Near-Fatal Heat Stroke during the 1995 Heat Wave in Chicago

Dematte, Jane; O’Mara, Karen; Buescher, Jennifer J.; Whitney, Caroline; Forsythe, Sean M.; McNamee, T.; Adiga, Raghuveer; Ndukwu, I. M.

doi:10.7326/0003-4819-129-3-199808010-00001

Cited by 407 publications

(362 citation statements)

References 38 publications

Supporting

Mentioning

328

Contrasting

Unclassified

Order By: Relevance

“…The onset of heatstroke occurs rapidly through progressively serious symptoms, including lethargy, confusion, disorientation, delirium, and coma (4,13). Survivors of heatstroke often experience persisting organ dysfunction that is predictive of 1-year mortality (i.e., death within 1 year of an event) (14). Heat stroke mortality and heat-related mortality from all causes appear to peak with a 1-to 2-day lag following high temperatures (6,15,16).…”

Section: Heat-related Health Risksmentioning

confidence: 99%

The Potential Impacts of Climate Variability and Change on Temperature-Related Morbidity and Mortality in the United States

McGeehin¹,

Mirabelli²

2001

Environmental Health Perspectives

301

View full text Add to dashboard Cite

Section: Heat-related Health Risksmentioning

confidence: 99%

The Potential Impacts of Climate Variability and Change on Temperature-Related Morbidity and Mortality in the United States

McGeehin¹,

Mirabelli²

2001

Environmental Health Perspectives

301

View full text Add to dashboard Cite

“…A hypothesis of how heat stress leads to multi-organ dysfunction has been proposed [2,13] . Heat stress stimulates metabolism and progressively reduces blood flow to critical splanchnic and brain tissues.…”

Section: Discussionmentioning

confidence: 99%

Kynurenic acid attenuates multiorgan dysfunction in rats after heatstroke

Hsieh

Chen

Yeh³

et al. 2011

Acta Pharmacol Sin

View full text Add to dashboard Cite

IntroductionHeatstroke is defined as a form of excessive hyperthermia (>40 °C) associated with a systemic inflammatory response that leads to multi-organ dysfunction in which central nervous system (CNS) disorders such as delusion, convulsion and coma predominate [1] . Our recent results have demonstrated that heatstroke rodents display hypotension, systemic inflammatory responses, hypothalamic ischemia and neuronal damage, and multi-organ dysfunction [2][3][4] .Kynurenic acid (KYNA) or its metabolic precursor L-kynurenine may be of therapeutic value in neurodegenerative diseased models [5,6] . For example, systemically administered high doses of KYNA had a neuroprotective effect in the gerbil model of global ischemia [7] . Both the homocysteine-induced impairment of endothelial cells [8] and the motility and inflammatory activation in the early phase of acute experimental colitis in the rat [9] were significantly reduced by administration of KYNA. The aim of this study was to investigate whether the heatstroke induced hypotension, systemic inflammatory responses, hypothalamic ischemia and damage, and multiorgan dysfunction could be attenuated by KYNA preconditioning. Accordingly, the temporal profiles of the apoptotic cell numbers of spleen, kidney, liver, lung, and hypothalamus, Kynurenic acid attenuates multiorgan dysfunction in rats after heatstroke Aim: To assess whether systemic delivery of kynurenic acid improves the outcomes of heatstroke in rats. Methods: Anesthetized rats were divided into 2 major groups and given vehicle solution (isotonic saline 0.3 mL/kg rat weight) or kynurenic acid (30-100 mg in 0.3 mL saline/kg) 4 h before the start of thermal experiments. They were exposed to an ambient temperature of 43 ºC for 68 min to induce heatstroke. Another group of rats were exposed to room temperature (26 ºC) and used as normothermic controls. Their core temperatures, mean arterial pressures, serum levels of systemic inflammatory response molecules, hypothalamic values of apoptotic cells and neuronal damage scores, and spleen, liver, kidney and lung values of apoptotic cells were determined. Results: The survival time values during heatstroke for vehicle-treated rats were decreased from the control values of 475-485 min to new values of 83-95 min. Treatment with KYNA (30-100 mg/kg, iv) 4 h before the start of heat stress significantly and dose-dependently decreased the survival time to new values of 152-356 min (P<0.05). Vehicle-treated heatstroke rats displayed hypotension, hypothalamic neuronal degeneration and apoptosis, increased serum levels of tunor necrosis factor-α (TNF-α), intercellular adhesion molecule-1 (ICAM-1), and interleukin-10 (IL-10), and spleen, liver, kidney, and lung apoptosis. KYNA preconditioning protected against hypotension but not hyperthermia and attenuated hypothalamic neuronal degeneration and apoptosis during heatstroke. KYNA preconditioning attenuated spleen, kidney, liver, and lung apoptosis and up-regulated serum IL-10 levels but down-regulated serum TNF-α and ICAM-1 lev...

