Mechanisms of hypophosphatemia in humans with heatstroke

Bouchama, Abderrezak; Cafege, A.; Robertson, W. B.; al-Dossary, S.; El-Yazigi, Adnan

doi:10.1152/jappl.1991.71.1.328

Cited by 21 publications

(14 citation statements)

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“…Sodium, potassium, calcium, and magnesium plasma concentrations are usually normal and hemoconcentration is uncommon with classic heat stroke (42,43). This is in contrast to exertional heat stroke where hyponatremia, hypocalcemia, hyperkalemia, and hypoglycemia may occur (189,348).…”

Section: Dehydration and Electrolyte Disturbancesmentioning

confidence: 99%

“…Thermal injury to the vascular endothelium is considered the primary event that initiates coagulation in heat stroke patients (41,47,260). In vitro heat exposure (43)(44) • C) was shown to activate platelet aggregation and cause irreversible hyperaggregation that persisted despite cooling (113,400). Treatment of cancer patients with whole body hyperthermia treatment at body temperatures as low as 39…”

Section: Hematologic Disturbancesmentioning

confidence: 99%

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Heat Stroke

Leon

Bouchama

2015

Comprehensive Physiology

343

356

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Heat stroke is a life-threatening condition clinically diagnosed as a severe elevation in body temperature with central nervous system dysfunction that often includes combativeness, delirium, seizures, and coma. Classic heat stroke primarily occurs in immunocompromised individuals during annual heat waves. Exertional heat stroke is observed in young fit individuals performing strenuous physical activity in hot or temperature environments. Long-term consequences of heat stroke are thought to be due to a systemic inflammatory response syndrome. This article provides a comprehensive review of recent advances in the identification of risk factors that predispose to heat stroke, the role of endotoxin and cytokines in mediation of multi-organ damage, the incidence of hypothermia and fever during heat stroke recovery, clinical biomarkers of organ damage severity, and protective cooling strategies. Risk factors include environmental factors, medications, drug use, compromised health status, and genetic conditions. The role of endotoxin and cytokines is discussed in the framework of research conducted over 30 years ago that requires reassessment to more clearly identify the role of these factors in the systemic inflammatory response syndrome. We challenge the notion that hypothalamic damage is responsible for thermoregulatory disturbances during heat stroke recovery and highlight recent advances in our understanding of the regulated nature of these responses. The need for more sensitive clinical biomarkers of organ damage is examined. Conventional and emerging cooling methods are discussed with reference to protection against peripheral organ damage and selective brain cooling.

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Section: Dehydration and Electrolyte Disturbancesmentioning

confidence: 99%

Section: Hematologic Disturbancesmentioning

confidence: 99%

Heat Stroke

Leon

Bouchama

2015

Comprehensive Physiology

343

356

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“…While some studies (11,45) have reported that acute hypophosphataemia and hypocalcaemia are observed in classical heat stroke and are probably related to the increased glucose phosphorylation seen in alkalotic conditions (22) a few authors (32,36) have noted hyperphosphataemia due to resultant rhabdomyolysis associated with sustained hyperthermia, hypoxia and hypoperfusion. Also, in some cases of heat stroke rhabdomyolysis may develop and muscle cells may be injured.…”

Section: Discussionmentioning

confidence: 99%

Clinical, haematological and biochemical findings in Saanen goat kids with naturally occurring heat stroke

