Diagnostic Value of Coagulation Factor and Intracranial Pressure Monitoring in Acute Liver Failure from Heat Stroke: Case Report and Review of the Literature

Ramanathan, Meera; Pedersen, Mark; Ramsey, Robert H.; Seetharam, Anil

doi:10.1016/j.transproceed.2015.02.007

Cited by 7 publications

(5 citation statements)

References 15 publications

(15 reference statements)

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“…56,58 The serious complications of heatstroke in dogs include rhabdomyolysis, neurological damage and dysfunction, acute kidney injury (AKI), acute respiratory distress syndrome (ARDS), hepato-billiary damage, sepsis, acute pancreatitis and DIC. 34,[69][70][71] It seems that the main causes of death in dogs with heatstroke are systemic hemodynamic deterioration and pulmonary lesions, as determined from postmortem studies of dogs that sustaibned naturally occurring heatstroke. 69…”

Section: Systemic Outlookmentioning

confidence: 99%

Pathophysiology of heatstroke in dogs – revisited

2017

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Heatstroke results from a failure to dissipate accumulated heat during exposure to hot environments, or during strenuous physical exercise under heat stress. It is characterized by core body temperatures > 41°C, with central nervous system dysfunction. Functional morphology and thermoregulatory effectors differences between dogs and humans may require special heatstroke protective adaptations in dogs, however, the risk factors for developing heatstroke are similar in both. In dogs, these include hot, especially highly humid environments, excessive physical activity, obesity, large (>15 kg) body weight, being of certain breed (e.g., Labrador retrievers and brachycephalic breeds), upper airway obstruction and prolonged seizures. Lack of acclimation to heat and physical fitness decreases the survival of heat stroked dogs. At the systemic level, blood pooling within the large internal organs (e.g., spleen, liver) is a major contributor to the development of shock and consequent intestinal ischemia, hypoxia and endothelial hyperpermeability, commonly occurring in heatstroke patients. Evoked serious complications include rhabdomyolysis, acute kidney injury, acute respiratory distress syndrome and ultimately, sepsis and disseminated intravascular coagulation. The most common clinical signs in dogs include acute collapse, tachypnea, spontaneous bleeding, shock signs and mental abnormalities, including depression, disorientation or delirium, seizures, stupor and coma. In such dogs, presence of peripheral blood nucleated red blood cells uniquely occurs, and is a highly sensitive diagnostic and prognostic biomarker. Despite early, appropriate body cooling, and intensive supportive treatment, with no available specific treatment to ameliorate the severe inflammatory and hemostatic derangements, the mortality rate is around 50%, similar to that of human heatstroke victims. This review discusses the pathophysiology of canine heatstroke from a veterinarian's point of view, integrating new and old studies and knowledge.

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Section: Systemic Outlookmentioning

confidence: 99%

Pathophysiology of heatstroke in dogs – revisited

2017

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“…However, a number of HS clinical criteria indicate that this condition also results in the occurrence of multiple organ failure (MOF), leading to death, and is treated using several kinds of cooling treatment and other management approaches [6,7,8,9,10,11,12]. However, the B-HS criteria only include the development of central nervous system disorders due to HS, and death cases may not be attributed to HS because other organ damage markers are not included in the criteria.…”

Section: Introductionmentioning

confidence: 99%

Comparison between the Bouchama and Japanese Association for Acute Medicine Heatstroke Criteria with Regard to the Diagnosis and Prediction of Mortality of Heatstroke Patients: A Multicenter Observational Study

