonary, oesophageal and gastrointestinal mucosal haemorrhages. Flame-shaped subendocardial shock haemorrhages were seen in the interventricular septum on the left side of the heart. The findings support a diagnosis of heat stroke. Various aspects related to heat stroke, the autopsy diagnosis and its prevention are discussed.

Adult↗
PubMed1993

The role of cytokines in heat stroke.

Heat stroke is a disease characterized by high fever. Cytokines such as interleukin-1 (IL-1), interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-delta) play a major role in fever production. In the current studies, eight patients with heat stroke were enrolled in a cytokine studies. Serum cytokine levels of these patients were determined by EIA methods, and in vitro IL-1 and IL-1 inhibitor production were determined by murine thymocyte proliferation assay and/or EIA. Significantly high levels of circulating IL-1, TNF-delta, and IL-6 were demonstrated. Positive correlations were demonstrated between the body temperature and the level of IL-1 beta, and the cooling time and level of serum IL-1 beta. In addition, monocytes from heat stroke patients after complete recovery, secreted a much higher amount of IL-1 than did normal volunteers. However, there was no difference in IL-1 inhibitor production. These results indicate that cytokines may play a major role in the pathogenesis of heat stroke, and the ability to make different amounts of IL-1 in response to exogenous stimulation appear to be risk factors for an attack of heat stroke.

Adult↗
PubMed2002

Antithrombin and near-fatal exertional heat stroke.

Heat waves result in excess deaths, excess emergency department visits, and intensive care unit admissions for heat stroke. We describe the clinical features and 3-month outcome of a patient with near-fatal heat stroke, admitted to our intensive care unit in July, 2001. After heavily working for hours at a construction site during a heat wave, the 28-year-old male presented with 41.4 degrees C body temperature and multiorgan failure, consisting of neurological impairment, rhabdomyolysis, acute renal failure, disseminated intravascular coagulation, and acute respiratory distress syndrome (ARDS). In the first week there was no evidence of infection. Treatment included cooling, aggressive volume resuscitation, administration of antithrombin-III concentrates and steroids. The patient survived and recovered normal neurological, renal, respiratory and haematological function, and no disability persisted. This case illustrates survival and complete recovery after multiorgan failure in heat stroke with vigorous intensive care. Treatment with antithrombin and steroids and may well have contributed to the favourable outcome. Correction of reduced antithrombin III levels to supranormal by therapeutic administration of antithrombin III concentrate in disseminated intravascular coagulation of heat stroke was not associated with any bleeding complications.

Adult↗
PubMed1991

Permanent neurologic deficits in heat stroke.

Heat stroke rarely develops permanent neurologic deficits. We present two patients (patients 1 and 2) who suffered from persistent neurologic deficits 3 years after heat stroke. Both patients have cerebellar dysfunction. In addition to cerebellar dysfunction, the first patient whose CT scan of brain demonstrates cerebellar atrophy, also has signs of transverse myelopathy of thoracic cord. We conclude the cerebellar symptoms are common neurologic complication of heat stroke and the heat stroke may be one of rare causes of the transverse myelopathy.

Adult↗
PubMedDate not supplied

[The effect of ionol on oxidative-reductive processes in the kidney during heat stroke].

Heat stroke was induced in intact rats in a thermal chamber (45 degrees C) and simultaneously a group of animals was subjected to overheating for the same time but was given intraperitoneal injections of ionol (120 mg/kg) for 2 days and 30 minutes before exposure in the chamber. Significant increase of the concentration of intermediates--lactate, pyruvate, malate, glutamate, ammonia--and decrease of the alpha-ketoglutarate content occurred in the renal tissue in animals of both groups. The NAD/NADH ratio in the cytoplasm and mitochondria reduced essentially, to a greater degree in animals given ionol injections. The last named were distinguished by higher survival and lower degree of hyperthermia.

Animals↗
PubMed1979

Cardiovascular and metabolic manifestations of heat stroke and severe heat exhaustion.

We prospectively studied the clinical, biochemical (including creatine phosphokinase (CPK) isoenzymes) and electrocardiographic features of exertional heat stroke in 13 patients (group 1) and severe heat exhaustion in 14 patients (group 2). Despite initial presentations with severe hyperthermia, tachycardia and hypotension, only one patient with heat stroke had myocardial ischemia. The CPK isoenzymes were not indicative of myocardial damage in any patient. The patients with heat stroke were somewhat more dehydrated than those with heat exhaustion as measured by differences in serum creatinine, sodium and osmolality, and the former (group 1) had a significantly lower initial glucose level (P less than 0.05). Although significant differences in potassium were not observed in the pretreatment samples, at 12 hours the serum potassium was significantly lower in group 1 (P less than 0.05). This suggests that this group may have been more potassium-depleted at the time of heat stroke. Prompt recognition and vigorous therapy were successful in rapidly lowering high temperatures and in preventing serious complications.

