Clinical biochemistry of hyperthermia

Abstract

Heatstroke is the most severe form of heat-related disorders that include mild heat intolerance, heat exhaustion and heat stress. The incidence of heat-related disorders is increasing due to several factors that include climate change, co-morbidities and drug usage. Patients with heatstroke present with a core body temperature above 408C, multiorgan dysfunction and central nervous system disorder. The pathogenesis of heatstroke is not fully understood; however, heat-shock proteins, inflammatory cytokines and their modulators have been implicated. The clinical biochemistry laboratory plays an important role in the management of patients with heatstroke. Biochemical findings in patients with heatstroke include elevated urea, creatinine, cardiac and skeletal muscle enzymes, myoglobin and troponin. There is also biochemical evidence of metabolic acidosis, respiratory alkalosis, hepatic injury with elevated enzyme levels as well as abnormal hematological and coagulation indices. This review article aims at increasing awareness of the biochemical changes seen in patients with heatstroke and their possible role in prognosis and in elucidating the pathogenesis of heatstroke.

Dangers of Prehospital Cooling: A Case Report of Afterdrop in a Patient with Exertional Heat Stroke

“…Appropriate supportive care should be employed to limit morbidity and mortality. Time-sensitive interventions that can be initiated in the emergency department include appropriate fluid resuscitation, correction of electrolyte abnormalities, and early identification and management of EHS and EHI complications, such as rhabdomyolysis, acute kidney injury, acute liver failure, and disseminated intravascular coagulation (17).…”

Heat-related illness in Jinshan District of Shanghai:A retrospective analysis of 70 patients

“…The levels of blood glucose, creatine kinase and lactate dehydrogenase increased significantly in the heat stroke patients. [8] Lactate dehydrogenase as a glycolytic enzyme existed in the cytoplasm of all tissues and cells in the body. The levels of creatine kinase and lactate dehydrogenase were elevated in the HRI patients, and were higher in the heat stroke patients than in the non-heat stroke patients (P=0.000, P=0.002).…”

“…This may be due to high fever, muscle damage, rhabdomyolysis. [8][9][10][11] The rise of blood glucose, however, is related to diabetes and the patient's stress response. [7] Hypothermia is the most important method for the early treatment of HRI.…”

Body-Cooling Paradigm in Sport: Maximizing Safety and Performance During Competition

“…When the body is under uncompensable heat stress and is unable to dissipate heat at the rate at which it is produced, the risk of EHS drastically increases and it becomes crucial for rapid body cooling to minimize the time that rectal temperature is above 40°C. [15][16][17][18] If the body is not rapidly cooled, the complications and prognosis of EHS may include renal failure, liver failure, rhabdomyolysis, coagulopathy, cardiac disorders (eg, arrhythmia, congestive heart failure, hypotension), pulmonary disorders (eg, pulmonary edema, respiratory distress syndrome), central nervous system damage, cognitive impairment, and death. 15,17,19 In the context of EHS treatment, the National Athletic Trainers' Association 20 and American College of Sports Medicine 21 have published guidelines that indicate whole-body cold-water immersion (CWI) as the most effective cooling method.…”