Kondo

Hifumi

Shimazaki

et al. 2019

IJERPH

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Background: This study aims to compare the Bouchama heatstroke (B-HS) and Japanese Association for Acute Medicine heatstroke (JAAM-HS) criteria with regard to the diagnosis and prediction of mortality and neurological status of heatstroke patients. Methods: This multicenter observational study recruited eligible patients from the emergency departments of 110 major hospitals in Japan from 1 July to 30 September, 2014. Results: A total of 317 patients (median age, 65 years; interquartile range, 39–80 years) were included and divided into the B-HS, JAAM-HS, and non-HS groups, with each group consisting of 97, 302, and 15 patients, respectively. The JAAM-HS (1.0; 95% confidence interval [CI], 0.87–1.0) and B-HS (0.29; 95% CI, 0.14–0.49) criteria showed high and low sensitivity to mortality, respectively. Similarly, the JAAM-HS (1.0; 95% CI, 0.93–1.0) and B-HS (0.35; 95% CI, 0.23–0.49) criteria showed high and low sensitivity to poor neurological status, respectively. Meanwhile, the sequential organ failure assessment (SOFA) scores demonstrated good accuracy in predicting mortality among heat-related illness (HRI) patients. However, both JAAM-HS and B-HS criteria could not predict in-hospital mortality. The AUC of the SOFA score for mortality was 0.83 (day 3) among the HRI patients. The patients’ neurological status was difficult to predict using the JAAM-HS and B-HS criteria. Concurrently, the total bilirubin level could relatively predict the central nervous system function at discharge. Conclusions: The JAAM-HS criteria showed high sensitivity to mortality and could include all HRI patients who died. The JAAM-HS criterion was considered a useful tool for judgement of admission at ED. Further investigations are necessary to determine the accuracy of both B-HS and JAAM-HS criteria in predicting mortality and neurological status at discharge.

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“…Several patients with HS-induced liver failure have also had signs of renal failure and required renal replacement therapy. [6][7][8][9][10][11][12][13] Therefore, combined kidney and liver transplant may be considered for these patients. In our case, the critical status of the patient, a kidney biopsy showing severe tubular necrosis, and prolonged renal replacement therapy requirement supported this decision.…”

Section: Discussionmentioning

confidence: 99%

“…3 It has been rarely reported that heat shock can lead to organ failure, and only a few case reports have described acute liver failure (ALF) due to HS. [4][5][6][7][8][9][10][11] Also, liver transplant has been recommended for treatment of severe liver failure; however, reports of long-term survival after this procedure in HS are scarce.…”

Section: Introductionmentioning

confidence: 99%

Heat Stroke as a Cause of Liver Failure and Evaluation of Liver Transplant

Martins¹,

Brüggenwirth²,

McDaid³

et al. 2022

Exp Clin Transplant

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Heat stroke is a multiple organ dysfunction syndrome of poorly understood pathogenesis. Exertional heat stroke with acute liver failure is a rarely reported condition. Liver transplant has been recommended as treatment in cases of severe liver dysfunction; however, there are only 5 described cases of long-term survival after this procedure in patients with heat stroke. Here, we present 2 cases of young athletes who developed heat stroke. Both patients developed acute liver failure and were listed for liver transplant. Liver function tests of one patient improved, and he was discharged on postoperative day 13. The other patient showed no signs of improvement and liver biopsy showed massive necrosis. The patient underwent combined kidney-liver transplant and was discharged on postoperative day 17. After a follow-up of longer than 6 years, both patients are doing well with normal liver function and no neurologic sequelae. We also reviewed all published cases of hepatic failure associated with heat stroke and found 9 published cases of liver transplant for heat stroke in the English literature. Conservative management appears to be justified in heat stroke-associated liver failure, even in the presence of accepted criteria for emergency liver transplant.

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Diagnostic Value of Coagulation Factor and Intracranial Pressure Monitoring in Acute Liver Failure from Heat Stroke: Case Report and Review of the Literature

Cited by 7 publications

References 15 publications

Pathophysiology of heatstroke in dogs – revisited

Pathophysiology of heatstroke in dogs – revisited

Comparison between the Bouchama and Japanese Association for Acute Medicine Heatstroke Criteria with Regard to the Diagnosis and Prediction of Mortality of Heatstroke Patients: A Multicenter Observational Study

Heat Stroke as a Cause of Liver Failure and Evaluation of Liver Transplant

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