Alanine Transaminase↗
PubMed2004

[Effect of fast-acting spray for heat stroke in enhancing heat tolerance of rats].

OBJECTIVE: To observe the effect of fast-acting spray for heat stroke, a preparation of traditional Chinese drugs, in enhancing the heat tolerance in rats. METHODS: Thirty SD rats were randomized into 3 groups(with 10 in each group), and group A was treated with the fast-acting spray for heat stroke, group B with chlorpromazine, and group C with cool boiled water, before they were exposed to heat at 41 degrees Celsius in a heat chamber with relative humidity of 70% till death. The rats' rectal temperature was measured before and 1 h after the heat exposure, and the time when death occurred in the rats was recorded. RESULT: In comparison with group C, the rats in groups A and B had lower rectal temperature and prolonged survival time with decrease mortality. CONCLUSION: The fast-acting spray for heat stroke we prepared may enhance the heat tolerance of rats.

Animals↗
PubMed1989

Heat stroke and related heat stress disorders.

Medical disorders related to environmental heat exposure are exceptionally common in persons who perform hard work in hot climates. They are also common in competitive athletes as well as in persons who participate in casual exercise to maintain health. The important issue of salt and water disturbances consequent to heavy sweating in hot climates is discussed in detail as are mechanisms of potassium deficiency and its implications. The major forms of environmental heat illness including heat syncope, heat cramp, heat exhaustion, and heat stroke are presented in detail with relevant clinical examples. A discussion of the differential diagnosis of hyperthermia and rhabdomyolysis follows. Because of the difference in treatment and complications, heat stroke is subdivided into the classic variety that affects the elderly and very young and that form that follows heavy physical work and is always associated with rhabdomyolysis. Because severe heat exhaustion and heat stroke are life-threatening disorders, the chapter includes a detailed discussion of complications and plans for treatment.

Animals↗
PubMed1994

The coagulopathy of heat stroke: alterations in coagulation and fibrinolysis in heat stroke patients during the pilgrimage (Haj) to Makkah.

Haemostatic measurements were undertaken in 132 patients diagnosed with heat stroke during the pilgrimage to Makkah, in two successive summers of 1989-90. The control group comprised 49 patients, all pilgrims, with a wide range of clinical conditions, but without hyperpyrexia or deranged haemostasis. Heat stroke patients showed (i) significant prolongation of the prothrombin (PT), activated partial thromboplastin (aPTT) and thrombin times (TT) but normal reptilase time (RT); (ii) significant reduction in plasma levels of antithrombin III (AT-III), factor V, proteins C and S, plasminogen activator inhibitor (PAI) and platelet count; (iii) increase in plasma factor VIII, tissue plasminogen activator (t-PA) and serum FDP; (iv) no significant changes in plasma fibrinogen, plasminogen, alpha 2-antiplasmin and factors VII and X. Heat stroke patients were then grouped into those with and those without bleeding symptoms. Bleeders showed greater prolongation of the PT, aPTT and TT and significant reductions in fibrinogen, AT-III, factors V, VIII and X, plasminogen, alpha 2-antiplasmin and platelet count. Logistic regression and discriminant analysis showed that AT-III was the parameter associated most with heat stroke and reliable enough to predict its occurrence, whether or not bleeding occurred. The results indicate that activation of the haemostatic mechanism, consumptive in nature, regularly accompanies heat stroke and highlights the physiological role of AT-III in checking this activation process.

Adult↗
PubMed1995

Rhabdomyolysis and myoglobinuric acute renal failure associated with classic heat stroke.

Classic heat stroke is a disorder of thermal regulation that predominantly affects elderly patients during heat waves. In contrast to exertional heat stroke, rhabdomyolysis and myoglobinuric acute renal failure are considered to be unusual manifestations of classic heat stroke. We retrospectively reviewed the charts of seven patients admitted to Maimonides Medical Center with classic heat stroke over a 3-day period during a heat wave in July 1993. Three of these patients with classic heat stroke had rhabdomyolysis, but no renal failure; two completely recovered; and one had an ataxic gait disturbance. Three additional patients had rhabdomyolysis and myoglobinuric acute renal failure; one of them completely recovered, one survived with quadriplegia, and one died. Our findings suggest that rhabdomyolysis and myoglobinuric acute renal failure are common manifestations of classic heat stroke. Recognition of this complication warrants rigorous hydration and alkalinization of the urine to prevent or attenuate myoglobinuric acute renal failure.

Acute Kidney Injury↗
PubMed1992

Animal models for heat stroke studies.

