Exertional Heat Stroke in a Male High School Runner with Disordered Eating: A Disablement Model Case Study

Abstract

A 16-year-old male high school cross country athlete collapsed at the end of an afternoon 5K cross country meet. The patient was unable to stand, and after outwardly displaying confusion and agitation, his coaches sought assistance from the athletic trainers (ATs). The patient consumed one cup of water and a granola bar on the day of the meet. The ambient air temperature was 90°F with 69% humidity. Differential diagnoses included exertional heat stroke (EHS), exertional heat exhaustion, exertional collapse associated with sickle cell trait, heat syncope, dehydration, malnutrition, and hypoglycemia. Approximately 20 minutes passed between activation of the emergency action plan (EAP), initial collapse, and cold-water immersion. Assessment of rectal temperature did not occur until after submersion due to waiting for parental consent. The patient was removed from the water after 12 minutes with a rectal temperature of 100.5°F. He was transported to the hospital, received 2 liters of intravenous normal saline among multiple other tests, with no significant findings, and was released approximately 9 hours later. It was later learned that the athlete dealt with disordered eating. The patient was asked to complete a seven-day food and drink log and was provided nutrition guidance by the ATs. This patient's disordered eating habits could have contributed to the development of EHS. The ATs were unaware of his eating patterns until after the EHS event. Athletes need to be educated on how to properly fuel themselves for athletic competition in anticipation of adverse environmental conditions. If a patient is already prone to disordered eating, this individual will not have the proper intake of nutrients to sustain athletic competition, nor to sustain everyday living. Athletic trainers should be aware of all potential medical concerns in their patients, including those not often discussed, to accurately diagnose conditions and avoid any potential sequelae.