show abstract

“…Though surgical incisions can result in post-operative elevation in blood CK, the rapid intra-operative exponential rise in CK levels, particularly in surgeries with isoflurane anesthesia without cisatracurium, indicate underlying skeletal muscle pathology. While, CK, AST, ALT may remain normal in MH , elevations in AST, ALT, GGT and bilirubin have been described in heat stroke, a close correlative of MH [14][15][16]. Although, heart, liver, skeletal muscle or RBC's could be the source of aminotransferases, the rapid intra-operative elevations in AST in our surgeries, without evident acute liver damage or peripheral RBC lysis, could only be explained by ongoing skeletal muscle damage with dark colored urine (recipients 1 and 2) due to myoglobinuria.…”

Section: Discussionmentioning

confidence: 99%

The Progression of Isoflurane-induced Malignant Hyperthermia and Its Attenuation by Cisatracurium in a Pre-clinical Porcine Model of Heart Transplant

Cao¹

2013

J Anesth Clin Res

View full text Add to dashboard Cite

Background: Even after several years of study, the intra-operative diagnosis of Malignant Hyperthermia (MH) and the approach to anesthesia in MH-susceptible individuals has remained a challenge. In this study we present the pre-operative and intra-operative findings of development and progression of MH in a porcine model that was assigned for heart transplants. Methods:Female Yorkshire swine were assigned as either donor or recipient and anesthetized with inhalational isoflurane with or without cisatracurium. The inadvertent development of signs indicating MH, including, alterations required in ventilator/bypass machine settings, arterial and venous blood tests, gross-and histo-pathology, were followed through the surgeries that lasted for variable durations between donors and recipients.Results: Both donors and the recipients were apparently MH-susceptible, and showed systemic intraoperative signs of variable severity, that were greater in longer duration recipient surgeries, and in those in which cisatracurium was not administered. These included features of hypermetabolism such as elevated pCO 2 and serum lactate, increased requirements for O 2 (FIO 2 ), and multi-organ changes, including pulmonary congestion, features of intestinal pseudo-obstruction, and inflammatory infiltrates in livers and hearts. Conclusions:The isoflurane-induced MH progressed temporally in severity with the duration of surgery. Use of cisatracurium was directly beneficial in attenuating and/or delaying the progress of MH.

show abstract

Near-Fatal Heat Stroke during the 1995 Heat Wave in Chicago

Cited by 407 publications

References 38 publications

The Potential Impacts of Climate Variability and Change on Temperature-Related Morbidity and Mortality in the United States

The Potential Impacts of Climate Variability and Change on Temperature-Related Morbidity and Mortality in the United States

Kynurenic acid attenuates multiorgan dysfunction in rats after heatstroke

The Progression of Isoflurane-induced Malignant Hyperthermia and Its Attenuation by Cisatracurium in a Pre-clinical Porcine Model of Heart Transplant

Contact Info

Product

Resources

About