Heat stroke is a medical emergency where quick diagnosis and management of victims are essential for positive prognosis. Several biochemical, physiological and hematological changes were observed in heat stroke. It seems that all of these changes are a consequence of induced tissue damage, or may have been a compensatory action by the body. Induction of hyperthermia and temperature measurement are important components in heat stroke studies to determine the stage of progression or regression of heat stroke. Several animal models have been established by investigators in heat related studies. Rats, dogs, monkeys, baboons, cows, rabbits, sheep and chicks have all been used in such studies that allow manipulation of exposure conditions and various designs of experiments. Amongst these species, rats, rabbits and sheep are the most suitable models because of their similarity to man in response to high temperature and in relation to their availability, cost and simplicity of handling. Such models may be used to study various pharmacological and biochemical parameters and functions concurrently. Further informations could also be obtained from isolated organ studies. The present review is to analyse and compare the available methodology for heat stroke studies.

Animals↗
PubMed2003

Transient cardiac dysfunction and pulmonary edema in exertional heat stroke.

Exertional heat stroke is a medical emergency that uncommonly results in severe cardiac dysfunction. The military physician diagnosed a 19-year-old military recruit from an elite unit to have exertional heat stroke. Immediate treatment in the field with rapid ice water cooling and vigorous fluid administration resulted in pulmonary edema. Transthoracic echocardiography on admission to the emergency department revealed moderate reduction in left and right ventricular function. After treatment, within a few days, rapid myocardial recovery was noted and persisted after 6 months of follow-up. Possible mechanisms of cardiac dysfunction in exertional heat stroke and treatment strategies are discussed. It is suggested that intravenous fluid administration to patients with suspected exertional heat stroke should preferably be done with appropriate hemodynamic monitoring and after cardiac dysfunction has been ruled out.

Adult↗
PubMed1999

Severe liver failure in exertional heat stroke.

Exertional heat stroke usually occurs in warm climates. Increased serum levels of liver enzymes is a common finding in this condition, whereas liver failure is a more rare event that carries a poor prognosis. Liver transplantation has been recommended as treatment in cases of severe liver failure, but no long-term survival after this procedure in exertional heat stroke has been described. We report the case of a 31-year-old man who had a heat stroke after running 5 km at 21 degrees C. He developed severe liver damage, with serum alanine aminotransferase (ALAT) activities increasing to 16,410 U/l (reference values, 10-50 U/l) after 48 h, concomitantly with a pronounced coagulation disturbance, with Normotest (NT) decreasing to 12% (international normalized ratio (INR) = 4.2) (reference values, 70%-130% for NT and 0.8-1.2 for INR). A liver biopsy on the 5th day after the incident showed extensive liver cell necrosis. The patient was referred to be considered for liver transplantation but recovered completely on conservative treatment. We conclude that exertional heat stroke is a diagnostic possibility also in temperate climates and that severe liver failure may ensue. The liver injury is reversible, and the indications for liver transplantation in this situation have not been clarified.

Adult↗
PubMed1998

Near-fatal heat stroke during the 1995 heat wave in Chicago.

BACKGROUND: In July 1995, Chicago sustained a heat wave that resulted in more than 600 excess deaths, 3300 excess emergency department visits, and a substantial number of intensive care unit admissions for near-fatal heat stroke. OBJECTIVE: To describe the clinical features of patients admitted to an intensive care unit with near-fatal classic heat stroke. Patients were followed for 1 year to assess delayed functional outcome and mortality. DESIGN: Observational study. SETTING: Intensive care units in the Chicago area. PATIENTS: 58 patients admitted to the hospital from 12 July to 20 July 1995 who met the case definition of classic heat stroke. MEASUREMENTS: The data collection tool was designed to compile demographic and survival data and to permit analysis of organ system function by abstracting data on physical examination findings, electrocardiography and echocardiography results, fluid resuscitation, radiography results, and laboratory findings. Data on functional status at discharge and at 1 year were collected by using a modified Stanford Health Assessment Questionnaire. RESULTS: Patients experienced multiorgan dysfunction with neurologic impairment (100%), moderate to severe renal insufficiency (53%), disseminated intravascular coagulation (45%), and the acute respiratory distress syndrome (10%). Fifty-seven percent of patients had evidence of infection on admission. In-hospital mortality was 21%. Most survivors recovered near-normal renal, hematologic, and respiratory status, but disability persisted, resulting in moderate to severe functional impairment in 33% of patients at hospital discharge. At 1 year, no patient had improved functional status, and an additional 28% of patients had died. CONCLUSIONS: Near-fatal classic heat stroke is associated with multiorgan dysfunction. A high percentage of patients had infection at presentation. A high mortality rate was observed during acute hospitalization and at 1 year. In addition, substantial functional impairment at discharge persisted 1 year. The degree of functional disability correlated highly with survival at 1 year.

Adult↗
PubMed1995

Extremely elevated body temperature: case report and review of classical heat stroke.

Classical heat stroke is a rare disease in moderate climates. We report a patient who demonstrated the classical triad of elevated body temperature, neurological disturbances, and anhidrosis. He developed rhabdomyolysis and acute renal failure. Eventually he died. Since manifestations of classical heat stroke appear to mimic an acute phase response, cytokines are thought to play an important role in its pathogenesis.

Acute Kidney Injury↗