Temizel¹,

Şentürk²,

Kasap³

2009

Tierarztl Prax Ausg G

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Summary Objective: Description of clinical, biochemical and haematological changes in Saanen goat kids post-exposure to a naturally occurring heat stroke. Material and methods: The experimental group consisted of goats of different age (1–4 months) and sex (8 males, 12 females) with an average weight of 7.2 ± 3.1 kg. Twenty clinically healthy, three to four months old, Saanen goat kids (sex-ratio 1:1) were used as a control. The average body weight in this group was 9.4 ± 2.6 kg. Case history, clinical signs, and results of haematology and blood biochemistry were documented in all goat kids. Results: Most common findings were hyperthermia, ataxia, muscle tremor and depression. Increased serum urea, creatinine, potassium and plasma lactate concentrations as well as an increase in aspartate aminotransferase and lactate dehydrogenase activity were observed in goats post-exposure to heat stroke when compared to the control group. Two goat kids died despite supportive treatment. Physical and biochemical blood parameters improved following treatment. Conclusion: This is the first study on heat stroke in Saanen goat kids. Heatstroke may be fatal in Saanen goat kids, despite appropriate treatment, and may lead to secondary complications. Plasma lactate concentration seems to be a reliable indicator for the prognosis of heat stroke in goat kids.

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“…Rats were housed under controlled temperature (22 ± 1°C) and lighting conditions (07:00 to 19:00), with food and water made available ad libitum throughout the experiments. The rats were randomly divided into four groups: [1] the normal control, [2] diabetic control, [3] diabetic heatstroke, and [4] diabeticheatstroke-whole body cooling (WBC), with 8 rats in each group. Diabetes was produced by injecting streptozotocin (STZ) (Sigma, St. Louis, MO, USA) at 30 mg/kg in the tail veins.…”

Section: Animals and Treatmentmentioning

confidence: 99%

“…Multiorgan dysfunctions ensue from severe heatstroke, including hepatic and renal dysfunction, pulmonary and brain edema, hypotension, cerebral ischemia and injury, and activated inflammation. Currently, the treatment of heatstroke is whole body cooling (WBC) (4,11,19,24). In rats, WBC immediately after the onset of heatstroke reduced the heatstroke-induced circulatory shock, cerebral ischemia, neuronal damage, and surge of tissue ischemia and damage markers in the hippocampus, and resulted in prolongation of survival time (8).…”

Section: Introductionmentioning

confidence: 99%

Decrease of Heatstroke-Induced Multiorgan Dysfunction by Whole Body Cooling in Streptozotocin-Induced Diabetic Rats

2009

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The present study was conducted to assess the effects of whole body cooling on multiorgan dysfunction that occurred during heatstroke in streptozotocin (STZ)-induced diabetic rats. The rats were randomly divided into four groups: [1] the normal control, [2] diabetic control, [3] diabetic heatstroke, and [4] diabetic heatstroke-whole body cooling (WBC). They were exposed to ambient temperature of 43°C for exactly 58 min to induce heatstroke. When the diabetic heatstroke rats underwent heat stress, their survival time values were found to be 11-13 min. Immediately after the onset of heatstroke, resuscitation with body cooling greatly improved survival (221-257 min). Compared with the diabetic (STZ-treated) controls, the diabetic-heatstroke rats displayed higher levels of body temperature, intracranial pressure, serum nitric oxide metabolite, tumor necrosis factor-α and dihydroxybenzoic acid, blood urea nitrogen, creatinine, alanine aminotransferase, aspartate aminotransferase, and alkaline phosphatase. In contrast, the values of mean arterial pressure, cerebral perfusion pressure, and brain levels of local blood flow, and partial pressure of oxygen were all significantly lower during heatstroke. The cerebrovascular, renal, and hepatic dysfunction, the increased levels of nitric oxide metabolites, tumor necrosis factor-α, and dihydroxybenzoic acid in the serum during heatstroke were significantly reduced by WBC. Although the serum interleukin-10 maintained at a negligible levels before heat stress, they were significantly elevated by WBC in diabeticheatstroke rats. The data demonstrate that heatstroke-induced multiorgan dysfunction in streptozotocininduced diabetic rats can be decreased by WBC.

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Mechanisms of hypophosphatemia in humans with heatstroke

Cited by 21 publications

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Heat Stroke

Heat Stroke

Clinical, haematological and biochemical findings in Saanen goat kids with naturally occurring heat stroke

Decrease of Heatstroke-Induced Multiorgan Dysfunction by Whole Body Cooling in Streptozotocin-Induced Diabetic Rats

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