Acute Liver Impairment in a Young, Healthy Athlete: Hypoxic Hepatitis and Rhabdomyolysis following Heat Stroke

Abstract

Any process that substantially diminishes arterial blood flow or arterial oxygen content to the liver can result in hypoxic (ischaemic) hepatitis. 90% of hypoxic hepatitis occurs in unstable patients in intensive care units with haemodynamic failure secondary to heart failure, respiratory failure and toxic shock. The rate of in-hospital mortality in hypoxic hepatitis is very high with studies recording mortalities of 61.5%. It tends to be very uncommon in healthy, young patients with no underlying medical problems. We report here the case of a young healthy athlete who developed heat stroke associated with rhabdomyolysis and hypoxic hepatitis while he was running the final stages of a marathon. The patient required intensive care admission and inotropic support for a few hours after he was admitted with heat stroke. He underwent a rapid recovery after he was resuscitated with fluids. N-acetyl cysteine was also given during the acute stage of the hepatitis. This case highlights an uncommon case of hypoxic hepatitis in a young, healthy patient secondary to hypotension and heat stroke. Inotropic support might have precipitated the hypoxic hepatitis in this young patient.

Heat stroke leading to acute liver injury & failure: A case series from the Acute Liver Failure Study Group

“…Hepatocellular injury is a well‐documented complication of heat stroke, but few case reports have described an association with acute liver injury or failure (ALI/ALF). Treatment of ALF from heat stroke involves mainly supportive care; few centres have performed liver transplantation (LT) . We describe the clinical characteristics and outcomes of ALI and ALF caused by heat stroke in a large North American prospective ALI/ALF cohort.…”

“…Hepatocellular injury is a well-documented complication of heat stroke, 6 but few case reports [7][8][9] have described an association with acute liver injury or failure (ALI/ALF). Treatment of ALF from heat stroke involves mainly supportive care; 8 few centres have performed liver transplantation (LT).…”

Outcome of Patients Admitted with Exertional Heat Related Illness in Intensive Care Unit of Tertiary Care Hospital

“…Exer onal heat related illness par cularly heat stroke is a life threatening condi on that frequently 2,3,4 occur in young military trainee. Heat related illness occurs when there is failure of thermoregulatory response to maintain core body 5 temperature between 36° -38° C. Types of HRI are heat cramps (muscle cramping), heat syncope (fain ng), heat exhaus on (hypotension followed by collapse) and heat stroke which is the severe form where core body temperature 6 is >40°C leading to central nervous system dysfunc on. Mortality rate of heat stroke varies from 10 -70 % with 6 persistent neurological damage in 7-20% of survivors.…”

“…Heat related illness occurs when there is failure of thermoregulatory response to maintain core body 5 temperature between 36° -38° C. Types of HRI are heat cramps (muscle cramping), heat syncope (fain ng), heat exhaus on (hypotension followed by collapse) and heat stroke which is the severe form where core body temperature 6 is >40°C leading to central nervous system dysfunc on. Mortality rate of heat stroke varies from 10 -70 % with 6 persistent neurological damage in 7-20% of survivors. Heat stroke can be non-exer onal or exer onal resul ng from 5,6 excessive heat produc on during strenuous ac vity.…”

“…Mortality rate of heat stroke varies from 10 -70 % with 6 persistent neurological damage in 7-20% of survivors. Heat stroke can be non-exer onal or exer onal resul ng from 5,6 excessive heat produc on during strenuous ac vity. Every year many recruits suffer from HRI at Nepali Army training centre.…”